P23S06: Diabetic foot
infection
Bottom line:
Information on diabetic foot infection was used to
maintain the management of a patient (continue with same medication). There were no information-related patient
health outcomes.
Level 1 outcome (situational relevance): On March 25,
2009, P23 did a search at work, by themselves, and after an encounter with a
patient. They retrieved three information hits about diabetic foot infection. The reported search objective was: to
address a clinical question. This patient, [a man between 50 and 60 years old], was admitted with
diabetic foot. [...] He had an ulcer,
and he was on antibiotics. When I started the rotation he was already on
antibiotics in fact. [...]My question was how
long he should be on the antibiotics.According to P23,
e-Therapeutics+ was the only source for information, and the found information
was relevant.
Level 2 outcome (cognitive impact): Three hits were
associated with a report of positive
cognitive impact (see table). Regarding practice improvement and learning, P23 stated: [The highlight
says] For
osteomyelitis, in the setting of diabetic foot infection, the usual duration of
antibacterial therapy is 4 to 6 weeks; if all infected bone is completely removed, a
shorter duration of 2 to 3 weeks may be sufficient, but if no debridement, 10
to 12 weeks of antibiotic has been curative. I was aware of the 4 to 6 weeks
duration, but I wasnt sure about what happens if the bone is removed or not. [...][My practice will be changed] because I will
know how to treat differently depending if there is any surgical removal or not
of the osteomyelitis. [...][The
nonpharmalogic choices] mention the surgical treatment of osteomyelitis, that if you start
antibiotics and if you see that there is no improvement of the infection then
you can consider the surgical intervention. If this would happen in the future
that a patient will not respond to antibiotherapy, I will just consult surgery
sooner.
Retrieved information hits:
1) e-Therapeutics+ (CIRT): Therapeutics
Tab Keyword: Diabetic foot Acute osteomyelitis Highlight (P23S06H01)
2) e-Therapeutics+ (CIRT): Therapeutics
Tab Keyword: Diabetic foot Acute osteomyelitis Nonpharmalogic choices(P23S06H02)
3) e-Therapeutics+ (CIRT): Therapeutics
Tab Keyword: Diabetic foot Acute osteomyelitis Antibacterials paragraph(P23S06H03)
Level 3 outcome
(information use): Information on diabetic foot infection was retrieved,
and used to maintain (be more certain about) the management of
a patient (information used
as presented in e-Therapeutics+). [
] We continued with
the same medication [
] [and we
decided that] the duration of therapy [would be for] 4 to 6 weeks.
Level 4 outcome (patient health): Without these
information hits, P23s management of the patient would have been the same.
There was no clear relationship between the information use and patient health
outcomes.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question |
Practice improved Learned something Reminded something Motivated to learn Confirmed Reassured |
Be more certain |
No outcome |