Improvement of the quality for foot care service in outpatient clinic for diabetic patients through promoting team-based care

探讨足部护理门诊护士如何尽早发现并妥善处理糖尿病足（DF），以及如何评估糖尿病神经病变（DN）。护士很难诊断DN并评估其分期。本研究表明，在神经科医师（督导）的教育指导下，护士评估DN及其分期的能力有所提高。每个足部病变随着DN分期的增加而恶化。虽然基于先前报道的DF评分并没有随着DN的分期而增加，但设计的评分，即每个足部病变的个体评分与DN分期的关联程度加权，随着DN的分期而增加。此外，对指短伸肌萎缩（EDB）的评估已被证明在DN的早期发展，这表明EDB可能为DN分期和/或预防DF提供有用的参数。

The procedure by which the nurse who works in foot care clinic could find out at the earliest and appropriately manage the daibetic foot (DF) and assess diabetic neuropathy(DN) which underlies DF has been explored.It appeared hard that the nurse could diagnose DN and evaluate its statging. The present study has shown that under the educational guidance of a neurologist(superviser) the ability for the nurse to evaluate DN and its staging has improved. Each foot lesion has worsened with increasing staging of DN. Although the DF score based on the previous reportrs has not increased with staging of DN, the devised score in which individual score for each foot lesion has been weighted for the degree of association with DN staging has increased with its staging.In addition, the evaluation for atrophy of extensor digitorum brevis muscles(EDB) has been shown to develop at the early stage of DN, suggesting that EDB may provide a usefull parameter for staging DN and/or preventing DF.