Harnarayan Patrick, Cawich Shamir O, Islam Shariful, Ramsewak Shivaa, Naraynsingh Vijay
Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago.
Patient Prefer Adherence. 2014 Sep 2;8:1173-7. doi: 10.2147/PPA.S68680. eCollection 2014.
There has been little focus on self-directed treatment for lower limb wounds, although it a common practice among persons with diabetes across the Caribbean. We sought to document this practice in a Caribbean nation.
We prospectively interviewed all consecutive patients with diabetes who were admitted with lower limb wounds at the San Fernando General Hospital in Trinidad and Tobago over a period of 18 months. A questionnaire was used to collect data on patient demographics, use of self-directed treatment, and details of these treatments.
Of 839 persons with diabetes who were admitted with infected lower limb wounds, 344 (41%) admitted to self-directed treatment before seeking medical attention. These patients were predominantly male (59.9%) at a mean age of 56.4±12.4 years. The practice was most common in persons of Afro-Caribbean descent (45.9%) and those with type 2 diabetes (93.9%). In this group, 255 (74.4%) patients were previously admitted to hospital for lower limb infections. And of those, 32 (12.6%) had a prior amputation and 108 (42.4%) had at least one operative debridement specifically for foot infections.
Caribbean cultural practices may be an important contributor to negative outcomes when treating lower limb wounds in persons with diabetes. Despite being acutely aware of the potentially devastating consequences of inadequate treatment, 41% of our patients with diabetes still opted to use self-directed treatment for lower limb wounds. This deserves further study in order to give a more tailored approach in care delivery.
尽管在加勒比地区，糖尿病患者自行治疗下肢伤口是一种常见做法，但目前对这种自我治疗方式的关注较少。我们试图记录加勒比地区一个国家的这种做法。
我们前瞻性地采访了特立尼达和多巴哥圣费尔南多总医院在18个月期间因下肢伤口入院的所有连续糖尿病患者。使用问卷调查收集患者人口统计学数据、自我治疗的使用情况以及这些治疗的详细信息。
在839名因下肢感染伤口入院的糖尿病患者中，344名（41%）承认在寻求医疗救治之前进行了自我治疗。这些患者以男性为主（59.9%），平均年龄为56.4±12.4岁。这种做法在非洲裔加勒比人后裔（45.9%）和2型糖尿病患者（93.9%）中最为常见。在这组患者中，255名（74.4%）此前曾因下肢感染入院。其中，32名（12.6%）曾接受过截肢手术，108名（42.4%）至少接受过一次专门针对足部感染的手术清创。
在治疗糖尿病患者的下肢伤口时，加勒比地区的文化习俗可能是导致不良后果的一个重要因素。尽管我们的41%的糖尿病患者敏锐地意识到治疗不当可能带来的毁灭性后果，但他们仍然选择对下肢伤口进行自我治疗。这值得进一步研究，以便在提供护理时采取更有针对性的方法。
