Study On The Construction Of Evidence-based Management Practice Program For Prevention Of Diabetic Foot Recurrence

Objective:Based on evidence-based nursing and Delphi method,this study finally formed an evidence-based management practice plan for preventing diabetic foot recurrence suitable for the clinical status of diabetic foot in China,in order to provide reference for clinical practice.Methods:1.The evidence-based management practice plan for preventing recurrence of diabetic foot was preliminarily formed by combining Meta-analysis,systematic evaluation and summary of guidelines.(1)A systematic search of case-control studies and cohort studies on risk factors for recurrence of diabetic foot patients in domestic and foreign databases.The Newcastle-Ottawa Scale was used to evaluate the quality of the included studies.Rev Man5.3 software was used to analyze the included data and identify the risk factors for recurrence of diabetic foot patients.(2)Randomized controlled trials on preventing recurrence of diabetic foot in domestic and foreign databases were systematically searched.The quality of the included literature was evaluated using the Cochrane Handbook for Systematic Evaluation of Interventional Studies-5.1.0 Edition updated by the Cochrane Collaboration in 2011.Secondly,the intervention measures included in the literature were des Criptively analyzed to clarify the intervention measures to prevent the recurrence of diabetic foot.(3)The quality of the included guidelines was evaluated by three researchers who received comprehensive training of JBI and other evidence,and the recommendations that met the inclusion Criteria were extracted and summarized.Two researchers summarized the above contents and initially constructed an evidence-based management practice plan to prevent the recurrence of diabetic foot.2.Delphi expert consultation was conducted,and the items were modified,deleted and added according to the expert ’s evaluation of the importance of the items,operability evaluation and related suggestions.Finally,an evidence-based management practice plan for preventing diabetic foot recurrence suitable for the clinical status of diabetic foot in China was formed.Results:1.(1)The results of Meta-analysis showed that the risk factors for diabetic foot recurrence included age,diabetic peripheral neuropathy,peripheral vascular disease,amputation,ulcer site,glycosylated hemoglobin,Wanger grade III-IV,and multi-drug resistant bacterial infection.(2)The results of systematic evaluation showed that improving nursing mode,improving health education mode,monitoring foot skin temperature,improving treatment methods,improving patient treatment shoes,optimizing wound care,and improving foot movement can effectively reduce the recurrence rate of diabetic foot.(3)The summary of the guidelines finally formed 64 best evidence,a total of 5 dimensions.Based on the above parts,an evidence-based management practice plan for preventing diabetic foot recurrence was initially constructed,including 5first-level items,12 second-level items,and 64 third-level items.The first-level items included the cognition and attitude of recurrence of diabetic foot patients;inspection,monitoring and evaluation;pressure prevention;surgical operation and related prevention;health education.Among them,cognition and attitude include necessity and risk factors;examination,monitoring and evaluation include identification of signs of ulcers,regular monitoring and evaluation;pressure prevention includes prevention of decompression braces and pressure treatment;surgery and related prevention include surgical intervention prevention,drug management,multidisciplinary collaboration;health education includes the importance of health education,metabolic management and exercise management.2.After two rounds of expert consultation,the recovery rates were 94 %and 100 % respectively.The results of the first round of expert consultation:the CV of item importance is 0.00-0.22,the CV of item operability is0.05-0.31,and the Kendall ’s W of importance and operability is 0.272 and0.246;the second round of expert consultation results : the CV of item importance is 0.00-0.16,the CV of item operability is 0.00-0.16,and the Kendall ’s W of importance and operability is 0.202 and 0.209.The Kendall’s W of the two rounds of expert consultation was statistically significant(P <0.05).Finally,an evidence-based management practice plan for preventing diabetic foot recurrence suitable for the clinical status of diabetic foot in China was formed,including five dimensions: cognition and attitude;inspection,monitoring and evaluation;pressure prevention;surgical operation and related prevention;health education.This scheme includes 5first-level items,12 second-level items and 66 third-level items.Conclusion:This study constructed an evidence-based management practice plan for preventing diabetic foot recurrence suitable for the clinical status of diabetic foot in China.The results of expert consultation are scientific and reliable,and provide reference and guidance for clinical practice.