Research On The Construction Of A Patient Guideline For Foot Management In High-risk Diabetic Patient

Objective① To systematically update and evaluate the clinical practice guidelines related to the prevention,care and management of diabetic foot at home and abroad,and select the best evidence of patients’ competence under this topic;② To analyze and synthesize the best evidence,and consult the needs and wishes of patients with high risk of diabetic foot,and identify the facilitating and hindering factors in the process of evidence translation;③ To integrate the best evidence with patients’ preference and clinical expertise,and consider the clinical context to translate and refine the evidence,and finally construct a foot management guideline for patients with high risk of diabetic foot,so as to provide scientific and comprehensive foot management knowledge and decision-making basis for patients with high-risk of diabetic foot and their related caregivers,and to promote the clinical application of the best evidence,and ultimately improve the knowledge level and the foot self-management ability of patients,and to prevent or delay the occurrence of complications and improve the outcome of patients.Methods①Using the method of literature research,to systematically search the literature from Chinese and English databases,such as PubMed and CNKI,guide-making institutions,diabetes-related academic associations from January 2016 to January 2018,and screen them according to certain inclusion and exclusion criteria,and use the quality evaluation tool to evaluate the quality of the evidence fit the criteria,and select the high level evidence;②To extract,translate and synthesize the recommendations in the guideline,and form the best evidence summary of the subject through expert consensus;③To use the semi-structured interview method to consult the patients with high-risk of diabetes foot for the best evidence summary,and to determine the presentation of evidence according to patients’ needs and hopes;④To use expert consensus method to translate and refine the best evidence summary to form the preliminary draft of foot management guidelines for patients with high-risk of diabetic foot;⑤To apply expert external review and AGREE II to evaluate the whole quality of the patients’ version of guideline;⑥The patients’version of guideline will be initially applied in clinical practice,and the effect will be evaluated.Finally,the foot management guideline for patients with high risk diabetic foot will be revised and improved based on expert review and feedback from patients after application.Results①Through updating,searching and screening,one evidence-based guideline was included.The quality evaluation of AGREE Ⅱ showed the guideline is an A-level guideline whose quality was very high;②There were altogether 30 recommendations in the updated guideline,and there were 52 recommendations in combination with 22 recommendations included in previous studies.After preliminary extraction and classification,the same or similar items were synthesized according to certain principles of evidence synthesis.After expert consensus,14 recommendations were synthesized,which belong to the category of patient competence;③The Semi-structured interview was used to investigate the needs of 5 patients.The results showed that patients with high-risk of diabetic foot were lacked of foot management knowledge and were in poor foot care.The evidence summarized in this study was in line with the needs and recognition of patients;④The expert consensus method was used to consult experts for suggestions in the process of evidence translation and refinement,experts all agreed with the process of recommendation translation.They believed that the included recommendations had high clinical significance and applicability.The preliminary draft of patient guidelines was set reasonably,but it still needs to improve its readability;⑤By using expert external evaluation and AGREE Ⅱ tools to evaluate the patients’ version of guideline,the results showed that the integration and translation of the recommendation in the study were scientific and reasonable,and had good usability.The patient’s guideline was reasonable in structure,and accurate in content,standardized in report and readable;⑥Feedback from patients after clinical application of the patient guideline showed that patients were satisfied with and interested in the guideline.Conclusion①At present,the quality of the guidelines about the prevention,nursing and management of diabetic foot in this research are very high.The contents of the recommendation in the guidelines are similar,and the relevant contents are relatively comprehensive,including knowledge education of diabetic foot,evaluation and screening of diabetic foot,prevention of diabetic foot,traditional Chinese medicine nursing technology,daily foot care,treatment of pre-ulcer lesions,etc.②The recommendations of foot management included have high clinical significance and meet the needs and wishes of patients.Experts have a high degree of recognition and availability.There are also very few recommendations that can not be carried out due to the limitation of clinical situation in China.However,some recommendations belong to the scope of medical staff or patients can not be implemented due to the limitation of conditions;③The patient’s guideline constructed in this study has scientific and rigorous process,reasonable content,standardized report and high quality.The satisfaction and interest of patients about the patient guideline are very high.However,there are still some problems to be improved.For example,we still need to take full account of the patient’s suggestions and adopt diversified presentation forms to improve readability and popularization.