Foot assessment in GP practices for people with diabetes

Diabetes increases the chance of lower-limb amputation: directly, as a result of ulcers caused by trauma and complicated by lack of sensation; and indirectly, by peripheral vascular disease. In any one patient both causes can occur.     

Foot care in patients with diabetes

This article outlines the three main factors that cause foot problems in people with diabetes: peripheral neuropathy, peripheral vascular disease and infection. It describes how these problems are classified and how nurses can use their skills in assessment and education to improve outcomes for these patients.     

Care of people with diabetes in hospital.

Although most hospitals have protocols for the care of people with diabetes who are admitted as a result of their condition or other illness, deficiencies in the care offered are still regularly reported. This article explores reasons why the care of people with diabetes in hospital seems to be unsatisfactory, and proposes some solutions to the problems.     

糖尿病患者足部护理

BACKGROUND:Incidenceofatherosclerosiswashigherinpatientswithdiabetes.Atherosclerosisofperipherallimbsmainlyaf-fectarteryoflowerlimbsandabnormalfeelingoffootandintermit-tentlimpingwasthemanifestation.OBJECTIVE:Toexplorenursingmethodsoffootinpatientswithdiabetes.UNIT:DepartmentofEmergency,SecondPeople'sHospitalofRongchengCity.SUBJECTS:70patientswithdiabeteswereinvolvedincluding48malesand22femalesaged42-74(mean:56.4)yearsolda-mongwhichwere18casesoftype1diabetes,52casesoftype2diabet…     

Foot and leg problems are important determinants of functional status in community dwelling older people

Purpose.?To determine whether foot and leg problems are independently associated with functional status in a community sample of older people after adjusting for the influence of socio-demographic, physical and medical factors.

Method.?Data were analysed from the Health Status of Older People project, a population-based study involving a random sample of 1000 community-dwelling people aged 65?–?94 years (533 females, 467 males, mean age 73.4 years?±?5.87). A structured interview and brief physical examination were used to investigate the associations between self-reported foot and leg problems and functional status. Functional status was assessed using: (i) timed ‘Up & Go’ test, (ii) self-reported difficulty climbing stairs, (iii) self-reported difficulty walking one kilometer, (iv) self-reported difficulty performing instrumental activities of daily living (IADLs), and (v) self-reported history of one or more falls in the previous 12 months. These associations were then explored after adjusting for socio-demographic, physical and medical factors.

Results.?Thirty-six percent of the sample reported having foot or leg problems. Univariate analyses revealed that people with foot and leg problems were significantly more likely to exhibit poorer functional status in all parameters measured. After adjusting for socio-demographic, physical and medical factors, foot and leg problems remained significantly associated with impaired timed ‘Up & Go’ performance (OR?=?2.15, 95%CI 1.55?–?2.97), difficulty climbing stairs (OR?=?3.33, 95%CI 1.98?–?5.61), difficulty walking one kilometer (OR?=?3.13, 95%CI 2.09?–?4.69), and history of falling (OR?=?1.73, 95%CI 1.26?–?2.37).

Conclusions.?Foot and leg problems are reported by one in three community-dwelling people aged 65 years and older. Independent of the influence of age, gender, common medical conditions and other socio-demographic factors, foot and leg problems have a significant impact on the ability to perform functional tasks integral to independent living.     

Foot and leg problems are important determinants of functional status in community dwelling older people

Purpose. To determine whether foot and leg problems are independently associated with functional status in a community sample of older people after adjusting for the influence of socio-demographic, physical and medical factors.

Method. Data were analysed from the Health Status of Older People project, a population-based study involving a random sample of 1000 community-dwelling people aged 65 - 94 years (533 females, 467 males, mean age 73.4 years ± 5.87). A structured interview and brief physical examination were used to investigate the associations between self-reported foot and leg problems and functional status. Functional status was assessed using: (i) timed 'Up & Go' test, (ii) self-reported difficulty climbing stairs, (iii) self-reported difficulty walking one kilometer, (iv) self-reported difficulty performing instrumental activities of daily living (IADLs), and (v) self-reported history of one or more falls in the previous 12 months. These associations were then explored after adjusting for socio-demographic, physical and medical factors.

Results. Thirty-six percent of the sample reported having foot or leg problems. Univariate analyses revealed that people with foot and leg problems were significantly more likely to exhibit poorer functional status in all parameters measured. After adjusting for socio-demographic, physical and medical factors, foot and leg problems remained significantly associated with impaired timed 'Up & Go' performance (OR = 2.15, 95%CI 1.55 - 2.97), difficulty climbing stairs (OR = 3.33, 95%CI 1.98 - 5.61), difficulty walking one kilometer (OR = 3.13, 95%CI 2.09 - 4.69), and history of falling (OR = 1.73, 95%CI 1.26 - 2.37).

Conclusions. Foot and leg problems are reported by one in three community-dwelling people aged 65 years and older. Independent of the influence of age, gender, common medical conditions and other socio-demographic factors, foot and leg problems have a significant impact on the ability to perform functional tasks integral to independent living.     

Skin problems in people with obesity

AIM: To establish the level and type of skin problems in people with obesity and the extent to which they sought advice on their problem. METHOD: A self-report survey was carried out in a specialist nutrition clinic in Scotland during 2001. A convenience sample of 100 patients was selected. RESULTS: A majority (n = 75, 75 per cent) of respondents had some type of skin problem. The main problems identified were itchiness and dry skin. The sites for skin problems varied although groin, limbs and beneath the breasts were the most prevalent areas. The two main causes of perceived skin problems were perspiration and friction. Forty four (59 per cent) had seen a doctor about their skin problem, but few (n = 12, 16 per cent) had consulted other healthcare professionals and some (25 per cent) had not sought any advice. CONCLUSION: There is a considerable level of skin problems in this patient group, which has not previously been reported or identified as a significant potential co-morbidity. Therefore, nurses and other healthcare professionals should incorporate some form of skin assessment into any assessment of patients with obesity. Further research is needed to determine the specificity and degree of skin problems in those who are diagnosed as obese and the impact it has on their life and their weight management.     

Lower-extremity amputation in people with diabetes. Epidemiology and prevention

The age-adjusted rate of lower-extremity amputation (LEA) in the diabetic population is approximately 15 times that of the nondiabetic population. Over 50,000 LEAs were performed on individuals with diabetes in the United States in 1985. Among individuals with diabetes, peripheral neuropathy and peripheral vascular disease (PVD) are major predisposing factors for LEA. Lack of adequate foot care and infection are additional risk factors. Several large clinical centers have experienced a 44-85% reduction in the rate of amputations among individuals with diabetes after the implementation of improved foot-care programs. Programs to reduce amputations among people with diabetes in primary-care settings should identify those at high risk; clinically evaluate individuals to determine specific risk status; ensure appropriate preventive therapy, treatment for foot problems, and follow-up; provide patient education; and, when necessary, refer patients to specialists, including health-care professionals for diagnostic and therapeutic interventions and shoe fitters for proper footwear. Programs should monitor and evaluate their activities and outcomes. Many issues related to the etiology and prevention of LEAs require further research.     

Helping people with alcohol problems

Many nurses may feel reluctant to include questions on alcohol use in their general patient assessments but studies have shown that brief interventions on this subject can help people cut down on their drinking and improve their health.