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远程足部研究:一项针对糖尿病患者的单中心试验,比较使用远程医疗管理和转诊护士与标准护理途径实现足部溃疡完全愈合所需的1年期间住院总时长。

Télépied Study: A Single-Centre Trial in Diabetic Subjects Comparing Total Duration of Hospitalization Over a 1-Year Period Required for Complete Healing of a Foot Ulcer Using Telemedicine Management and a Referral Nurse Versus the Standard Care Pathway.

作者信息

Dardari Dured, Franc Sylvia, Charpentier Guillaume, Bobony Elise, Demangeon Laetitia, Bouly Marie, Xhaard Ilham, Orlando Laurent, Alhajj Maria, Sall Kadijatou Ly, Randazzo Caroline, Penfornis Alfred

机构信息

Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France.

Cordeliers Research Centre INSERM U1138 "Diabetes, Metabolic Diseases and Comorbidities" Team, 15 rue de l'Ecole de Médecine, 75270, Paris cedex 06, France.

出版信息

Diabetes Ther. 2020 Jun;11(6):1419-1427. doi: 10.1007/s13300-020-00821-1. Epub 2020 May 7.

Abstract

PURPOSE

The aim of this study is to demonstrate that the total number of days in hospital required for healing of a de novo diabetes-related foot ulcer (DFU) is lower in patients followed up using a telemedicine platform (Télépied Follow-Up group [Group 2]) than in patients followed up using standard care (Standard Follow-Up control group [Group 1]). Patients are assigned to either Group 1 or Group 2 depending on whether their first inclusion visit is during an even or odd week. Patients included in Group 1 are to be followed at spaced intervals during day hospital visits by the investigator assisted by a specialized referral nurse as part of the regular follow-up procedure (dressing changes + ulcer monitoring). Between visits, an independent nurse (IN) provides local care on a daily basis. Patients included in Group 2 have their DFU treated by a referral nurse trained at the diabetic foot unit of the investigating centre, and they are also followed up by an IN under the supervision of a referral nurse. In Group 2, monitoring of lesions is performed weekly by the referral nurse using photos of the DFU with planimetry taken by the IN and sent to the referral nurse via telemedicine software. The referral nurse can, in turn, provide guidance to the IN on the care to be provided and/or decide that a further hospital visit is needed. Both treatment groups are to be followed for 12 months or until complete healing of the ulcer.

RESULTS

Recruitment for the study began in March 2017 and ended in May 2019, with the final study visit scheduled for May 2020.

CONCLUSION

The aim of the Télépied study is to assess the impact of ambulatory foot ulcer management in diabetics over a 1-year period by a non-specialized IN working under the supervision of a referral nurse via telemedicine follow-up versus standard follow-up by an IN alone. The primary endpoint is the total duration of hospitalization required until full healing of the ulcer.

摘要

目的

本研究旨在证明,与采用标准护理进行随访的患者(标准随访对照组[第1组])相比,使用远程医疗平台进行随访的患者(远程足部随访组[第2组])中,新发糖尿病相关足部溃疡(DFU)愈合所需的总住院天数更少。根据患者首次纳入访视是在偶数周还是奇数周,将其分配到第1组或第2组。第1组的患者在日间医院就诊期间,由一名专业转诊护士协助研究者按照固定的随访程序(换药+溃疡监测)进行定期随访。在两次访视之间,一名独立护士(IN)每天提供局部护理。第2组的患者由在研究中心糖尿病足病单元接受培训的转诊护士治疗其DFU,并且他们也在一名转诊护士的监督下由一名IN进行随访。在第2组中,转诊护士每周使用由IN拍摄的带有面积测量的DFU照片,通过远程医疗软件发送给转诊护士,对病变进行监测。转诊护士继而可以就应提供的护理向IN提供指导和/或决定是否需要进一步的医院就诊。两个治疗组均随访12个月或直至溃疡完全愈合。

结果

该研究于2017年3月开始招募,2019年5月结束,最终研究访视定于2020年5月。

结论

远程足部研究的目的是评估在1年期间,由一名非专业IN在转诊护士的监督下通过远程医疗随访与仅由一名IN进行标准随访相比,对糖尿病患者门诊足部溃疡管理的影响。主要终点是溃疡完全愈合所需的总住院时间。

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