Volume 39 Number 1

Neuropathic limb care

Ruth Connors

For referencing Connors R. Book review – Neuropathic Limb Care. WCET® Journal 2019; 39(1):40

DOI https://doi.org/10.33235/wcet.39.1.40

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Author(s)

中文

Title Neuropathic limb care 

  • Diabetic Ulceration -Leprosy-Congenital Disorders-Trauma
  • A Practical Guide to procedures for Reducing Disabilities and Amputations

Author Grace Warren MD (with Sydney Nade MD)

Publisher George Jacksett Australia. Honeysett Press. 2018

ISBN ISBN 978-1-876158-10-1 paperback. ISBN 978-1-876158-11-8 eBook

neuropathic book.jpg

This book is a revision of Dr Grace Warren’s “The Care of Neuropathic Limbs, A Practical Manual” and was first published by the Parthenon Publishing Group in 1999. 

Introduction

Dr Warren saw that there was a need to provide a comprehensive manual on the management of neuropathic limbs. She felt it should focus on the long-term dedication required to manage this problem to prevent limb deformity and amputation. She explains the current literature is fragmented and mostly defines experiences in managing these conditions in economically rich countries. Her wide experience working in developing countries as a surgeon with a focus on prevention of amputation showed her there were many options to assist limb salvage that are overlooked that can be effective in managing neuropathy.

Content 

The text begins by defining the challenge of managing neuropathic limbs which now is seen largely in patients with diabetes but Dr Warren covers case studies of patients with other neuropathies. She begins with the importance of patient centred care and how a dedicated multifaceted approach can result in limb salvage.

The book continues with a very comprehensive section on assessment and studies to assess and diagnose neuropathic limbs. These assessments are very low tech such as charting sensation and radiography. This could be easily and cheaply achieved in developing countries and remote locations.

A very extensive range of interventions and treatments are described and the emphasis is very much on patient education, intervention and self-management. I believe this is one aspect that is overlooked in developed countries. I suspect many of my podiatry colleagues would be very reluctant to teach our patients to debrided their own calluses but Dr Warren explains how she does and teaches this and notes it can be very effective. Even in Australia there are very few patients that get callus or wound debridement as regularly as they require it. 

The book finishes with useful appendices from other health professionals and adds additional insights into the management of neuropathic limbs.

This text provides a clearly written and practical guide to the management of neuropathy. It would be useful to any practitioner or patient looking to improve their understanding of these challenging conditions and as a podiatrist working with Aboriginal and Torres Strait Islander people many with neuropathic diabetic foot ulcers I think this text successfully challenges us to do more and consider how we help our patients. 

The real strength in this text is for those clinicians in developing countries without access to comprehensive expensive medical care, where the clinical care advocated in this book will really make a difference.

A criticism of this book is in the section on wound care. Whilst it is a comprehensive cover of traditional wound care treatments and dressings I think it overlooks the advances made. I do understand that wound therapies can be expensive and not applicable in all settings but I think an appreciation of the principles of wound care is another skill set useful in our tool box of therapies.

Conclusion 

I believe this book provides a very practical guide to management of neuropathic limbs. I applaud Dr Warren, clearly her dedication and passion to practice quality patient care in many countries has paved the way for us today to continue to fight to save limbs and she provides the road map to do this.


标题 神经病理性肢体护理

Ruth Connors

DOI: https://doi.org/10.33235/wcet.39.1.40

Author(s)

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标题 神经病理性肢体护理

  • 糖尿病溃疡 - 麻风 - 先天性疾病 - 创伤
  • 减少残障和截肢的实用指南

作者 Grace Warren MD (with Sydney Nade MD)

出版公司 George Jacksett Australia.Honeysett出版公司2018年

ISBN ISBN 978-1-876158-10-1 平裝版ISBN 978-1-876158-11-8 电子版

 

neuropathic book.jpg

 

本书基于Grace Warren医生的《神经病理性肢体护理 - 实用手册》(The Care of Neuropathic Limbs, A Practical Manual)改编,由 Parthenon出版集团于1999年首次出版。

前言

Warren医生认为有必要提供一本关于神经病理性肢体护理的全面手册。她认为应该长期坚持管理这个问题,以防肢体畸形,并避免截肢。她解释道,目前的文献非常分散,大多数是经济发达国家管理这些疾病的经验。作为一名专注于预防截肢的外科医生,她在发展中国家工作的丰富经验使她意识到许多有助于避免截肢的方法被人们忽视了,而这些方法在管理神经疾病方面可能是有效的。

内容

本书首先定义了管理神经病理性肢体所遇到的挑战。虽然此类疾病目前主要出现在糖尿病患者中,但Warren医生也介绍了一些其他神经疾病的病例研究。她首先强调了以护理患者为本的重要性以及专门的多因素方法如何能够避免截肢。

本书还用一个完整章节介绍了用于评估和诊断肢体神经疾病的评估和研究。这些评估的技术要求非常低,如绘制感觉图和放射检查。这种评估方式可以轻松和廉价地应用在发展中国家和偏远地区。

书中描述了非常广泛的干预措施和治疗方法,重点强调患者教育、干预和自我管理。我相信,这是在发达国家被忽略的一个方面。我猜想,许多足病医生都非常不愿意向患者传授如何切除自己脚上的老茧,但Warren医生解释了她的做法,并发现这些做法非常有效。即使在澳大利亚,也很少有患者会按需求定期请人切除老茧或清创伤口。

本书的最后是其他医务人员提供的一些有用附录,就神经病理性肢体的护理提出了额外见解。

本书为管理神经疾病提供了明确的书面实用指南。对于任何希望对这些挑战性疾病加深理解的医务人员或患者来说,这本书都非常有用,而且作为一名服务土著和托雷斯海峡岛民(许多人神经病性糖尿病足部溃疡)的足病医生,我认为此书成功地对我们提出了更多挑战,要求我们做的更多,并考虑如何帮助我们的患者。

本书的真正优势在于它面向无法享受昂贵的全面医疗的发展中国家的医务人员。在这些国家里,本书提倡的临床护理真的会产生效果。

对本书的批评体现在伤口护理部分。虽然本书全面涵盖了传统伤口护理治疗和敷料,但我认为它忽略了取得的进步。我理解,伤口治疗会非常昂贵,不适合所有情况,但我认为,对伤口护理原则的理解是我们开展治疗时的另一个有用技能。

结论

我相信,本书是神经病理性肢体管理的一本非常实用的指南。我为Warren医生喝彩,显然,她在许多国家为患者提供高质量护理的敬业精神和热情为我们今天的工作指明了方向,我们可以继续努力以避免患者截肢,而她为此给我们提供了路标。

Ruth Connors

足病医生

Townsville Aboriginal & Islander Health Service

澳大利亚昆士兰州


Author(s)

Ruth Connors
Podiatrist
Townsville Aboriginal & Islander Health Service
Queensland, Australia