Rheumatology Department, Royal Free NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
Musculoskeletal Care. 2020 Mar;18(1):92-97. doi: 10.1002/msc.1433. Epub 2020 Jan 21.
Digital ulcers (DU) remain one of the most burdensome co-morbidities in systemic sclerosis. The objectives of the study were to describe patient-level stratification and to evaluate a nurse-led DU clinic service development.
A nurse-led digital ulcer clinic was established to identify patients with DU and manage them. Patients were recruited through scleroderma clinics, GP referrals, and self-referrals. The clinic involved patients being treated with appropriate treatment. Patients were stratified according to their DU risk level based on number and severity of ulcers. Among these, 22 patients were asked to complete a patient satisfaction survey. Data were analyzed descriptively.
Seventy-five patients were seen in the clinic, 46 (61%) were 56 years of age and above. Patients were identified as high (23%), medium (51%) or low risk (26%) for development of DU. The duration of DU history was from 7 months to 40 years. Prior to attending the nurse-led DU clinic, 90% of patients had received up to six courses of antibiotics for their DU, 76% had attended A&E, and 90% had unscheduled appointments. 90% had been seen by the GP due to DU and subsequently required hospital admissions. During the nurse-led clinic follow-up, only two patients had emergency admission. All patients reported that their needs in personal care of DU were met.
There are a significant number of people with SSc who have DUs affecting their quality of life as well as needing more healthcare services. A dedicated specialist nurse-led DU clinic may improve overall care of patients.
手指溃疡（DU）仍然是系统性硬化症最具负担性的合并症之一。本研究的目的是描述患者分层，并评估护士主导的 DU 诊所服务的发展。
建立了一个由护士主导的数字溃疡诊所，以识别和管理患有 DU 的患者。患者通过硬皮病诊所、全科医生转诊和自我转诊招募。该诊所涉及为患者提供适当治疗。根据溃疡的数量和严重程度，根据 DU 风险水平对患者进行分层。其中，22 名患者被要求完成患者满意度调查。对数据进行描述性分析。
该诊所共接诊了 75 名患者，其中 46 名（61%）年龄在 56 岁及以上。患者被确定为 DU 发展的高（23%）、中（51%）或低风险（26%）。DU 病史的持续时间从 7 个月到 40 年不等。在参加护士主导的 DU 诊所之前，90%的患者因 DU 接受了多达六轮抗生素治疗，76%的患者去过急症室，90%的患者有非预约就诊。由于 DU，90%的患者看过全科医生，随后需要住院治疗。在护士主导的诊所随访期间，只有两名患者紧急入院。所有患者都表示他们在 DU 的个人护理方面的需求得到了满足。
有相当数量的 SSc 患者患有 DU，这影响了他们的生活质量，并且需要更多的医疗保健服务。专门的护士主导的 DU 诊所可以改善患者的整体护理。
