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及早发现糖尿病足（DF）并进行适当的处理，以及评估糖尿病神经病变（DN）的程序。目前的研究表明，在神经科医生（监督者）的教育指导下，护士评估DN及其分期的能力有所提高。随着DN分期的增加，每个足部病变都恶化。尽管基于先前的诊断的DF评分并没有随着DN的分期而增加，但是设计的评分（其中每个足部病变的个体评分已经加权与DN分期的关联程度）随着其分期而增加。此外，对趾短伸肌（EDB）萎缩的评估已经显示在DN的早期发展，这表明EDB可以提供用于分级DN和/或防止DF的有用参数。

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.