The results suggest that use of TM technology can be a relevant alternative and supplement to usual care, at least for patients with more superficial ulcers.

Modern medicine is complex. Reports and surveys demonstrate that patient safety is a major problem. Health educators focus on professional knowledge and less on how to improve patient care and safety. The ability to act as part of a team, fostering communication, co-operation and leadership is seldom found in health education. This paper reports the findings from pilot testing a simulated training program in interprofessional student teams. Four teams each comprising one medical, nursing, and intensive nursing student (n = 12), were exposed to two simulation scenarios twice. Focus groups were used to evaluate the program. The findings suggest that the students were satisfied with the program, but some of the videos and simulation exercises could be more realistic and more in accordance with each other. Generally they wanted more interprofessional team training, and had learned a lot about their own team performance, personal reactions and lack of certain competencies. Involving students in interprofessional team training seem to be more likely to enhance their learning process. The students' struggles with roles, competence and team skills underline the need for more focus on combining professional knowledge learning with team training.

ObjectivesTo investigate whether A) duration of ulcer before start of treatment in specialist health care, and B) severity of ulcer according to University of Texas classification system (UT) at start of treatment (baseline), are independent predictors of healing time.MethodsThis retrospective cohort study, based on electronic medical record data, included 105 patients from two outpatient clinics in Western Norway with a new diabetic foot ulcer during 2009–2011. The associations of duration of ulcer and ulcer severity with healing time were assessed using cumulative incidence curves and subdistribution hazard ratio estimated using competing risk regression with adjustment for potential confounders.ResultsOf the 105 participants, 45.7% achieved ulcer healing, 36.2% underwent amputations, 9.5% died before ulcer healing and 8.5% were lost to follow-up. Patients who were referred to specialist health care by a general practitioner ≥ 52 days after ulcer onset had a 58% (SHR 0.42, CI 0.18–0.98) decreased healing rate compared to patients who were referred earlier, in the adjusted model. High severity (grade 2/3, stage C/D) according to the UT classification system was associated with a decreased healing rate compared to low severity (grade1, stage A/B or grade 2, stage A) with SHR (95% CI) equal to 0.14 (0.05–0.43) after adjustment for referral time and other potential confounders.ConclusionEarly detection and referral by both the patient and general practitioner are crucial for optimal foot ulcer healing. Ulcer grade and severity are also important predictors for healing time, and early screening to assess the severity and initiation of prompt treatment is important.

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Background Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. Methods The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer–Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. Results In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. Conclusions There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants’ health, well-being and quality of life. Trial registration Clinicaltrials.gov, NCT01710774. Registered October 19th, 2012.

BackgroundThis paper presents the protocol for an ongoing study to evaluate a telemedicine follow-up intervention for patients with diabetes-related foot ulcers. Diabetes-related foot ulcers represent challenges for patients and the health services. The large increase in the prevalence of diabetes, combined with the aging population, means that the absolute number of patients with diabetes-related foot ulcers is likely to continue to increase. Health care services therefore need to provide close clinical follow-up care for people with diabetes both in primary and specialist care. Information and communication technologies may enable more integrated treatment and care pathways across organizational boundaries. However, we lack knowledge about the effect of telemedicine follow-up and how such services can be optimally organized.ObjectiveTo present the design and methods of a study evaluating a telemedicine follow-up intervention for patients with diabetes-related foot ulcers.MethodsThe study is designed as a cluster randomized controlled trial (noninferiority trial) involving municipalities or municipality districts (clusters) belonging to one clinical site in Western Norway. The study includes patients with type 1 and type 2 diabetes presenting with a new foot ulcer at the initial visit to the clinic. Patients in the intervention group receive telemedicine follow-up care in the community. The key ingredient in the intervention is the close integration between health care levels. The intervention is facilitated by the use of an interactive wound platform consisting of a Web-based ulcer record combined with a mobile phone, enabling counseling and communication between nurses in the community and specialist health care. Patients in the control group receive standard hospital outpatient care. The primary endpoint in the trial is healing time; secondary outcomes include amputation and death, patient-reported outcome measures, and follow-up data on the recurrence of foot ulcers. In addition, qualitative substudies are being performed to provide a more comprehensive evaluation of the ongoing processes during the trial with the patients in the intervention and control groups and those health care professionals either working in primary care or in specialist care delivering the intervention.ResultsThe project has been funded. The inclusion of patients started in September 2012. Because recruitment goals were not met in the initial period, two more clinical sites have been included to meet sample size requirements. Patient recruitment will continue until June 2016. Data collection in the qualitative substudies has been completed.ConclusionsThis telemedicine trial operates in a novel setting and targets patients with diabetes-related foot ulcers during a 12-month follow-up period. The trial addresses whether integrated care using telemedicine between primary and specialist health care can be an equivalent alternative to standard outpatient care.Trial RegistrationClinicalTrials.gov NCT01710774; https://clinicaltrials.gov/ct2/...

IntroductionNursing students undergo clinical training in a rapidly changing health care system and many stress the need for evidence-based health interventions (1). However, educating students in evidence-based practice (EBP) is a challenge for both faculties and clinical practice, because EBP educational interventions may improve students' knowledge, but do not ensure its application in a clinical setting (2,3). Improving the transmission of EBP from the classroom to the clinical setting and to facilitate students' ability to integrate EBP naturally into their professional upskilling, requires an environment that challenges students in terms of evidence-based issues. It is only in such critical clinical settings that students can experience the challenge of applying evidence in their care of real patients (1,4). Nurses should challenge students to identify clinical problems and search for evidence-based solutions during their clinical training just as they challenge them about their clinical observations, interventions, procedures, etc. (5). For example faced with the assignment whether sterile intermitted catheterization is better to prevent urinary track infection compare to clean intermitted catheterization, nurses should challenge the students to conduct search in different databases, instead of given them the answer or asked the students to find answer in the textbook. However, according to Sackett et al. (6) this requires nurses with the competence to formulate answerable questions, search and critically appraise the evidence, apply the evidence and evaluate it. Research has shown that this competence is still lacking among nurses (7,8). A recent study in Norway concluded that nurses with skills in EBP could reduce the obstacles to the use of EBP and increase the use of science in practice (9), which is consistent with previous research (3,10).As has been stressed in previous research, problems are associated with the implementation of EBP when it is transferred from the faculty to clinical practice. Consequently, a collaboration between a faculty and a clinical practice was established to allow the implementation of EBP by students during their clinical training. The aim of this study was to examine the nursing students' experiences during the implementation of EBP in a practical setting. This article presents the main findings of this study. Literature reviewIn Norway, the focus on EBP in nursing education has increased since 2004, but no studies have examined Norwegian undergraduate nursing students' experiences of EBP or whether they support its use in clinical practice. Internationally, there is no research consensus about the role nursing students should play when EBP is integrated into clinical practice (11). A few studies have recommended a partnership between faculties and practices to facilitate EBP. Stone et al. (12) involved undergraduate students in finding the appropriate evidence for nurses in clinical practice, which led to changes in policy and nursing practice. They concluded that stud...

This study evaluated whether students can learn to critically appraise a scientific article through evidence-based teaching methods. The course trains students in three steps of evidence-based practice--formulating a question, searching the evidence, and critically appraising the evidence. We gave the students two scientific articles. The articles were divided into sections, and 1 to 2 days were spent on each section. Every day had the same structure: a brief lecture on the relevant part of the article, group work, and interactive plenary discussions. At the end of the course, the students had a group examination in which they critically appraised a new scientific article. Most students reported that having learned steps one, two, and three involved in evidence-based practice was useful in critically appraising a scientific article. The results from the examination supported this. Knowledge about evidence-based practice can increase students' critical attitudes toward the evidence and their own practice.