Toolkit para la creación de unidades de úlcera de pie diabético / A toolkit to create diabetic foot ulcer units

Bajo el nombre de «Toolkit para unidades de úlcera de pie diabético» se han diseñado un conjunto de herramientas para facilitar la puesta en marcha, el funcionamiento y la evaluación de este tipo de unidades clínicas. El Toolkit ha sido realizado por 6 cirujanos vasculares y 2 metodólogos, y para su elaboración se han consultado las principales guías de práctica clínica en el manejo del pie diabético. El Toolkit incluye material destinado a atención primaria y otras especialidades fuera del ámbito de la cirugía vascular (conceptos básicos, algoritmos de manejo, recomendaciones de prevención primaria y criterios de derivación a cirugía vascular), y material para el propio servicio de cirugía vascular (recomendaciones sobre los recursos necesarios para montar una unidad de úlcera de pie diabético, algoritmos clínicos de manejo, cuadernos de recogida de datos, base de datos en Microsoft Access y herramientas de evaluación clínica y económica de la unidad) (AU)

Under the name of «The Diabetic Foot Ulcer Units Toolkit» we have designed a set of tools as an aid for the implementation, performance and evaluation of these Clinical Units. The Toolkit has been prepared by 6 vascular surgeons and 2 experts in methodology. Major clinical practice guidelines in the management of diabetic foot were consulted. The Toolkit includes tools for primary care and other specialties outside the field of vascular surgery (basic concepts, criteria for referral to DFUU, initial basic tests and recommendations for clinical management and primary prevention), and tools for vascular surgery service (list of optimal resources for the DFUU implementation, clinical management algorithms, data collection forms, Microsoft Access database, and tools for the clinical and economical evaluation) (AU)

Iron deficiency in the acute-phase reaction after open aortic surgery.

The objective of this study was to quantify the magnitude of iron deficiency in the postoperative period after open aortic surgery. This was a prospective observational study in 55 consecutive patients. Blood samples were obtained on postoperative days 1, 2, 4, 30, and 45, and the parameters determined were the following: iron, transferrin, transferrin saturation index, transferrin-soluble receptor, ferritin, red cell count, hemoglobin, hematocrit, serum C-reactive protein, fibrinogen, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and number of blood units transfused. We performed statistical ANOVA test for repetitive measurements (lower bound) in regard to its basal level. Iron deficiency and its parameters reached the maximum at 48 hours postoperatively (iron: 18.92 g/dL and transferrin saturation index: 11.1%) (P <.05). There was not a complete recovery after 45 days (iron: 51.23 g/dL and transferrin saturation index: 18.0%) (P <.05). A similar evolution was observed in the other measured parameters (red cell count: 3.5 x 106/L.; hemoglobin: 10.4 g/dL; hematocrit: 30.7%) (P <.005), none affecting the values of concentration or volume (P <.05). Transferrin-soluble receptors, normal at first, were increased at postoperative days 30 and 45 (2.7 and 2.4 mg/dL respectively, P <.005). After open aortic surgery there is an important acute-phase reaction, a dramatic iron deficiency, and a lack of its transporters until the 45th analyzed day. The elevation of transferrin-soluble receptors in the 4th and 6th weeks denotes a necessity of iron supplementation for a correct development of the immature hematic cells since blood parameters do not reach normal levels in the 6th postoperative week.