Local antibiotic delivery: early intervention in infection management strategy

Chadwick P, Ahmad N, Dunn G, Elston D, Fisher N, Haycocks S, Kosnarova P, Morley R, Redfearn V, Smith M, Spruce P and Townsend R

Citation: Chadwick P, Ahmad N, Dunn G et al (2022) Local antibiotic delivery: early intervention in infection management strategy. The Diabetic Foot Journal 25(2): 44–52

Key words  - Foot infection  - Local delivery of antibiotics  - Targeted antimicrobial therapy

Authors

Prof Paul Chadwick is (Lead & Facilitator) Visiting Professor, Birmingham City University, UK; Noel Fisher is Consultant Orthopaedic Surgeon, Macclesfield Hospital, UK; Naseer Ahmad is Consultant Vascular Surgeon, Manchester Royal Infirmary, UK; George Dunn is Advanced Podiatric Specialist (High Risk), East Cheshire NHS Trust, UK; Prof Rob Townsend is Consultant Medical Microbiologist, Sheffield Teaching Hospitals NHS Foundation Trust, UK; Rob Morley is Consultant Podiatric Surgeon, UK; Debra Elston is Specialist Community Podiatrist, Heywood, Middleton and Rochdale, NHS Pennine Care, UK; Michelle Smith is High Risk Foot Team Podiatrist, Tameside and Glossop Integrated Care Foundation Trust, UK; Pavla Kosnarova is Consultant Diabetologist, Barnsley Hospital, UK; Victoria Redfearn is Wound Care Specialist Podiatrist, The Robert Hague Centre for Diabetes and Barnsley Hospital, UK; Samantha Haycocks is Consultant Podiatrist (High Risk), Salford Royal Foundation Trust, UK; Pamela Spruce is Clinical Director TVRE Consultant, UK

Article points

1. Systemic antibiotics are routinely prescribed for infected foot ulcers in individuals with diabetes but effective treatment can be disrupted by complications developing with their use

2. A method of delivering antibiotics directly to the site of infection, via antibiotic loaded beads, in addition to systemic use was debated by a multidisciplinary expert team of clinicians

3. These discussions resulted in the creation of a ‘tool kit’ of documents developed to support the safe and effective use of Stimulan by podiatrists in clinical practice

Systemic antibiotics are routinely prescribed for infected foot ulcers in individuals with diabetes. However, effective treatment can be disrupted by complications developing with their use, including allergic reactions, antibiotic-resistant organisms, the risk of clostridium difficile and possible organ toxicity. Poor vascular perfusion can also limit the availability of antimicrobial therapy to infected tissue. A method of delivering antibiotics directly to the site of infection, in addition to systemic use was debated by a multidisciplinary expert team of clinicians. Stimulan® (Biocomposites Ltd) is a system where antibiotics are mixed with calcium sulfate paste to form small beads. These can be placed in the foot wound following debridement, within a framework of standard best practice. The antibiotics are then released at therapeutic concentrations to the site of infection. As a result of these discussions, a ‘tool kit’ of documents was developed to support the safe and effective use of Stimulan by podiatrists in clinical practice. These could be adapted to meet the requirements of local protocols for care and, as a result, deliver additional antibiotic therapy to the infected wound.

Frailty Syndromes: should wounds be considered an additional syndrome?

SAMANTHA HOLLOWAY Academic Editor, Wounds UK; Reader, Programme Director, Cardiff University School of Medicine, Cardiff

Foot screening in diabetes: What? — So what? — Now what?

David Wylie

Citation: Wylie D (2022) Foot screening in diabetes: What? — So what? — Now what? The Diabetic Foot Journal 25(2): 28–31

Contributors: Dr Paul Chadwick  Jill Cundell  Prof Mike Edmonds  Krishna Gohil  Duncan Stang  Stephanie Stanley  Rosalyn Thomas

Author

David Wylie is Is Associate Director NMAHP, NHS Education for Scotland, Glasgow, UK; Honorary Fellow, Glasgow Caledonian University, UK; Director of Professional Education, Royal College of Physicians & Surgeons, Glasgow, UK

Advanced clinical practice within the diabetes multidisciplinary team: a reflective review

Citation: Guttormsen K (2022) Advanced clinical practice within the diabetes multidisciplinary team: a reflective review. The Diabetic Foot Journal 25(2): 24–7

Key words - Advanced clinical practice - Multidisciplinary team - 360-degree feedback

Article points

1. Advanced clinical practice (ACP) is a level of practice delivered by experienced, registered

2. A small, low powered, crosssectional study aimed to demonstrate that multidisciplinary working can help provide sustainable workforce solutions, as well as improve the working of the multidisciplinary team healthcare practitioners

3. 360-degree feedback is an excellent adjunct to clinical supervision

4. Low-powered studies can be scaled up to demonstrate benefit

5. The lower-limb diabetes MDT is an ideal place for

Author：Karl Guttormsen

Karl Guttormsen is Advanced Clinical Practitioner (Diabetes, Endocrinology and General Medicine) North Manchester General Hospital the Manchester Foundation Trust, UK cultivation of ACPs

Advanced clinical practice (ACP) is a level of practice delivered by experienced, registered healthcare practitioners. It incorporates a high degree of autonomy and complex decision making and is underpinned by a master’s level award or equivalent. Most ACP roles within the UK are undertaken by nurses and it is of vital importance that allied health professionals are actively encouraged to develop their skills and knowledge through the lens of the multidisciplinary framework for advanced clinical practice and to actively seek out apprenticeship opportunities. This small, low-powered, cross-sectional study aims to demonstrate that multidisciplinary working can help provide sustainable workforce solutions and improve the workings of the multidisciplinary team (MDT). A total of 100% of respondents agreed that the ACP was able to demonstrate improved MDT working across the four pillars of advanced clinical practice. 360-degree feedback is an excellent adjunct to clinical supervision and its ability to be scaled up makes it a valuable tool in evidencing the impact of advanced clinical practice.

A “Wight” approach to diabetic foot screening?

Stephanie Stanley

Citation: Stanley S (2022) A “Wight” approach to diabetic foot screening? The Diabetic Foot Journal 25(2): 53–7

Key words  - Diabetic foot ulcer  - Podiatrist-led screening service  - Screening

Article points

1. Early identification of patients at high risk of developing diabetic foot ulceration is of paramount importance.

2. The annual screening appointment is an opportunity to check not only neuropathy and vascular supply, but also other issues.

3. The Isle of Wight provides a podiatrist-led screening service and this is currently being reviewed to improve capacity.

Author

Stephanie Stanley Consultant Podiatrist, Clinical, Professional and Operational Lead for Podiatry Podiatry Department St. Mary’s Hospital Parkhurst Road Newport Isle of Wight

Early identification of patients at high risk of developing diabetic foot ulceration is a top priority due to the associate clinical, economic and psychosocial burdens. Routine screening is necessary for preventive care and optimal use of resources. Attendance at the screening appointment gives an opportunity to check not only neuropathy and vascular supply, but also myriad other issues. Involving patients in their own care decreases foot complications, such as ulceration and amputation. The Isle of Wight provides a podiatrist-led screening service and this is currently being reviewed to improve capacity.

Early and ongoing stable glycaemic control is associated with a reduction in major adverse cardiovascular events in people with type 2 diabetes: A primary care cohort study

Martin B. Whyte PhD1 | Mark Joy PhD2 | William Hinton BSc1,2 | Andrew McGovern MD1 | Uy Hoang PhD1 | Jeremy van Vlymen BSc1 | Filipa Ferreira BSc2 | Julie Mount PhD3 | Neil Munro DPhil1 | Simon de Lusignan MD1,2

1 Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK

2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

3 Eli Lilly and Company, Hampshire, UK

Correspondence

Martin B. Whyte, PhD, Department of Clinical & Experimental Medicine, Leggett Building, University of Surrey, Guildford GU2 7WG, UK.

Email: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 Funding information Eli Lilly and Company

Abstract

Aim: To determine whether achieving early glycaemic control, and any subsequent glycaemic variability, was associated with any change in the risk of major adverse cardiovascular events (MACE).

      Materials and Methods: A retrospective cohort analysis from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database—a large, English primary care network—was conducted. We followed newly diagnosed patients with type 2 diabetes, on or after 1 January 2005, aged 25 years or older at diagnosis, with HbA1c measurements at both diagnosis and after 1 year, plus five or more measurements of HbA1c thereafter. Three glycaemic bands were created: groups A (HbA1c < 58 mmol/mol [<7.5%]), B (HbA1c ≥ 58 to 75 mmol/mol [7.5%- 9.0%]) and C (HbA1c ≥ 75 mmol/mol [≥9.0%]). Movement between bands was determined from diagnosis to 1 year. Additionally, for data after the first 12 months, a glycaemic variability score was calculated from the number of successive HbA1c readings differing by 0.5% or higher (≥5.5 mmol/mol). Risk of MACE from 1 year postdiagnosis was assessed using time-varying Cox proportional hazards models, which included the first-year transition and the glycaemic variability score.

      Results: From 26 180 patients, there were 2300 MACE. Compared with group A->A transition over 1 year, those with C->A transition had a reduced risk of MACE (HR 0.75; 95% CI 0.60-0.94; P = .014), whereas group C->C had HR 1.21 (0.81-1.81; P = .34). Compared with the lowest glycaemic variability score, the greatest variability increased the risk of MACE (HR 1.51; 1.11-2.06; P = .0096). Conclusion: Early control of HbA1c improved cardiovascular outcomes in type 2 diabetes, although subsequent glycaemic variability had a negative effect on an individual's risk.

KEYWORDS: computerized, diabetes complications, macrovascular, medical record systems, primary care, type 2 diabetes