《2014+美国糖尿病足溃疡管理指南》由会员分享，可在线阅读，更多相关《2014+美国糖尿病足溃疡管理指南（13页珍藏版）》请在金锄头文库上搜索。
1、ORIGINAL ARTICLESThe Management of Diabetic Foot Ulcers Through Optimal Off-Loading Building Consensus Guidelines and Practical Recommendations to Improve OutcomesRobert J. Snyder, DPM, MSc* Robert G. Frykberg, DPM, MPH Lee C. Rogers, DPM Andrew J. Applewhite, MDjj jj Desmond Bell, DPM#* Gregory Boh
2、n, MD Caroline E. Fife, MD Jeffrey Jensen, DPM* James Wilcox, RNjjjjjjjjBackground: We sought to develop a consensus statement for the use of off-loading in the management of diabetic foot ulcers (DFUs).Methods: A literature search of PubMed for evidence regarding off-loading of DFUs was initially c
3、onducted, followed by a meeting of authors on March 15, 2013, in Philadelphia, Pennsylvania, to draft consensus statements and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to assess quality of evidence and develop strength of recommend
4、ations for each consensus statement.Results: Evidence is clear that adequate off-loading increases the likelihood of DFU healing and that increased clinician use of effective off-loading is necessary. Recommendations are included to guide clinicians on the optimal use of off-loading based on an init
5、ial comprehensive patient/wound assessment and the necessity to improve patient adherence with off-loading devices.Conclusions: The likelihood of DFU healing is increased with off-loading adherence,and, current evidence favors the use of nonremovable casts or fixed ankle walking braces as optimum of
6、f-loading modalities. There currently exists a gap between what theevidence supports regarding the efficacy of DFU off-loading and what is performed in clinical practice despite expert consensus on the standard of care. (J Am Podiatr Med Assoc 104(6): 555-567, 2014)*Barry University School of Podiat
7、ric Medicine, Miami Shores, FL. Carl T. Hayden Veteran Affairs Medical Center, Phoenix, AZ. Midwestern University School of Podiatric Medicine, Glendale, AZ. Amputation Prevention Center, Sherman Oaks Hospital, Los Angeles, CA. jjComprehensive Wound Center of Baylor University Medical Center, Dallas
8、, TX. Save a Leg, Save a Life Foundation, Jacksonville, FL. #Limb Salvage Institute and Wound Care on Wheels, Jacksonville, FL. *Memorial Hospital of Jacksonville, St. Vincents Medical Center Southside and Specialty Hospital of Jacksonville, Jacksonville, FL. Trinity Center for Wound Care and Hyperb
9、aric Medicine, Trinity Bettendorf and Moline Clinics, Trinity Regional Medical Center, Bettendorf, IA. Intellicure Inc, The Woodlands, TX. St. Lukes Wound Care Clinic, The Woodlands, TX. jjjjHealogics, Jacksonville, FL. Corresponding author: Robert J. Snyder, DPM, MSc, Barry University School of Pod
10、iatric Medicine, Paul 2) moderate, further research is likely tohave an important effect on confidence in the estimate of the effect and may change the estimate; 3) low, further research is very likely to have animportant effect on confidence in the estimate of the effect and is likely to change the
11、 estimate; and 4) very low, any estimate of effect is very uncertain. The recommendation levels are 1) strong, patients should receive the recommended course of action, and 2) weak, contextual evaluation of the recom- mendation by the clinician for a particular patient.4 Further details of the GRADE
12、 method are shown in Table 1. Each consensus guideline and type of off-loading device or technique was ranked by its supporting evidence from the included studies. Categorization of the level of evidence was conducted according to the Wound Healing Society.5Thus, of approximately 90 selected studies
13、, 64 were included in the evidence tables, with three additional publications (cited in the References section) known by the authors but not found in the literature searches. The consensus guidelines with recommendations were subsequently reviewed and approved by the panel.ResultsIn the literature,
14、total contact casting (TCC) is often referred to as the gold standard; however, the evidence supporting this is of only moderate quality.Despite the ostensible benefits of off-loading with casts, this modality is not currently widely adopted in clinical practice, and neither is aggressive off- loadi
15、ng with other studied methods routinely practiced in the medical community at large.6,7 Eight evidence-based consensus guidelines and core recommendations resulted from the collabora- tive work of the panel. Each consensus statement was scored by GRADE using the evidence presented in Table 2. Each s
16、tatement references the level of evidence and the strength of the recommendation (eg, moderate/strong).Consensus Statement #1: Vascular Management, Infection Management and Prevention, and Pressure Relief Are Essential to DFU Healing (High/Strong)The acronym VIP (Vascular Management, Infection Management and Prevention, and Pressure Relief) is a useful tool to recall key concepts in the management of DFUs, and it is often cited in the556November/December 2014?Vol 104?No
