ABSTRACT
INTRODUCTION: In this study the evaluation of the care process of the diabetic foot will be carried out after the implementation of an intra-hospital clinical pathway and a multidisciplinary consultation. OBJECTIVES: Evaluate the influence on factors related to the care, amputations, and rehabilitation of the amputee patient. METHODOLOGY: Retrospective study, in which the comparison of three periods has been made. First (3years): Before the implantation of the pathway. Second (5years): After the implementation of the pathway. Third (10years): After the implementation of the consultation. RESULTS: A specialized consultation in diabetic foot care contributes to a reduction in femoral and minor amputations. The assessment and treatment by rehabilitation of patients undergoing major amputation has been optimized. CONCLUSION: The implantation of the pathway and consultation contributes to the preservation of the lower limb. However, the incidence remains high, suggesting that diabetic foot care remains suboptimal.
Subject(s)
Diabetes Mellitus , Diabetic Foot , Amputation, Surgical , Diabetic Foot/surgery , Humans , Lower Extremity/surgery , Patient Care Team , Retrospective StudiesABSTRACT
OBJECTIVE: Our aim was to study the behavior and validity of PEFR and FEV1 in the free-running exercise test in order to diagnose exercise-induced asthma during childhood. PATIENTS AND METHODS: We studied 30 asthmatic children and 30 healthy children as controls. A provocation test was performed by means of free-running exercise in an indoor sports center. Environmental temperature and humidity were equal in both groups. Forced breathing spirometry and the "Mini-Wright peak flow meter" test were recorded before and two, five, fifteen and twenty minutes after the exercise challenge. The spirometric values representing two standard deviations below the mean for each variable studied in the control group were considered as reference values (FEV1 > or = 83.5% and PEFR > or = 81.5%). RESULTS: There was a decrease in FEV1 in 17 asthmatic children (56.7%) and a decrease in PEFR occurred in 14 children (46.7%). No statistically significant differences were found in either test. Specificity was 100% for FEV1 and 96.7% for PEFR. The greatest decrease in both spirometric parameters occurred at five minutes. CONCLUSIONS: According to our results, in a free-running provocation test if we maintain previously controlled environmental conditions and exercise intensity "forced breathing spirometry" and "Mini-Wright peak flow" can be used interchangeably in order to diagnose exercise-induced asthma.
Subject(s)
Asthma, Exercise-Induced/diagnosis , Exercise Test/methods , Lung/physiopathology , Running/physiology , Adolescent , Asthma, Exercise-Induced/physiopathology , Child , Electrocardiography , Exercise Test/statistics & numerical data , Forced Expiratory Volume , Humans , Linear Models , Peak Expiratory Flow Rate , Reproducibility of ResultsABSTRACT
BACKGROUND: Exercise is one of the most common precipitating factors of acute asthmatic crises in childhood. Although it has been described as more frequent among children, this is probably due to their more abundant physical activity. Nevertheless, it also occurs at other ages. OBJECTIVE: The aim of this study is to assess possible differences in postexercise spirometry after treadmill and free running provocation tests. METHODS: We compared the results obtained in a treadmill test performed by 30 asthmatic children and 30 healthy children with the results obtained with these same children in a free running test, keeping similar environmental conditions (temperature and humidity), exercise intensity (assessed by heart rate), and airway status at the time of the test. RESULTS: Seventy-three percent of the patients had positive treadmill tests and 63.3% had positive free running tests. For the spirometric parameters studied, there were no significant differences in the percent decrease in postexercise performance after either of the provocation tests. For FEV1, which is the most sensitive diagnostic parameter, the sensitivity was 53.3% in treadmill running and 56.7% in free running, with a specificity of 100% in both tests. CONCLUSIONS: If environmental conditions, exercise intensity, and airway status are controlled at the time of the test, treadmill and free running can be used indistinctly as asthma-inducing exercises.