Riesgo de pie diabético y déficit de autocuidados en pacientes con Diabetes Mellitus Tipo 2 / Diabetic foot risk and self-care shortfalls among Type 2 Diabetes Mellitus patients / Risco de pé diabético e déficit de autocuidados em pacientes com Diabetes Mellitus Tipo 2

Objetivo: Conocer los factores de riesgo de pie diabético y el nivel de conocimientos sobre autocuidados en una muestra de pacientes con diabetes mellitus tipo 2 (DM2), de un centro de salud urbano. Método: Estudio observacional descriptivo en Atención Primaria. Intervención de enfermería relacionada con pie diabético en una muestra de usuarios diagnosticados de DM2. Recogida de datos de historia clínica, valoración clínica y aplicación de un cuestionario ad hoc sobre factores de riesgo y conocimiento de autocuidados. Análisis estadístico descriptivo e inferencial. Resultados: 42 hombres y 31 mujeres. Media de edad de 69.1 años. El 65.8% fueron diagnosticados de DM2 hace más de 10 años. El valor medio de la HbA1c fue de 6.9%, el cual fue más elevado en los hombres (p=0.02). También, se observó mayor riesgo de complicaciones vasculares y neuropáticas en los hombres (p=0.04); y una mayor presencia de deformidades (helomas y hallux valgus) en las mujeres (p<0.01). Déficit de conocimientos en más de la mitad de los pacientes, relacionado con la hidratación diaria de los pies (p<0.01) y el uso de calzado adecuado (p<0.01). Conclusiones: El control de los factores de riesgo de pie diabético debe ser mejorado por parte de los pacientes de nuestro estudio. El déficit de conocimientos se relacionó con un bajo nivel informativo y con la aplicación inadecuada de las recomendaciones. Se hace necesario formar a los pacientes en estos aspectos y realizar una valoración clínica, según la práctica basada en la evidencia, lo que posiblemente influya en un mejor control del riesgo de pie diabético.

To explore the risk factors associated with diabetic foot, and the level of knowledge on self-care, in a sample of type 2 Diabetes Mellitus patients (DM2) from an urban health center. Method: This is an observational and descriptive study in the area of nursing interventions in Primary Attention. Collected data included clinical history, clinical assessment, and the results of an ad hoc questionnaire on DM2 associated risk factors, and the self-care knowledge level. Descriptive and inferential statistics were calculated. Results: There were 42 male and 31 female patients with a mean age of 69.1 years old. 65.8% had been diagnosed with DM2 longer than 10 years ago. The median value of HbA1c was 6.9%, which was higher among males (p = 0.02). A higher risk of suffering vascular and kidney-related complications was observed among males as well (p = 0.04), whereas a higher presence of deformities such as calluses and hallux valgus was observed among females (p <0.01). Shortfalls in knowledge, including those on daily feet hydration (p < 0.01) and the use of adequate shoes (p<0.01) were observed in more than half of these patients. Conclusions: The control of the related risk factors must be improved by the patients in our study. Moreover, their knowledge shortfalls were related to the inadequate fulfillment of the corresponding recommendations. Thus, and considering the Evidence-Based Practice, it is necessary to better prepare these patients so that they can better control their diabetic foot risks.

Objetivo: Conhecer os fatores de risco de pé diabético e o nível de conhecimentos sobre autocuidados em uma amostra de diabéticos mellitus tipo 2 (DM2), de um centro de saúde urbano. Método: Estudo observacional descritivo em Atenção Primária. Intervenção de enfermagem relacionada com pé diabético em uma amostra de usuários diagnosticados de DM2. Coleta de dados de história clínica, avaliação clínica e aplicação de um questionário ad hoc sobre fatores de risco e conhecimento de autocuidados. Análise estatística descritiva e inferencial. Resultados: 42 homens e 31 mulheres. Média de idade de 69.1 anos. O 65.8% foram diagnosticados de DM2 até mais de 10 anos. A média da HbA1c foi de 6.9%, a qual foi mais elevada nos homens (p=0.02). Também, se observou maior risco de complicações vasculares e neuropáticas nos homens (p=0.04); e uma maior presença de deformidades (helomas e hallux valgus) nas mulheres (p0<.01). Déficit de conhecimentos em mais da metade dos pacientes, relacionado com a hidratação diária dos pés (p<0.01) e o uso de calçado adequado (p<0.01). Conclusões: O controle dos fatores de risco de pé diabético deve ser melhorado por parte dos pacientes de nosso estudo. O déficit de conhecimentos relacionou-se com um baixo nível informativo e com a aplicação inadequada das recomendações. Faz-se necessário formar aos pacientes nestes aspectos e realizar una avaliação clínica, segundo a prática baseada na evidencia, o que possivelmente influencie em um melhor controle do risco de pé diabético.

Assessment of evidence and quality of clinical practice guidelines on deterioration of skin integrity: ulcers and chronic wounds / Evaluación de las evidencias y calidad de las guías de práctica clínica sobre deterioro de la integridad cutánea: úlceras y heridas crónicas.

Background. The epidemiological, social, and economic situation that surrounds the deterioration of skin integrity is a big problem for the health system. Its prevention and treatment create uncertainty and professional variability and it remains a priority to have good clinical practice guidelines (CPG). The objective was to determine the quality of the CPG on prevention and treatment of pressure ulcers (PU), venous ulcers of the leg (VUL) and diabetic foot ulcers (DFU). Methodology. Systematic review of the quality of Spanish and international CPG on PU, VUL and DFU. Bibliographic search in specialized sources. Selection of CPG, not older than 5 years (2010-2015). Use of the AGREE Instrument II and revision by 4 experts. Descriptive statistics. Results. Twenty-three CPG (10 PU, 6 VUL and 7 DFU), of which 4 were Spanish and 19 international. Eight CPG on PU, 3 VUL and 5 DFU were considered "Highly Recommended". Domain nº 2 (participation) and Domain nº 5 (applicability) were the worst valued. The quality of the evidence was "very good" in 19 GPC. The best CPG were the British NICE (PU), the Australian AWMA (VUL) and the Canadian RNAO (DFU). Conclusions. We observed a good methodological quality in the CPG on PU and DFU, but there needs to be improvement in the VUL. In general, it would be necessary to increase the participation of users, and describe possible barriers for the implementation of the CPG in clinical practice.

RCP obstétrico: diferenciarlo mejora la supervivencia / Obstetrics cardiopulmonary resuscitation: differentiation improves survival

No disponible