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    Pico 1

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    Hend maarof
    Daily foot temperature monitoring reduces the risk of diabetic foot ulcers compared to not checking temperatures daily. Two studies found that diabetic patients who checked their foot temperatures daily using an infrared thermometer in multiple spots were less likely to develop ulcers than patients who did not check temperatures. Both randomized controlled trials found that daily temperature monitoring can help prevent ulcers by identifying potential issues early. However, future research with more participants over longer periods is still needed to further validate these findings. Providing diabetic patients with thermometers and education on their importance could help temperature monitoring become a standard of care.

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    Pico 1

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    Hend maarof
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    Daily foot temperature monitoring reduces the risk of diabetic foot ulcers compared to not checking temperatures daily. Two studies found that diabetic patients who checked their foot temperatures daily using an infrared thermometer in multiple spots were less likely to develop ulcers than patients who did not check temperatures. Both randomized controlled trials found that daily temperature monitoring can help prevent ulcers by identifying potential issues early. However, future research with more participants over longer periods is still needed to further validate these findings. Providing diabetic patients with thermometers and education on their importance could help temperature monitoring become a standard of care.

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    Daily foot temperature monitoring reduces the risk of diabetic foot ulcers compared to not checking temperatures daily. Two studies found that diabetic patients who checked their foot temperatures daily using an infrared thermometer in multiple spots were less likely to develop ulcers than patients who did not check temperatures. Both randomized controlled trials found that daily temperature monitoring can help prevent ulcers by identifying potential issues early. However, future research with more participants over longer periods is still needed to further validate these findings. Providing diabetic patients with thermometers and education on their importance could help temperature monitoring become a standard of care.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    14 views15 pages

    Pico 1

    Uploaded by

    Hend maarof
    Daily foot temperature monitoring reduces the risk of diabetic foot ulcers compared to not checking temperatures daily. Two studies found that diabetic patients who checked their foot temperatures daily using an infrared thermometer in multiple spots were less likely to develop ulcers than patients who did not check temperatures. Both randomized controlled trials found that daily temperature monitoring can help prevent ulcers by identifying potential issues early. However, future research with more participants over longer periods is still needed to further validate these findings. Providing diabetic patients with thermometers and education on their importance could help temperature monitoring become a standard of care.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 15

    Evidenced Based

    Health Practice:
    PICO Presentation
    By: Anna Ingersoll, RN
    PICO Question
    • In patients with diabetes, does taking ones foot temperature
    daily, compared to not checking a daily foot temperature,
    reduce the incidence rate of diabetic ulcer formation??

    • P- diabetic patients

    vs
    • I- daily foot temperature
    • C- no daily foot temperature
    • O- reduce the incidence rate of diabetic ulcer formation
    Literature Results
    • Key words; diabetic ulcer formation, ulcer prevention, diabetic
    daily skin assessment, diabetic skin breakdown, checking foot
    temperatures in diabetic patients, reducing diabetic ulcer
    formation

    • Search Engine: Pubmed

    • Final Search: “effectiveness of daily skin assessment on


    diabetic feet”
    Research Articles
    • # 1- Armstrong, D., Holtz-Neiderer, K., Wendel, C., Mohler,
    J., Kimbriel, H., & Lavery, L. (2007). Skin Temperature
    Monitoring Reduces the Risk for Diabetic Foot Ulceration in
    High-risk Patients. The American Journal of Medicine,
    120(12)1042-1046. doi: 10.1016/j.amjmed.2007.06.028

    • # 2- Lavery, L., Higgins, K., Lanctot, D., Constantinides, G.,


    Zamorano, R., Athanasiou, K., Armstrong, D., & Agrawal, C.
    (2007). Preventing Diabetic Foot Ulcer Recurrence in High-
    Risk Patients. American Diabetes Association Diabetes Care,
    30 (1) 14-20. doi: 10.1016/j.amjmed.2007.06.028
    Evaluation of Articles
    • Both articles contain quantitative research.

    • Both articles involved individuals diagnosed with diabetes


    who are participating in daily temperature monitoring of feet
    by using a specific thermometer.

    • Both articles used the intervention of taking ones foot


    temperature in multiple spots.
    Evaluation of Article # 1
    • Theory: The objective of this study was to evaluate the effectiveness of home
    temperature monitoring to reduce the incidence of foot ulcers in high-risk diabetic
    patients.
    • Type of Study: Quantitative
    • Design: physician-blinded, randomized controlled trial
    • Methods: There were 225 diabetic subjects for this trial. They were divided up into
    two groups; one group was the Standard Therapy Group and the second was the
    Dermal Thermometry Group. Both groups received therapeutic footwear, diabetic
    foot education, regular foot care, and performed a structured foot inspection daily.
    The difference being that the second group used an infrared skin thermometer to
    measure temperatures on 6 foot sites twice daily. Those with greater than a 4
    degree difference from left to right side would told to contact the study nurse to
    report these findings and reduce activity until temperatures were normal.
    • Findings: A total of 8.4% subjects had ulcer formation over the study period. Those
    in the Standard Therapy Group were 2/3 likely to ulcerate, whereas the Dermal
    Group was only 1/3 likely.
    Evaluation of Article # 2
    • Theory: The study was to evaluate the effectiveness of a temperature monitoring
    instrument to reduce the incidence of foot ulcers.
    • Type of Study: Quantitative
    • Design: physician-blinded, randomized multicenter trial
    • Methods: There were 173 subjects who were divided into two categories of:
    standard therapy/structured foot examination, or enhanced therapy groups. Each
    group received proper footwear, diabetic foot education and regular foot care.
    Subjects in the structured group performed a specific foot exam daily and
    recorded their findings. Subjects in the enhanced group used an infrared skin
    thermometer to measure each foots temperature daily using six access points.
    Each group were given specific instructions when to contact the study nurse.
    • Findings: Subjects in the enhanced group had fewer foot ulcers then the standard
    group/structured foot group (8.5% compared to 29.3%) Meaning that those in
    the standard/structured group were 1.5 times more likely to develop an ulcer.
    Ethical Considerations
    • Study 1- While it was expected that all subjects would use the
    thermometer twice daily, there was no indication as to whether
    all participants were strict with this. Also, it was expected that
    all subjects would test 6 different areas on their foot and there
    was no indication as to whether this was strictly followed.
    • Study 2- For those subjects in the standard group, whose
    incidence risk was much higher then the enhanced group, there
    was no indication how group 1 did with their daily foot
    assessment. If a patient(s) were to not complete their daily
    assessment, this could increase the risk from lack of care
    rather then what instrument was used or not used.
    Criteria for Study # 1
    • Strength: Randomization and blinding procedures. All participants had equal
    conditions regarding instructions, education and proper foot wear. The study was
    conducted in the participant’s natural environment.
    • Quality: There was some possibility of bias. Participants’ personal opinions, both
    negative or positive, towards strict instructions of using the thermometer twice
    daily in 6 different spots, may have influenced the results. It was also impossible
    to make sure participants used the thermometer correctly at all times.
    • Credibility: This article was published in The American Journal of Medicine,
    which is a credible journal along with the benefit of being a peer reviewed
    journal.
    • Does study make a contribution to EBP? Yes, this study demonstrates that daily
    interventions amongst the diabetic population is important to help reduce the
    incidence rate of diabetic ulcer formation. It indicates that the subjects found
    temperature monitoring to be beneficial. It indicates that education and
    assistance with obtaining equipment as this would be beneficial for one’s health
    which correlates to healthier living.
    Criteria for Study # 2
    • Strength: Randomization and blinding procedures. All participants had equal
    conditions regarding instructions, education and proper foot wear. The study was
    conducted in the participant’s natural environment.
    • Quality: There was some possibility of bias. Participants’ personal opinions, both
    negative or positive, towards strict instructions of using the thermometer daily in 6
    different spots, may have influenced the results if they did not follow these strict
    guidelines. It was also impossible to make sure participants in group 2 used the
    thermometer correctly at all times and that participants in group 1 followed the strict
    foot exam designated to them.
    • Credibility: This article was published in The American Diabetes Association, which is
    peer reviewed and a credible organization.
    • Does study make a contribution to EBP? Yes, this study demonstrates that daily
    interventions amongst the diabetic population is important to help reduce the incidence
    rate of diabetic ulcer formation. It indicates that the subjects found temperature
    monitoring to be beneficial. It indicates that continued education and assistance with
    obtaining proper equipment would be beneficial for one’s health which correlates to
    healthier living and decreases preventative medical care.
    Relevant to current practice
    • How would these findings be communicated?

    • what level
    o Patients should have these statics available at their PCP office and/or Diabetic clinic.

    • Individual level
    o Through individual research and education

    • Standard of Care
    o Along with diabetic education, food planning, medication administration, and glucose
    monitoring, daily skin assessments including monitoring of ones foot temperature should
    be part of daily routines.

    • Professional Level
    o It should be the responsibility of physicians and other professionals to acknowledge
    preventative interventions for this specific group.
    Relevant to current practice
    • Diabetes education, early prevention and early treatment are all
    implications that should be practiced on a daily basis.
    • By preventing a diabetic ulcer from forming, not only is one increasing
    their quality of life, but also decreasing future complications.
    • This can not fall on just one discipline, patient’s need to be their own
    advocates, but also the physician needs to take charge and ensure the
    patient has been given the proper tools and resources to make a difference.
    • Daily skin assessments, including daily temperature monitoring should be
    the standard of care for all diabetic patients. However as a society, we
    are not there yet. I don’t feel it is an intervention that is discussed with
    this population. I am unclear if it is because it is a newer revelation or if
    for some reason it hasn’t gain popularity yet.
    Implications of Research
    Articles
    • While this article’s findings concluded that daily temperature
    monitoring can decrease ulcer formation, there were other
    implications that they did not take into consideration.
    • According to the first study; quality of life, functional status,
    self-efficacy, satisfaction with care and cost will need to be
    addressed in future articles and research.
    • While the authors felt that this study mirrored other projects,
    they go onto suggest completing a study over an extended
    period of time with more test subjects would conclude the
    same information.
    Barriers
    • Potential barriers for this population is whether there are
    resources available to them. Every diabetic patient receives a
    glucose monitor at time of diagnosis, so why not include a foot
    thermometer in this practice? I am not sure if it is cost related,
    unpopularity of treatment or something not listed.
    • Other PICO questions to consider:
    o In patients with diabetes, does assessing ones feet daily, compared to not assessing ones
    feet daily, reduce the incidence rate of diabetic complications?
    o In patients with diabetes, does proper diabetic education, compared to having no diabetic
    education, reduce the risk of diabetic complications?
    Conclusion
    • Patients and families must bridge the gap between physician
    examinations by taking responsibility in daily skin assessment
    of feet.
    • Self-monitoring is essential to identify areas on the foot that
    are at risk for injury.
    • Once injury occurs, it is extremely important to continue
    monitoring and assessing as it can help prevent worsening
    complications such as lower extremity amputation.
    • Continuing education with this group of individuals is key to
    success at improving their quality of life as well as helping
    decrease further medical interventions.

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