In Vitro and In Vivo Evaluation of Chitosan/HPMC/Insulin Hydrogel for Wound Healing Applications.

Treatment of chronic wounds is challenging, and the development of different formulations based on insulin has shown efficacy due to their ability to regulate oxidative stress and inflammatory reactions. The formulation of insulin with polysaccharides in biohybrid hydrogel systems has the advantage of synergistically combining the bioactivity of the protein with the biocompatibility and hydrogel properties of polysaccharides. In this study, a hydrogel formulation containing insulin, chitosan, and hydroxypropyl methyl cellulose (Chi/HPMC/Ins) was prepared and characterized by FTIR, thermogravimetric, and gel point analyses. The in vitro cell viability and cell migration potential of the Chi/HPMC/Ins hydrogel were evaluated in human keratinocyte cells (HaCat) by MTT and wound scratch assay. The hydrogel was applied to excisional full-thickness wounds in diabetic mice for twenty days for in vivo studies. Cell viability studies indicated no cytotoxicity of the Chi/HPMC/Ins hydrogel. Moreover, the Chi/HPMC/Ins hydrogel promoted faster gap closure in the scratch assay. In vivo, the wounds treated with the Chi/HPMC/Ins hydrogel resulted in faster wound closure, formation of a more organized granulation tissue, and hair follicle regeneration. These results suggest that Chi/HPMC/Ins hydrogels might promote wound healing in vitro and in vivo and could be a new potential dressing for wound healing.

Diabetes-related distress and quality of life among people with type 2 diabetes at primary care level in Brazil.

PURPOSE: Living with diabetes can be challenging, particularly when it comes to dealing with psychological distress and requiring self-care directives. Patients may feel frustrated, angry, overwhelmed, and discouraged. This study aimed to investigate the diabetes-related distress and quality of life among people with type 2 diabetes mellitus (T2DM). METHODS: A cross-sectional study carried out at the Clinical Research Centre at the University of Campinas, Brazil, between September 2020 and April 2021. Patients answered data regarding demographic and clinical variables, the Brazilian version of the Diabetes Distress Scale and the Diabetes Quality of Life (QOL) Measure by telephone contact. The data were managed using the RedCap System. For statistical analysis of the data, the Mann-Whitney and Kruskal-Wallis tests were applied for comparisons, and the Chi-square test for associations. The correlations were evaluated using the Spearman correlation coefficient. RESULTS: Out of the 302 participants we recruited, 50.33% exhibited significant diabetes-related distress. Those with elevated diabetes-related distress scores had shorter education levels (p < 0.05), lower HbA1c levels (p < 0.05), and lower total scores in Diabetes QOL Measure (p < 0.0001), particularly in the QOL impact (p < 0.0001), social/vocational worry (p < 0.05), and diabetes worry (p < 0.0001) subscales compared to the group with the lowest diabetes-related distress. CONCLUSION: Elevated diabetes-related stress scores significantly affect patients' QOL. Therefore, early screening of individuals at risk for this condition, using well-coordinated protocols, could mitigate adverse QOL effects and enhance their overall experience during disease management.

Nursing consultation for insulin use: construction and validity of a simulation scenario / Consulta de enfermería para el uso de insulina: construcción y validación de un escenario de simulación / Consulta de enfermagem para o uso de insulina: construção e validação de cenário de simulação

ABSTRACT Objective: To build and validate a clinical simulation scenario for teaching students about nursing consultations for people with type 2 Diabetes Mellitus in initial insulin use. Method: A methodological study, carried out in a higher education institution in Minas Gerais, Brazil, between December 2021 and November 2022. The steps taken involved scenario construction, validity by 16 judges and scenario testing by 30 students. The conceptual model proposed by Jeffries and International Nursing Association for Clinical Simulation in Learning guidelines were followed to elaborate the scenario. Results: The scenario was called "Nursing consultation for teaching initial insulin use to people with type 2 Diabetes Mellitus". The scenario and the checklist for its validity were constructed, then, face and content validity was performed. The final validated version consisted of seven conceptual components (context, background, design, simulated experience, facilitator actions and educational strategy, participants and expected results). The overall value of the Content Validity Index was 0.98. High comprehensibility was noted by the target audience when testing the scenario. Conclusion: The scenario obtained adequate validity and comprehensibility. Using this teaching tool can contribute to the training of future nurses regarding the consultation for patients using insulin.

RESUMEN Objetivo: Construir y validar un escenario de simulación clínica para enseñar a los estudiantes sobre consultas de enfermería para personas con diabetes mellitus tipo 2 que usan insulina por primera vez. Método: Estudio metodológico, realizado en una institución de educación superior de Minas Gerais, Brasil, entre los meses de diciembre de 2021 y noviembre de 2022. Los pasos seguidos fueron la construcción del escenario, la validación por 16 jueces y la prueba del escenario por 30 estudiantes. Para la elaboración del escenario se siguió el modelo conceptual propuesto por Jeffries y las guías de la International Nursing Association for Clinical Simulation in Learning. Resultados: El escenario se denominó "Consulta de Enfermería para la enseñanza del uso inicial de insulina a personas con Diabetes Mellitus Tipo 2". Se construyó el escenario y la lista de chequeo para su validación. Luego se realizó la validación facial y de contenido. La versión final validada constó de siete componentes conceptuales (contexto, background, design, experiencia simulada, acciones del facilitador y estrategia educativa, participantes y resultados esperados). El valor global del índice de validez de contenido fue de 0,98. El público objetivo notó una alta comprensibilidad al probar el escenario. Conclusión: El escenario obtuvo adecuada validez y comprensibilidad. El uso de esta herramienta didáctica puede contribuir a la formación de los futuros enfermeros en cuanto a la consulta de pacientes usuarios de insulina.

RESUMO Objetivo: construir e validar um cenário de simulação clínica para o ensino de estudantes sobre consulta de enfermagem à pessoa com diabetes mellitus tipo 2 em uso inicial de insulina. Método: Estudo metodológico, realizado em instituição de ensino superior de Minas Gerais, Brasil, entre os meses de dezembro de 2021 e novembro de 2022. As etapas percorridas envolveram construção do cenário, validação por 16 juízes e testagem do cenário por 30 estudantes. O modelo conceitual proposto por Jeffries e os guias da International Nursing Association for Clinical Simulation in Learning foram seguidos para elaboração do cenário. Resultados: O cenário denominou-se "Consulta de enfermagem para o ensino do uso inicial de insulina à pessoa com Diabetes Mellitus tipo 2". Construiu-se o cenário e a lista de verificação para a sua validação; em seguida, realizou-se validação de face e conteúdo. A versão final validada foi constituída por sete componentes conceituais (contexto, background, design, experiência simulada, ações do facilitador e estratégia educacional, participantes e resultados esperados). O valor geral do índice de validade de conteúdo foi 0,98; notou-se alta compreensibilidade pelo público-alvo na testagem do cenário. Conclusão: O cenário obteve adequada validade e compreensibilidade. A utilização desta ferramenta de ensino pode contribuir para a formação de futuros enfermeiros com relação à consulta para o paciente em uso de insulina.

Histological and Molecular Evidence of the Positive Performance of Glycerol-Plasticized Chitosan-Alginate Membranes on Skin Lesions of Hyperglycemic Mice.

The purpose of this study was to investigate tissue repair of excisional wounds in hyperglycemic animals treated with chitosan-alginate membranes (CAM) produced in the presence of glycerol. 8-week C57B1 male mice were divided into normoglycemic animals with a 0.9% saline solution topical treatment (CTSF); hyperglycemic animals with 0.9% saline solution topical treatment (DMSF) and hyperglycemic animals with glycerol-plasticized chitosan-alginate membrane topical treatment (DMCAM). On post-wound day three, the DMCAM group presented a lower number of leukocytes, mature mastocytes, a higher number of vessels (p < 0.05), and active mastocytes (p < 0.05) when compared to the CTSF and DMSF groups. There were no differences regarding the distribution, deposition, organization, and thickness of collagen fibers. On day 7 there were no differences in the analysis of fibroblasts, mastocytes, and TGF−ß1 and VEGF expressions among the groups. Regarding collagen fibers, the DMCAM group presented slight red-orange birefringence when compared to the CTSF and DMSF groups. On day 14 there was a slight concentration of thinner elastic fibers for the DMCAM group, with a greater reorganization of papillary skin and improved red-orange birefringence collagen fibers, as well as net-shaped orientation, similar to intact skin. In addition, improved elastic fiber organization distributed in the entire neo-dermis and a larger presence of elaunin fibers were observed, in a similar pattern found in the intact skin. The use of CAM in cutaneous lesions boosted tissue repair since there was a smaller number of inflammatory cells and mastocytes, and an improvement in collagen deposition and collagen fibers. These results demonstrate the high potential of plasticized chitosan-alginate membrane for skin wound dressing of hyperglycemic patients.

Cuidados de enfermagem e posição prona: revisão integrativa / Atención de enfermería y decúbito prono: revisión integradora / Nursing care and prone position: Integrative review

Objetivo: explorar, na literatura científica, práticas atuais de cuidado de enfermagem ou intervenções para pacientes com síndrome respiratório agudo grave (SRAG) submetidos à posição prona. Síntese do conteúdo: revisão integrativa, na qual foram realizadas buscas nas bases de dados PubMed, CINAHL, Scopus, Web of Science e LILACS em setembro de 2020 e janeiro de 2022, sem recorte temporal, por meio da questão deste estudo: "Quais são os cuidados de enfermagem para pacientes com SRAG submetidos à posição prona?". Foram selecionados 15 artigos, a partir da busca nas bases de dados. Após a leitura, os cuidados encontrados foram categorizados em alinhamento do corpo para a prevenção de lesões neuromusculares, cuidados com equipamentos diversos, cuidados tegumentares e recomendações neurológicas. Conclusões: o enfermeiro deve ter conhecimento sobre as implicações e as complicações de se manter um paciente na posição prona. Tal conhecimento permitirá tomadas de decisões na construção ou no seguimento de protocolos institucionais que contribuam com a prevenção de riscos e resultem em melhores desfechos para o paciente.

Objetivo: explorar dentro de la literatura científica las prácticas o intervenciones actuales del cuidado de enfermería para los pacientes con síndrome respiratorio agudo grave (SRAG) sometidos a la posición de decúbito prono. Síntesis de contenido: revisión integradora mediante búsquedas en las bases de datos Pubmed, CINAHL, Scopus, Web of Science y LILACS, entre septiembre de 2020 y enero de 2022, sin recorte temporal, a través de la pregunta: ¿cuáles son los cuidados de enfermería para los pacientes con SRAS sometidos a la posición de decúbito prono? En total, se seleccionaron 15 artículos tras la búsqueda en bases. Tras la lectura de estos documentos, se observó que los cuidados identificados se podían categorizar en lineación corporal para prevenir lesiones neuromusculares, cuidados con equipos diversos, cuidados cutáneos y recomendaciones neurológicas. Conclusiones: el profesional de enfermería debe conocer las implicaciones y complicaciones de mantener a los pacientes en decúbito prono. Este conocimiento permitirá tomar decisiones para la construcción o el seguimiento de protocolos institucionales que contribuyan a la prevención de riesgos y generen mejores resultados para el paciente.

Objective: To explore within scientific literature the current nursing care practices or interventions for patients with severe acute respiratory syndrome (SARS) submitted to prone positioning. Content synthesis: Integrative review carried out in Pubmed, CINAHL, Scopus, Web of Science and LILACS databases from September 2020 to January 2022, with no time cutting, addressing the question: What are the nursing care practices for patients with SARS and placed under prone positioning? A total of 15 articles were selected from the database search. After analysis, it was observed that the care provided by nursing professionals could be categorized in body alignment to prevent neuromuscular injuries, care with various equipment, cutaneous care, and neurological recommendations. Conclusions: Nurses must acknowledge the implications and complications of keeping a patient in the prone position. Such awareness will allow decision making in the development or follow-up of institutional protocols that contribute to risk prevention and that will result in better outcomes for patients.

Atitudes, conhecimento e interesse dos futuros profissionais em relação à geriatria: um estudo transversal / Attitudes, knowledge, and interest of future professionals towards geriatrics: a cross-sectional study / Actitudes, conocimientos e interés de los futuros profesionales hacia la geriatría: un estudio transversal

OBJETIVO: este estudo teve como objetivo analisar as atitudes, conhecimentos e interesse dos estudantes de saúde em relação à geriatria e gerontologia e avaliar suas associações. MÉTODO: participaram do estudo 225 estudantes do último ano dos cursos de Enfermagem, Medicina, Fonoaudiologia, Farmácia e Educação Física. Os questionários incluíram um formulário de características demográficas, a Escala de Diferencial Semântico de Envelhecimento e Questionário Palmore - Fatos sobre o envelhecimento. Foram utilizados modelos de regressão múltipla. RESULTADOS: a atitude em relação aos idosos foi negativa (50,67%) e associada ao menor interesse. O nível de conhecimento foi melhor entre os estudantes de Enfermagem, Medicina e estudantes mais velhos. O aumento do conhecimento se relacionou com a atitude e, no total, 71,43% apresentavam interesse em geriatria. O interesse esteve fortemente associado ao gênero feminino. CONCLUSÃO: os estudantes apresentaram um alto nível de conhecimento, interesse em geriatria e uma atitude negativa em relação aos cuidados geriátricos. Ações focadas na capacitação em geriatria devem ser implementadas.

OBJECTIVE: this study aimed to examine health students' attitudes, knowledge, and interest towards geriatrics and gerontology and evaluate associations. METHOD: a total of 225 students in the final year of Nursing, Medicine, Speech therapy, Pharmacy, and Physical education participated. The questionnaires included a characterization form, the Aging Semantic Differential Scale, and the Palmore Fact on Aging Quiz. Multiple regression models were used. RESULTS: the attitude towards older people was negative (50.67%) and associated with less interest. The level of knowledge was better among Nursing, Medicine, and older students. Increased knowledge was related to attitude and, in total, 71.43% were interested in geriatrics. Interest was strongly associated with female gender. CONCLUSION: students showed a high level of knowledge, interest in geriatrics, and a negative attitude towards geriatric care. Actions focused on geriatric training should be implemented.

OBJETIVO: este estudio tuvo como objetivo examinar las actitudes, los conocimientos y el interés de los estudiantes de salud hacia la geriatría y la gerontología y evaluar las asociaciones. MÉTODO: participaron un total de 225 estudiantes de los últimos años de cursos de Enfermería, Medicina, Fonoaudiología, Farmacia y Educación Física. Los cuestionarios incluían un formulario de caracterización, la Escala de Diferencial Semántico de Envejecimiento y el Cuestionario de Hechos sobre el Envejecimiento de Palmore. Se utilizaron modelos de regresión múltiple. RESULTADOS: la actitud hacia las personas mayores fue negativa (50,67%) y asociada a un menor interés. El nivel de conocimiento fue mejor entre los estudiantes de Enfermería, Medicina y de edad mayor. El aumento de conocimientos estuvo relacionado con la actitud, en total, el 71,43% estaba interesado en la geriatría. El interés estuvo fuertemente asociado con el género femenino. CONCLUSIÓN: los estudiantes mostraron un alto nivel de conocimiento, interés por la geriatría y una actitud negativa hacia la atención geriátrica. Deben implementarse acciones enfocadas a la formación geriátrica.

Incidência de lesão por pressão em posição prona durante a pandemia de COVID-19: um estudo de coorte / Incidence of prone position pressure sores during the COVID-19 pandemic: a cohort study / Incidencia de lesión por presión en decúbito prono durante la pandemia de COVID-19: un estudio de cohorte

OBJETIVO: avaliar a incidência de lesão por pressão na posição prona e seus fatores de risco em pacientes admitidos em unidades de terapia intensiva diagnosticados com COVID-19. MÉTODO: trata-se de um estudo de coorte prospectiva (n=30) com duração de seis meses. Informações relacionadas a estado da prona, tempo de duração, presença ou ausência de lesão por pressão e características sociodemográficas e clínicas foram coletadas. Estatística descritiva e inferencial foi realizada para comparar os pacientes que desenvolveram e os que não desenvolveram lesão por pressão. Para análise dos dados, foi utilizada Regressão de Poisson com variância robusta. RESULTADOS: o tempo médio na posição prona foi de 20,1 horas (DP=3,9). A incidência de lesão por pressão foi de 70%, sendo as localizações mais comuns: tórax esquerdo, abdômen, bochechas e testa. Ao comparar os grupos com e sem lesão por pressão, não houve diferença entre eles (p>0,05). CONCLUSÃO: a incidência não foi associada a nenhuma variável sociodemográfica ou clínica dos pacientes.

OBJECTIVE: this study aimed to assess the incidence of prone-positioning pressure sores and its risk factors in patients admitted to intensive care units diagnosed with COVID-19. METHOD: a six-month follow-up prospective cohort study (n=30) was conducted. Information regarding proning status, duration of prone position (PP), presence or absence of PPPS, and sociodemographic and clinical variables were collected. Descriptive and inferential statistics were performed to compare the patients who developed or did not develop pressure sores. Poisson regression with robust variance was used for data analysis. RESULTS: the mean PP time was 20.1 hours (SD=3.9). The incidence of PPPS was 70%, with the most common locations being the left chest, abdomen, cheek, and forehead. When comparing the groups with and without prone-positioning pressure sores, there was no difference between them (p>0.05). CONCLUSION: the incidence of prone-positioning pressure sores was not associated with any sociodemographic or clinical variable of the patients.

OBJETIVO: evaluar la incidencia de lesión por presión en decúbito prono y sus factores de riesgo en pacientes ingresados ​​en unidades de cuidados intensivos con diagnóstico de COVID-19. MÉTODO: se trata de un estudio de cohorte prospectivo (n=30) con una duración de seis meses. Se recolectó información relacionada con el decúbito prono, tiempo de duración, presencia o ausencia de lesión por presión y características sociodemográficas y clínicas. Se realizó estadística descriptiva e inferencial para comparar pacientes que desarrollaron y no desarrollaron lesiones por presión. Para el análisis de datos se empleó la regresión de Poisson con varianza robusta. RESULTADOS: el tiempo medio en decúbito prono fue 20,1 horas (DE=3,9). La incidencia de lesiones fue 70%, siendo las localizaciones más frecuentes: tórax izquierdo, abdomen, mejillas y frente. Al comparar los grupos, no hubo diferencia (p>0,05). CONCLUSIÓN: la incidencia no se asoció con ninguna variable sociodemográfica o clínica de los pacientes.

Systematic review and meta-analysis of the efficacy of Unna boot in the treatment of venous leg ulcers.

This systematic review determined the effectiveness of the Unna boot in the treatment of venous leg ulcers (VLUs) by assessing the quality of the available evidence. A systematic search of studies published between August 2019 and February 2020 was conducted using the PubMed, PubMed/PMC, BVS/BIREME, CINAHL, Web of Science, MEDLINE, Embase, Cochrane, ProQuest, BDTD, CAPES Thesis and Dissertation, OPEN THESIS, Centre for Reviews and Dissemination and SciELO databases. Studies were eligible if they reported primary studies, controlled clinical trials, quasi-experimental studies or observational studies (cross-sectional studies or cohort studies). We identified 302 articles. After screening and critical appraisal, eight articles were included in this review, while six articles were included in the meta-analysis. Four studies were included in the outcome of complete ulcer healing rate with a weighted estimate of the odds ratio of 0.43 (95% CI = 0.188-1.01). No evidence of the presence of considerable heterogeneity was observed (p = 0.35, I2 = 32%). Two studies were assigned to the outcome time to complete ulcer healing (days) with a weighted estimated mean difference of 41.3 days (95% CI = 21.62-61.04). Evidence of the presence of considerable heterogeneity was observed (p = 0.01, I2 = 85%). The results showed a moderate degree of evidence that there is no difference in the healing rates of VLUs with the use of the Unna boot. For the time to complete ulcer healing, the low number of studies and low classification impaired the reporting at any level of evidence.

Prophylactic dressings in the prevention of pressure ulcer related to the use of personal protective equipment by health professionals facing the COVID-19 pandemic: A randomized clinical trial.

Device-related pressure injury (DRPI) is a serious problem that is affecting professionals working on the front lines against COVID-19 due to the prolonged use of personal protective equipment (PPE). In addition to the physical and psychological integrity of professionals, these injuries can compromise the quality of care. Therefore, using technologies to prevent this adverse effect is an urgent matter. This is a parallel two-arm randomized clinical trial without the use of a control group to compare the use of foam and extra-thin hydrocolloid in preventing DRPI associated with the use of PPE by health professionals working on the front lines against coronavirus. In total, 88 professionals were divided into two groups: foam and hydrocolloid. Data were collected using two instruments and related to demographic and professional characteristics and skin evaluation. Each volunteer received one of the dressings, both with the same dimensions and arranged over similar regions, and data were gathered at baseline and after 6 or 12 hours. Descriptive and inferential analytic statistical methods were used; the significance level adopted was 5%. No participant developed DRPI, but four areas with hyperemia were observed in the foam group (two in the forehead, one in the cheeks, and one in the nose bridge), as well as four areas with hyperemia in the hydrocolloid group (two in the nose bridge, one in the right ear, and one in the left ear). There was no difference between the groups regarding skin conditions and discomfort (P > .05). The average cost obtained was $ 5.8/person and $ 4.4/person in the foam group and the hydrocolloid group, respectively, considering the dressing measurements. The results show that foam and extra-thin hydrocolloid were effective in preventing DRPI associated with the use of PPE.

Intervenções em saúde mental para profissionais de saúde frente a pandemia de Coronavírus / Mental health interventions for health professionals in the context of the Coronavirus pandemic / Intervenciones de salud mental para profesionales de la salud ante la pandemia de Coronavírus

Objetivo: refletir sobre as intervenções/ações de cuidado em saúde mental voltados aos profissionais da saúde que prestam assistência ao paciente suspeito ou diagnosticado com COVID-19. Conteúdo: A pandemia de COVID-19 traz o desafio para profissionais da saúde em lidar com sua própria saúde mental e a dos pacientes. É fundamental conhecer e refletir sobre iniciativas que países apresentam para lidar com a manutenção da saúde mental de profissionais da saúde em tempos de pandemia e que contribuem para repensar o planejamento, execução e avaliação de estratégias a serem utilizadas no Brasil. Considerações finais: foi possível elencar ações em saúde mental que têm se mostrado assertivas no cuidado aos trabalhadores de saúde, atuantes na ponta do cuidado, sobretudo as baseadas no esclarecimento da doença, uso adequado de equipamentos de proteção individual, além do mapeamento daqueles profissionais fragilizados emocionalmente e/ou com sofrimento mental anterior à pandemia, além do suporte emocional oferecido por meio de plataformas digitais.

Objective: to reflect on mental health care interventions/actions aimed at health professionals who provide assistance to patients suspected or diagnosed with COVID-19. Content: The COVID-19 pandemic challenges health professionals to lead with their own and patients' mental health. It is essential to know and to reflect about countries' initiatives to deal with health professional's mental health maintenance in times of pandemic, and to help to re-think strategies planning, execution and evaluation to be used in Brazil. Final considerations: it was possible to list actions in mental health that have shown to be assertive in the care of health workers who are in the front line of caring, especially those based on clarifying the disease, appropriate use of individual protective equipment, in addition to mapping those emotionally weakened professionals and or with mental suffering prior to the pandemic, in addition to the emotional support offered through digital platforms.

Objetivo: reflexionar sobre las intervenciones/acciones de atención de salud mental dirigidas a profesionales de la salud que prestan asistencia a pacientes sospechosos o diagnosticados con COVID-19. Contenido: La pandemia COVID-19 desafía a los profesionales de la salud a hacer frente con la salud mental propia y de los pacientes. Es esencial conocer y reflexionar sobre las iniciativas de los países para enfrentar al mantenimiento de la salud mental de los profesionales de la salud en tiempos de pandemia, y para ayudar a repensar la planificación, ejecución y evaluación de estrategias que se utilizarán en Brasil. Consideraciones finales: fue posible enumerar acciones en salud mental que han demostrado ser asertivas en la atención de los trabajadores de salud que trabajan en la primera línea de atención de la salud, especialmente aquellos basados en la aclaración de la enfermedad, el uso apropiado de equipos de protección individual, además de mapear aquellos profesionales debilitados emocionalmente y / o con sufrimiento mental antes de la pandemia, además del apoyo emocional ofrecido a través de plataformas digitales.

Introducing a very low carbohydrate diet for a child with type 1 diabetes.

Type 1 diabetes mellitus is a serious autoimmune disease for which no cure is available. The treatment includes insulin therapy, carbohydrate counting, eating healthy foods, exercising regularly, and maintaining a healthy weight. The goal is to keep blood glucose levels close to normal most of the time to delay or prevent complications. Despite the increase in the use of insulin pumps and continuous glucose monitors in recent years, the management of type 1 diabetes remains suboptimal in terms of glycaemic control and normal glycated haemoglobin (HbA1c) level. This article discusses the case of a child with type 1 diabetes who was successfully treated with a very low-carbohydrate diet, resulting in normal levels of HbA1c and normal blood glucose 95% of the time in a range of 70-180 mg/dL (4.0 mmol/L-10 mmol/L). Therefore, further studies are needed to verify how a very low carbohydrate diet impacts child development.

Topical Insulin Modulates Inflammatory and Proliferative Phases of Burn-Wound Healing in Diabetes-Induced Rats.

The healing time of burn wounds depends on surface area and depth of the burn and associated comorbidities. Diabetes mellitus (DM) causes delays in the healing process by extending the inflammatory phase. Treatment with topical insulin can improve the inflammatory phase, restore metabolic dysregulation, and modulate impaired cellular signaling in burn wounds. The objective of this study was to evaluate markers of the inflammatory and proliferative phases of second-degree burns after topical insulin treatment in diabetic rats. Type I DM was induced with streptozotocin in male Wistar rats. The animals' backs were shaved and subjected to thermal burning. Rats were randomized into two groups: control diabetic (DC) and insulin diabetic (DI). At Days 7 and 14 postburn, rats were euthanized, and wound-tissue sections were evaluated by hematoxylin and eosin, Weigert, and Verhöeff staining, immunohistochemistry-paraffin, and enzyme-linked immunosorbent assay. A significant increase in reepithelialization was seen on Days 7 and 14 in DI versus DC rats. On Day 7, interleukin (IL)-1ß, IL-6, monocyte chemotactic protein (MCP)-1, and F4/80 expression were increased in DI versus DC rats. On Day 14, MCP-1 expression was decreased and F4/80 increased in DI versus DC rats. On Days 7 and 14, Ki-67, transforming growth factor-ß1, vascular endothelial growth factor expression, and formation of elastic fibers were increased in DI versus DC rats. Topical insulin modulates burn-wound healing in diabetic animals by balancing inflammation and promoting angiogenesis and formation of elastic fibers.

Effectiveness of the strategies of an orientation programme for the lifestyle and wound-healing process in patients with venous ulcer: A randomised controlled trial.

This study aimed to evaluate the effect of strategies of a lifestyle orientation programme on patients with venous ulcer in elastic compression therapy. This was a single-blind, 2-arm, randomised clinical controlled trial. The primary outcome included the reduction of the wound surface area. The secondary outcomes included the perception of pain, questionnaire of ulcer status, and quality of life. Seventy-one patients with ulcers of venous aetiology were randomised into 2 arms: control group (CG) and intervention group (IG), with a 12-week follow up. The CG was provided with the routine guidelines of the health services. Meanwhile, the IG was provided with lifestyle guidelines regarding the physiopathology of a venous ulcer, importance of compression therapy, physical exercises and rest in 4 face-to-face and 2 telephone interviews. The IG had significant improvement on the wound healing on 30, 60, and 90 days of follow up when compared with the CG (P = .0197; P = .0472; P = .0116). There were no statistical differences between groups; both had improvement in the quality of life and pain perception. Our results demonstrated that elastic compression therapy along with guidelines on lifestyle is effective adjunctive treatment to promote wound healing in patients with leg ulcers.

Biofilme e feridas crônicas: reflexões para o cuidado de enfermagem / Biofilm and chronic wound: reflections for nursing care

Objetiva-se refletir sobre o tema biofilme e ferida crônica para o cuidado de enfermagem. Estudo teórico-reflexivo, no qual os dados foram baseados em pesquisa na base de dados Scientific Electronic Library Online (SciELO) e PubMed, no período de 2010 à 2015, utilizando-se os descritores infecção, biofilmes e cicatrização de feridas. Os resultados apresentaram o crescimento microbiano em feridas crônicas é uma preocupação na prática clínica e a presença do biofilme prejudica o processo de cicatrização. O biofilme obtém nutrientes do plasma e do exsudato presentes no leito da ferida, e regula o metabolismo, a virulência e motilidade pela liberação e detecção de moléculas denominadas de quorum sensing. Abordagens no tratamento de feridas crônicas com foco no biofilme consistem na avaliação das características da ferida e na utilização de métodos de desbridamento para remoção da necrose e do esfacelo. Concluí-se que a limpeza do leito da ferida e o uso de antimicrobianos contribuem para o controle da carga microbiana, mas a administração destes produtos requer uma avaliação criteriosa. Novos métodos de diagnóstico para o controle do biofilme são necessários com vistas à prevenção, ao tratamento e cura das lesões em menor tempo

The aim is to reflect on biofilms in chronic wound for nursing care. A theoretical and reflective study based on Scientific Electronic Library Online (SciELO) and PubMed database, on the period 2010 to 2015. The used descriptors were infection, biofilms and wound healing. The results showed the microbial growth in chronic wounds is a concern in a clinical practice, and the presence of biofilm harms the healing process. The biofilm obtains plasma and exudate nutrients found in the wound bed, and regulates metabolism, virulence and motility by releasing and detecting molecules named quorum sensing. Approaches on treatment of chronic wounds focused on biofilm consist on the evaluation of the wound characteristics and on the usage of debridement methods to remove necrotic tissue and slough. It concludes that cleaning the wound bed help on controlling microbial load, but the usage of antimicrobial agents is also an expedient currently employed to control biofilm. The search for new diagnostic methods and biofilm control is necessary in order to prevent, to treat and to heal the wound in lesser time

Effect of atorvastatin on wound healing in rats.

Skin-wound healing is a complex and dynamic biological process involving inflammation, proliferation, and remodeling. Recent studies have shown that statins are new therapeutical options because of their actions, such as anti-inflammatory and antioxidant activity, on vasodilation, endothelial dysfunction and neoangiogenesis, which are independent of their lipid-lowering action. Our aim was to investigate the effect of atorvastatin on tissue repair after acute injury in healthy animals. Rats were divided into four groups: placebo-treated (P), topical atorvastatin-treated (AT), oral atorvastatin-treated (AO), topical and oral atorvastatin-treated (ATO). Under anesthesia, rats were wounded with an 8-mm punch in the dorsal region. Lesions were photographed on Days 0, 1, 3, 7, 10, 12, and 14 post-injury and samples taken on Days 1, 3, 7, and 14 for protein-expression analysis of insulin receptor substrate (IRS)-1, phosphatidylinositol 3-kinase (PI3K), protein kinase B (Akt), glycogen synthase kinase (GSK)-3, endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF), extracellular signal-regulated kinase (ERK), interleukin (IL)-10, IL-1ß, IL-6, and tumor necrosis factor (TNF)-α. Upon macroscopic examination, we observed significant reductions of lesion areas in groups AT, AO, and ATO compared to the P group. Additionally, AT and AO groups showed increased expression of IRS-1, PI3K, Akt, GSK-3, and IL-10 on Days 1 and 3 when compared with the P group. All atorvastatin-treated groups showed higher expression of IRS-1, PI3K, Akt, GSK-3, IL-10, eNOS, VEGF, and ERK on Day 7. On Days 1, 3, and 7, all atorvastatin-treated groups showed lower expression of IL-6 and TNF-α when compared with the P group. We conclude that atorvastatin accelerated tissue repair of acute lesions in rats and modulated expressions of proteins and cytokines associated with cell-growth pathways.

A confiabilidade no desenvolvimento e avaliação de instrumentos de medida na área da saúde / Reliability in the development and evaluation of measurement instruments in the health field / Confiabilidad en el desarrollo y evaluación de instrumentos de medición en el área de salud

A avaliação de intervenções e tratamentos atualmente procura englobar variáveis subjetivas, destacando a importância da perspectiva do paciente sobre a doença e os efeitos do tratamento. Estas medidas devem ser confiáveis, satisfazendo propriedades básicas, como validade, confiabilidade, sensibilidade e responsividade que representam um amplo e extenso repertório metodológico para avaliação. O presente estudo teve como objetivo realizar uma revisão de literatura sobre o conceito e métodos de avaliação da confiabilidade de instrumentos de medidas da área de saúde, com levantamento bibliográfico nas principais bases de dados desta área. Após seleção e análise dos textos, as informações foram organizadas, apresentando bases conceituais e métodos utilizados para avaliar a confiabilidade destes instrumentos, incluindo estabilidade, equivalência e consistência interna. O estabelecimento da confiabilidade é essencial para demonstrar a qualidade metodológica de instrumentos de medida. Além disso, as demais propriedades psicométricas de um instrumento também devem ser verificadas, garantindo a fidedignidade do processo de avaliação...

The evaluation of interventions and treatments currently seeks to comprise subjective variables, highlighting the importance of the patient's perspective regarding the disease and treatment effects. These measurements must be reliable and meet basic properties such as validity, reliability, sensitivity and responsiveness, which represent a broad and extensive methodological evaluation repertoire. The objective was to perform a literature review regarding the concept and methods of evaluating the reliability of measurement instruments, through a bibliographic search on the main databases in the health field. After selecting and analyzing the texts, the information was organized, and a presentation was made of the conceptual bases and methods used to evaluate the reliability of those instruments, including stability, equivalence and internal consistency. It is essential to establish reliability to demonstrate the methodological quality of measurement instruments. Furthermore, the other psychometric properties of an instrument must be verified, thus guaranteeing the trustworthiness of the evaluation process...

La evaluación de intervenciones y tratamientos actualmente procura incluir variables subjetivas, destacando la importancia de la perspectiva del paciente sobre la enfermedad a efectos del tratamiento. Estas medidas deben ser confiables, satisfaciendo propiedades básicas como validez, confiabilidad, sensibilidad y responsividad, que representan un extenso repertorio metodológico para evaluación. El presente estudio objetivó realizar una revisión de literatura sobre el concepto y métodos de evaluación de confiabilidad de instrumentos de medidas del área de salud, con relevamiento bibliográfico en las principales bases del área. Luego de selección y análisis de los textos, las informaciones fueron organizadas, presentando bases conceptuales y métodos utilizados para evaluación de confiabilidad de estos instrumentos, incluyendo estabilidad, equivalencia y consistencia interna. El establecimiento de confiabilidad es esencial para demostrar la calidad metodológica de instrumentos de medición. Además, las otras propiedades psicométricas de un instrumento deben también ser verificadas, garantizando que el proceso de evaluación sea fidedigno...

Nursing diagnoses of diabetic patient medical charts: a descriptive study

Aim: identifying taxonomy II nursing diagnoses from the North American Nursing Diagnoses Association International using nursing records associated with outpatient diabetic treatment. Method: a descriptive and retrospective study. Data obtained from 35 patients' medical charts, using a tool devised by the authors and analyzed using relative and absolute frequencies. Result: from eight diagnoses, three of the following showed up in more than 50% of the samples: Ineffective health maintenance; Imbalanced nutrition - more than body requirements; Sedentary lifestyle. Discussion: The findings show that these three diagnoses relate to a very important and unique issue in treating diabetic patients: the difficulty on the part of patients to adhere to treatment and self-care. Conclusion: The findings show that nursing diagnoses are useful with regard to identifying phenomena that require attention in specific treatment contexts, as well as acting as a guide in terms of the assistance offered.

Tradução e adaptação do "Diabetes Distress Scale - DDS" na cultura brasileira / Translation and adaptation of the

OBJETIVO: Traduzir e adaptar o Diabetes Distress Scale para a cultura brasileira. MÉTODOS: o processo seguiu as normas internacionais para adaptação de um instrumento: tradução, retrotradução e avaliação por um grupo de juízes e pré-teste. RESULTADOS: as etapas de tradução e retrotradução foram realizadas com sucesso, e a avaliação da versão síntese pelo comitê de juízes resultou em alteração de itens, assegurando as equivalências entre a versão original e a traduzida. Durante o pré-teste, foram realizadas reformulações de alguns itens, tornando-os mais claros e de fácil compreensão. CONCLUSÃO: a versão brasileira do Diabetes Distress Scale encontrou resultados satisfatórios em relação ao processo de tradução e adaptação cultural.

OBJECTIVE: To translate and adapt the Diabetes Distress Scale for the Brazilian culture. METHODS: The process followed international standards for adaptation of an instrument: translation, back translation and evaluation by a panel of judges, and pretest. RESULTS: The stages of translation and back translation were performed successfully, and the evaluation of the synthesis version by the expert panel resulted in modification of items, ensuring the equivalence between the original and translated versions. During the pretest, there were reformulations of some items, making them clearer and easier to understand. CONCLUSION: The Brazilian version of the Diabetes Distress Scale received satisfactory results with respect to the process of translation and cultural adaptation.

OBJETIVO: Traducir y adaptar la Diabetes Distress Scale para la cultura brasilera. MÉTODOS: el proceso siguió las normas internacionales para la adaptación de un instrumento: traducción, retrotraducción y evaluación por un grupo de jueces y pre test. RESULTADOS: Las etapas de traducción y retrotraducción fueron realizadas con éxito, y la evaluación de la versión síntesis por el comité de jueces dio como resultado la alteración de items, asegurando las equivalencias entre la version original y la traducida. Durante el pre test, fueron realizadas reformulaciones de algunos items, volviéndose más claros y de fácil comprensión. CONCLUSIÓN: la versión brasilera de la Diabetes Distress Scale encontró resultados satisfactorios en relación al proceso de traducción y adaptación cultural.

[Planning the hospital discharge of patients with diabetes: the construction of a proposal]. / Planejamento da alta hospitalar do paciente diabético: construção de uma proposta.

The acute and chronic complications that patients with diabetes and their families have to deal with after hospital discharge may be a consequence of the deficiencies in the educational process across hospitalization and the formal preparation for discharge. The objective of this study is to present a proposal of the plan for hospital discharge of adult patients with diabetes. A literature review on the hospital discharge of the assessed population was performed, including articles published between 2004 and February 2009. Taking the literature into consideration, a flier was created to guide the discharge process. The flier lists the information that should be collected and worked with the patient during the first four days of hospitalization, considering their individual needs and the Ineffective self health management. The discharge must be inserted in the Nursing Process, as nurses have an essential role in identifying the needs of patients and their families. The flier helps to identify the patient's needs and the actions to be performed by the team.

Planejamento da alta hospitalar do paciente diabético: construção de uma proposta / Planning the hospital discharge of patients with diabetes: the construction of a proposal / Planeamiento del alta hospitalaria del paciente diabético: construcción de una propuesta

As complicações agudas e crônicas enfrentadas pelo paciente diabético e sua família após a alta hospitalar podem ser consequência de deficiências no processo educativo ao longo da hospitalização e do preparo formal para alta. O objetivo deste estudo é apresentar uma proposta de planejamento da alta hospitalar do paciente diabético adulto. Foi realizada revisão de literatura sobre alta hospitalar da clientela em questão, selecionando-se artigos publicados de 2004 a fevereiro de 2009. Considerando a literatura, foi desenvolvido um impresso para nortear o planejamento da alta. Este abrange informações a serem colhidas e trabalhadas junto ao cliente, ao longo dos primeiros quatro dias de internação, considerando as necessidades individuais e o Autocontrole ineficaz da saúde. A alta precisa estar inserida no Processo de Enfermagem, uma vez que o enfermeiro tem papel fundamental na identificação das necessidades do paciente e família. O impresso auxilia a identificação das necessidades do cliente e das ações realizadas pela equipe.

The acute and chronic complications that patients with diabetes and their families have to deal with after hospital discharge may be a consequence of the deficiencies in the educational process across hospitalization and the formal preparation for discharge. The objective of this study is to present a proposal of the plan for hospital discharge of adult patients with diabetes. A literature review on the hospital discharge of the assessed population was performed, including articles published between 2004 and February 2009. Taking the literature into consideration, a flier was created to guide the discharge process. The flier lists the information that should be collected and worked with the patient during the first four days of hospitalization, considering their individual needs and the Ineffective self health management. The discharge must be inserted in the Nursing Process, as nurses have an essential role in identifying the needs of patients and their families. The flier helps to identify the patient's needs and the actions to be performed by the team.

Las complicaciones agudas y crónicas enfrentadas por el paciente diabético y su familia luego del alta hospitalaria pueden derivar de deficiencias en el proceso educativo durante la hospitalización y de la preparación formal para el alta. Este estudio objetivó presentar una propuesta de planeamiento de alta hospitalaria del paciente diabético adulto. Se realizó revisión de literatura sobre alta hospitalaria de pacientes en cuestión, seleccionándose artículos publicados desde 2004 hasta febrero 2009. Según la literatura, se desarrolló un impreso para orientar el planeamiento del alta. Este incluye informaciones para recoger y trabajar junto al paciente, durante los primeros cuatro días de internación, considerando necesidades individuales y Autocontrol ineficaz de la salud. El alta necesita insertarse en el Proceso de Enfermería, toda vez que el enfermero tiene papel fundamental en identificación de necesidades del paciente y familia. El impreso ayuda a identificar las necesidades del paciente y las acciones del equipo.