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Enferm. clín. (Ed. impr.) ; 30(2): 72-81, mar.-abr. 2020. tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-FGT-3069


Objetivo: Evaluar el nivel de autocuidados en la población con diabetes y determinar el riesgo de padecer lesiones de pie diabético mediante el uso de 3 sistemas de estratificación, así como establecer el grado de concordancia entre estos sistemas. Método: Estudio observacional, transversal y descriptivo realizado en la Zona básica de salud de Santa Brígida (Gran Canaria, Islas Canarias, España) en personas diagnosticadas de diabetes (DM tipo 1/DM tipo 2) (n = 182). Se realizaron entrevista, exploración física, revisión de la historia clínica y cumplimentación del cuestionario Diabetic Foot Self-Care questionnaire of the University of Malaga. Tras ello se calculó la estratificación del riesgo con 3 sistemas (sistema del National Institute for Health Care Excellence, clasificación del International Working Group on the Diabetic Foot y High-Risk Diabetic Foot-60-Second Tool© 2012). Se calculó el índice kappa para estudiar la concordancia entre sistemas, se estimaron el riesgo relativo de screening negativo de un método frente a otro y el test exacto de Fisher para establecer si existían diferencias. Resultados: Un 30,2% de los diabéticos tenían un nivel bajo de autocuidados, un 45,1% un nivel medio y un 24,7% nivel alto. Los niveles de riesgo calculados fueron: fueron clasificación National Institute for Health Care Excellence (riesgo negativo 71,4%; riesgo positivo 28,6%), clasificación del International Working Group on the Diabetic Foot (riesgo negativo 67,0%; riesgo positivo 33,0%) y High-Risk Diabetic Foot-60-Second Tool© (riesgo negativo 62,6%; riesgo positivo 37,4%). Conclusiones: Los 3 sistemas poseen una buena concordancia entre sí. El High-Risk Diabetic Foot-60-Second Tool© solo distingue 2 niveles de riesgo pero detecta mayor porcentaje de personas en situación de riesgo. El cuestionario Diabetic Foot Self-Care questionnaire of the University of Malaga puede ser útil en el contexto de Atención Primaria para evaluar el nivel de autocuidados de las personas con diabetes

Objective: To assess the level of self-care in the population with diabetes and determine the risk of diabetic foot lesions through the use of 3 stratification systems as well as to establish the degree of concordance between these systems. Method: Observational, cross-sectional and descriptive study carried out in the Basic Health Area of Santa Brígida (Gran Canaria-Canary Islands-Spain) in people diagnosed with diabetes (DM Type 1/DM Type 2) (n = 182). Interview, physical examination, review of clinical history and completion of the Diabetic Foot Self-Care questionnaire of the University of Malaga were carried out. The risk stratification was then calculated using 3systems (System of the National Institute for Health Care Excellence, Classification of the International Working Group on the Diabetic Foot and High-Risk Diabetic Foot-60-Second Tool©-2012). The Kappa index was calculated to study the concordance between systems, the relative risk of negative screening of one method against another was estimated and the exact Fisher test to establish whether there were differences. Results: 30.2% of diabetics had a low level of self-care, 45.1% a medium level and 24.7% a high level. The risk levels calculated were: National Institute for Health Care Excellence Classification (Negative Risk 71.4%-Positive Risk 28.6%), International Working Group on the Diabetic Foot Classification (Negative Risk 67.0%-Positive Risk 33.0%) and High-Risk Diabetic Foot-60-Second Tool© (Negative Risk 62.6%-Positive Risk 37.4%). Conclusions: All 3 systems have good concordance with each other. The High-Risk Diabetic Foot-60-Second Tool© only distinguishes 2 levels of risk but detects a higher percentage of people at risk. The Diabetic Foot Self-Care questionnaire of the University of Malaga may be useful in the context of Primary Care to assess the level of self-care of people with diabetes

Aten Primaria ; 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31932015


OBJECTIVES: This study is aimed at analyzing the impact of the main factors contributing to short and long-term mortality in patients at final stages of heart failure (HF). SETTING: Patients attended at any of the 279 primary health care centers belonging to the Institut Català de la Salut, in Catalonia (Spain). PARTICIPANTS: Patients with Advanced HF. DESIGN: Multicenter cohort study including 1148 HF patients followed for one-year after reaching New York Heart Association (NYHA) IV. MAIN MEASUREMENTS: The primary outcome was all-cause mortality. Multivariate logistic regression models were performed to assess the outcomes at 1, 3, 6, and 12 months. RESULTS: Mean age of patients was 82 (SD 9) years and women represented 61.7%. A total of 135 (11.8%) and 397 (34.6%) patients died three months and one year after inclusion, respectively. Male gender, age, and decreased body mass index were associated with higher mortality at three, six and twelve months. In addition, low systolic blood pressure levels, severe reduction in glomerular filtration, malignancy, and higher doses of loop diuretics were related to higher mortality from 6 to 12 months. The most important risk factor over the whole period was presenting a body mass index lower than 20kg/m2 (three months OR 3.06, 95% CI: 1.58-5.92; six months OR 4.42, 95% CI: 2.08-9.38; and 12 months OR 3.68, 95% CI: 1.76-7.69). CONCLUSIONS: We may conclude that male, age, and decreased body mass index determined higher short-term mortality in NYHA IV. In addition, low systolic blood pressure, reduced glomerular filtration, malignancy, and higher doses of loop diuretics contribute to increasing the risk of mortality at medium and long-term. Such variables are easily measurable and can help to decide the best way to face the most advances stages of the disease.

Enferm Clin ; 2019 Sep 06.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31500959


OBJECTIVE: To assess the level of self-care in the population with diabetes and determine the risk of diabetic foot lesions through the use of 3stratification systems as well as to establish the degree of concordance between these systems. METHOD: Observational, cross-sectional and descriptive study carried out in the Basic Health Area of Santa Brígida (Gran Canaria-Canary Islands-Spain) in people diagnosed with diabetes (DM Type 1/DM Type 2) (n=182). Interview, physical examination, review of clinical history and completion of the Diabetic Foot Self-Care questionnaire of the University of Malaga were carried out. The risk stratification was then calculated using 3systems (System of the National Institute for Health Care Excellence, Classification of the International Working Group on the Diabetic Foot and High-Risk Diabetic Foot-60-Second Tool©-2012). The Kappa index was calculated to study the concordance between systems, the relative risk of negative screening of one method against another was estimated and the exact Fisher test to establish whether there were differences. RESULTS: 30.2% of diabetics had a low level of self-care, 45.1% a medium level and 24.7% a high level. The risk levels calculated were: National Institute for Health Care Excellence Classification (Negative Risk 71.4%-Positive Risk 28.6%), International Working Group on the Diabetic Foot Classification (Negative Risk 67.0%-Positive Risk 33.0%) and High-Risk Diabetic Foot-60-Second Tool© (Negative Risk 62.6%-Positive Risk 37.4%). CONCLUSIONS: All 3systems have good concordance with each other. The High-Risk Diabetic Foot-60-Second Tool© only distinguishes 2levels of risk but detects a higher percentage of people at risk. The Diabetic Foot Self-Care questionnaire of the University of Malaga may be useful in the context of Primary Care to assess the level of self-care of people with diabetes.

Int Wound J ; 16(1): 256-265, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30393963


The aims of the study were to describe and analyse the temporal trend of the prevalence and incidence of venous leg ulcers (VLU) over the years 2010 to 2014, to determine healing times and temporal trends in the study period, and to evaluate related aspects such as the use of the Ankle-Brachial Pressure Index (ABPI) in a primary care health centre. This was a retrospective study based on a time series (years 2010-2014) of the prevalence and incidence of VLUs in people aged over 40 years in a primary care centre in Barcelona City. We reviewed 3920 electronic health records selecting patients, per year (2010-2014), with VLUs based on the ICD-10 diagnoses. For prevalence, we took into account any patient with an active VLU in the year of study. For incidence, we took into account patients with a new VLU in the year of study. A descriptive analysis was carried out based on each of the collected variables. The variables were examined according to the years of study (time series) by one-factor analysis of variance (anova) or Kruskal-Wallis non-parametric test, as appropriate. A survival analysis by Kaplan-Meier curves and log-rank test was also performed. A total of 139 patients met the VLU criteria. Among them, only 79.2% were classified as having a VLU and had a correct ICD diagnosis. The prevalence and incidence increased over the years, doubling in patients aged over 65 years. Incidence increased from 0.5 new cases per 1000 people/year in 2010 to 1 new case for every 1000 people/year in 2014. Moreover, the prevalence ranged between 0.8 and 2.2 patients with VLU for every 1000 people/year. During the study period, a total of 84.2% of the VLUs healed (117/139 VLU). Regarding average annual time to healing, the trend indicates that lesions took less time to heal (Kruskal-Wallis test, P = 0.004), ranging between 453,9 weeks in 2005 to 19 weeks in 2014. The use of ABPI also evolved and was found to be increasingly performed prior to the appearance of the lesion. The epidemiological profile of people affected by VLUs continues to be, mainly, that of women of an advanced age, over 70 years. The frequency of VLU occurrence rose continually over the years, but healing took less time, and use of ABPI improved. Assigning a reference nurse in the wounds unit and the organisational structure around this problem may have an influence on improving care and the approach to these types of lesions.

Úlcera da Perna/epidemiologia , Úlcera da Perna/terapia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Úlcera Varicosa/epidemiologia , Úlcera Varicosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Epidemiológicos , Feminino , Previsões , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia , Estudos de Tempo e Movimento
Rev. Rol enferm ; 41(11/12): 730-737, nov.-dic. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-179764


Dentro de las respuestas que han surgido a la problemática ocasionada por las heridas crónicas, la creación de unidades clínicas especializadas ha sido una de las que mayor interés ha despertado en los últimos años. Estas unidades están conformadas por profesionales de diferentes disciplinas que se organizan de acuerdo con un servicio-departamento unificado. A través de enfoques interdisciplinarios-transdisciplinarios consiguen una atención integral a estos pacientes, identificando todos los factores que pueden afectar a la cicatrización de heridas crónicas y paliando los problemas asociados a la complejidad y heterogeneidad de estas lesiones. La implantación de este modelo todavía no está completamente desarrollada en nuestro país a pesar de su conveniencia y la creación de nuevas unidades de heridas a menudo acarrea dificultades y dudas. Este trabajo aporta algunas claves de las ventajas de la adopción de este modelo organizativo y sugiere algunas ideas para aquellas personas u organizaciones que estén planteándose la instauración de este modelo

Among the responses to the problems caused by chronic wounds, the creation of specialized clinical units has been one of the most interesting in recent years. These units are made up of professionals from different disciplines who are organized on the topic of a unified department-service. Through interdisciplinary-transdisciplinary approaches, they achieve comprehensive care for these patients, identifying all the factors that can affect the healing of chronic wounds and alleviating the problems associated with the complexity and heterogeneity of these lessions. The implementation of this model is not yet fully developed in our country despite its desirability and the creation of new wounds units often carry difficulties and doubts. This work provides some keys to the advantages of adopting this organizational model and suggests some key points for those people or organizations that are considering the establishment of this model

Humanos , Lesão por Pressão/enfermagem , Técnicas de Fechamento de Ferimentos/enfermagem , Infecção dos Ferimentos/enfermagem , Ferimentos e Lesões/enfermagem , Unidades Hospitalares/organização & administração , Doença Crônica/enfermagem , Cuidados de Enfermagem/métodos , Equipe de Assistência ao Paciente/organização & administração
Rev. Rol enferm ; 41(11/12): 768-776, nov.-dic. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-179769


La dermatitis asociada a la incontinencia (DAI) es un tipo de dermatitis de contacto irritante, que se observa frecuentemente en pacientes con incontinencia fecal o urinaria. Se manifiesta como una inflamación de la superficie de la piel caracterizada por eritema, y en ocasiones erosión cutánea. Es una condición prevalente y clínicamente relevante, con serias repercusiones sobre el estado de salud y la calidad de vida del paciente. Su etiología es compleja y multifactorial y sus complicaciones implican la infección cutánea y la aparición de otras lesiones añadidas. Es fundamental la correcta diferenciación entre las DAI y otras lesiones cutáneas similares como paso principal para su prevención y tratamiento, y el uso de instrumentos validados para su valoración, seguimiento y monitorización. La ausencia de estudios bien planteados hace que las recomendaciones para el abordaje de la DAI se apoyen en la opinión de expertos y las mejores prácticas disponibles. Las bases de la prevención y tratamiento de la DAI son el abordaje de la incontinencia y la aplicación de un programa o protocolo estructurado de cuidados de la piel que incluya la limpieza suave, la aplicación de productos barrera y el uso de agentes tópicos hidratantes. El presente artículo intenta recoger el estado actual del conocimiento sobre los aspectos fundamentales de la DAI y su implicación para la práctica enfermera

Incontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis, which is frequently observed in patients with fecal and/or urinary incontinence. It manifests as an inflammation of the surface of the skin characterized by erythema, and occasionally skin erosion. It is a prevalent and clinically relevant condition, with serious repercussions on the patient's state of health and quality of life. Its etiology is complex and multifactorial and its complications involve cutaneous infection and the appearance of other lesions added. The correct differentiation between IAD and other similar skin lesions is fundamental as the main step for their prevention and treatment, and the use of validated instruments for their assessment, follow-up and monitoring. The absence of well-designed studies means that the recommendations for the approach to the IAD are based on expert opinion and best practices available. The bases of the prevention and treatment of the IAD are the approach to incontinence and the application of a structured program or protocol of skin care that includes gentle cleansing, the application of barrier products and the use of topical moisturizing agents. The present article tries to collect the current state of knowledge about the fundamental aspects of the IAD and its implication for nursing practice

Humanos , Dermatite das Fraldas/terapia , Incontinência Urinária/complicações , Incontinência Fecal/complicações , Técnicas de Fechamento de Ferimentos/enfermagem , Tampões Absorventes para a Incontinência Urinária/efeitos adversos , Higiene da Pele/enfermagem , Cuidados de Enfermagem/métodos , Fatores de Risco , Agentes Molhantes/uso terapêutico
Rev. Rol enferm ; 41(11/12): 778-783, nov.-dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-179770


El uso de las tecnologías de la información y comunicación es cada vez más extendido en las prácticas de salud-enfermedad y, por ende, también en el cuidado de las heridas. Son muchas las aplicaciones que se han desarrollado en este sentido pero pocas se han evaluado respecto a su utilidad. En este artículo se presenta, a modo de caso, HELCOS, sistema integrado para el manejo de heridas y los resultados obtenidos hasta ahora

The use of information and communication technologies is increasingly widespread in health-disease practices and, therefore, also in wound care area. There are many applications that have been developed in this regard but few have been evaluated regarding their usefulness. In this article we present, as a case, HELCOS, an integrated system for the management of wounds and the results obtained so far

Humanos , Cicatrização/fisiologia , Técnicas de Fechamento de Ferimentos , Ferimentos e Lesões/terapia , Índice de Gravidade de Doença , Aplicativos Móveis , Consulta Remota/métodos , Ferimentos e Lesões/enfermagem , Assistência Integral à Saúde/métodos
Gerokomos (Madr., Ed. impr.) ; 29(4): 181-191, dic. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182264


Introducción: Las heridas crónicas representan un problema actual que genera un impacto a muchos niveles y cuyo tratamiento se basa en infinidad de productos disponibles actualmente en el mercado. A medida que avanza la tecnología se desarrollan nuevos dispositivos que mejoran el tratamiento y repercuten en beneficios para los pacientes. La terapia de presión negativa, incluida en las técnicas de curación avanzada, es un ejemplo representativo de ello, pero una correcta utilización de esta requiere de un personal entrenado capaz de hacer un uso adecuado a través de sus conocimientos. Objetivo: El objetivo principal es determinar el nivel actual de conocimientos de los profesionales sanitarios sobre generalidades y manejo de la terapia de presión negativa. Material y método: Se realizó un estudio observacional, descriptivo y analítico en el Hospital General Universitario de Alicante. La población a estudio estuvo formada por 65 profesionales del ámbito de la enfermería y la medicina que trabajaban en las unidades donde se encuentran más familiarizados con su uso, y la recogida de datos se realizó mediante un cuestionario tipo ad hoc. Resultados: El 20% de los profesionales muestran un bajo nivel de conocimientos, el 61,5%, un nivel adecuado y el 18,5%, un nivel de conocimientos alto. Por tanto, un 80% de la población estudiada tiene un nivel adecuado o alto de conocimientos. Conclusiones: Una formación específica mediante la asistencia a cursos y jornadas, el tratamiento de un mayor número de heridas con terapia de presión negativa y el hecho de sentirse capacitados se convierten en requisitos indispensables para una correcta utilización del dispositivo. El nivel de conocimientos actual no exime de la necesidad de crear un protocolo que permita la unificación de criterios entre los profesionales y la necesidad de formación para actualizar los conocimientos

Introduction: Chronic wounds represent a current problem that generates an impact on many levels and whose treatment is based on an infinite number of products available on the market nowadays. As technology progresses, new devices are developed improving the treatment and affecting in benefits for patients. Topical Negative Pressure theraphy, included in the advanced healing techniques, is a representative example of this but a correct use of it requires a trained staff able to use it suitably through their knowledge. Aim: The main objective is to determine the current level of health workers' knowledge about generalities and the handling of topical negative pressure therapy. Method: An observational, descriptive and analytical study was conducted at the Hospital General Universitario de Alicante. The study population was made up of 65 professionals in the field of nursing and medicine working in units where they are more familiar with their use, carrying out the collection of data by means of a questionnaire type ad hoc. Results: 20% of professionals show a low level of knowledge, 61.5%, an appropriate level and the 18.5%, a high level of expertise. Therefore, 80% of the studied population has an adequate or high level of expertise. Findings: Specific training through attendance at courses and conferences, the treatment of a greater number of injuries with TNP and the fact of being trained become prerequisites for a correct use of the device. The current level of knowledge does not exempt from the need to create a protocol allowing the unification of criteria between the professionals and the need for training to upgrade the expertise

Humanos , Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Ferimentos e Lesões/terapia , Tratamento de Ferimentos com Pressão Negativa/métodos , Tratamento de Ferimentos com Pressão Negativa/enfermagem , Análise de Dados
Gerokomos (Madr., Ed. impr.) ; 29(4): 197-209, dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-182266


Introducción: Se han publicado diversos sistemas de clasificación para las lesiones de pie diabético, si bien ninguno de los propuestos ha sido asumido por la comunidad científica como el sistema a utilizar por todos, y esto es debido a múltiples razones. Objetivos: Dar visibilidad a los nuevos sistemas de clasificación de pie diabético surgidos en los últimos años, además de poder contrastarlos con los sistemas ya conocidos anteriormente. Material y método: Búsqueda bibliográfica en las bases de datos SCOPUS, PubMed/Medline, WOS, CINHAL, Cochrane y CUIDEN. La ecuación de búsqueda utilizada fue la combinación booleana de los términos MeSH "diabetic foot AND classification". La búsqueda se realizó entre el 1 febrero de 2018 y el 30 marzo de 2018. Resultados: Existen 25 sistemas de clasificación de úlceras de pie diabético, que se pueden dividir en sistemas de clasificación-severidad de la lesión o sistemas de predicción de curación-amputación. Muy pocos sistemas han sido validados adecuadamente. Conclusiones: La elección del sistema de pie diabético a utilizar va a estar condicionada por aspectos como el ámbito asistencial, los recursos disponibles o los objetivos que se persiguen. En los últimos años se prefiere el uso de sistemas con enfoque predictivo frente a los sistemas con enfoque descriptivo

Introduction: Various classification systems have been published for diabetic foot ulcers, although none of the proposed systems has been accepted by the scientific community as the system to be used by all, and this is due to multiple reasons. Objectives: To give visibility to the new systems of diabetic foot classification that have emerged in recent years, as well as to compare them with the systems already known previously. Methods: Bibliographic search in the SCOPUS, Pubmed/Medline, WOS, CINHAL, Cochrane and CUIDEN databases. The search equation used was the boolean combination of the MeSH terms "diabetic foot AND classification". The search was conducted between 1 February 2018 and 30 March 2018. Results: There are 25 classification systems for diabetic foot ulcers, which can be divided into classification-severity systems or healing-amputation prediction systems. Very few systems have been properly validated. Conclusions: The choice of the diabetic foot system to be used will be conditioned by aspects such as the assistencial scene, the available resources or the objectives pursued. In recent years, the use of systems with a predictive approach has been preferred over systems with a descriptive approach

Humanos , Pé Diabético/classificação , Cicatrização , Índice de Gravidade de Doença , Úlcera do Pé/classificação , Úlcera do Pé/terapia , Pé Diabético/fisiopatologia , Pé Diabético/cirurgia
Gerokomos (Madr., Ed. impr.) ; 29(2): 92-99, jun. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-175039


Objetivo: El objetivo que se plantea en este trabajo de revisión es responder a la pregunta: ¿Son los cambios posturales efectivos en la prevención de las úlceras por presión? Metodología: Revisión integrativa de la literatura mediante la identificación de documentos en las principales bases de datos relacionadas con las ciencias de la salud: MEDLINE, CINAHL, sciELO, Cochrane y CUIDEN, y mediante búsqueda inversa en los artículos identificados. Se incluyeron estudios prospectivos, revisiones sistemáticas u otro tipo de estudios, que evaluaran la efectividad de los cambios posturales. No hubo restricciones en fechas de publicación hasta diciembre de 2014, pacientes, contexto, estado de la publicación o idioma. Resultados: De 108 artículos, potencialmente relevantes para la revisión, se incluyeron 13: 6 ensayos clínicos, 1 estudio de cohortes, 4 revisiones sistemáticas y una histórica, además de un estudio cualitativo. No se encuentran evidencias sólidas para recomendar los cambios posturales cada 2 horas, pero si hay evidencia que apoya los cambios posturales cada 4 horas combinados con una superficie de apoyo viscoelástica. Conclusiones: No existen estudios que comparen la efectividad, solamente, de los cambios posturales frente a la no realización de estos cambios. La conjunción de una superficie viscoelástica con cambios posturales cada 3-4 horas dispone de la mejor evidencia. Los pacientes en decúbito lateral de 90 grados tienen una tasa casi 4 veces superior de lesiones que los que están a 30 grados. La investigación cualitativa es casi inapreciable en los estudios sobre cambios posturales

Aim: to answer the question: Are repositioning effective in preventing pressure ulcers? Methods: Integrative review of the literature through identification of papers in the main databases related to health sciences: MEDLINE, CINAHL, sciELO, COCHRANE and CUIDEN, and by reverse search on identified articles. We included prospective studies, systematic reviews or other types of studies that evaluated the effectiveness of repositioning. There were no restrictions on publication dates until December 2014, patients, context, publication status or language. Results: From 108 articles, potentially relevant for the review, 13 were included: 6 clinical trials, 1 cohort study, 4 systematic reviews and one historical review, as well as a qualitative study. There is no solid evidence to recommend postural changes every 2 hours. But there is evidence that supports repositioning every 4 hours combined with a viscoelastic support surface. Conclusions: There are no studies that compare the effectiveness of repositioning versus nonrepositioning. The combination of a viscoelastic surface with repositioning every 3-4 hours has the best evidence. Patients in 90 degrees lateral decubitus have a rate almost 4 times higher than those who are at 30 degrees

Humanos , Animais , Cães , Ratos , Lesão por Pressão/prevenção & controle , Posicionamento do Paciente/métodos , Úlcera Cutânea , Postura/fisiologia
Gerokomos (Madr., Ed. impr.) ; 28(3): 142-150, sept. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-168999


Introducción: A pesar del interés creciente por las unidades de heridas como modelo organizativo para la prestación de servicios a las personas con heridas crónicas, no tenemos información acerca del número, distribución, funcionamiento y características de estas estructuras en España. Objetivos: Identificar las unidades de atención especializada de heridas crónicas en nuestro país y realizar el primer censo de estas. Metodología: Estudio observacional de tipo descriptivo de corte transversal. Se realizó un sistema de muestreo no probabilístico compuesto por tres escalones de muestreo. Se utilizó un cuestionario específicamente diseñado para ello (CVI-Total para Pertinencia = 0,96 y CVI-Total para Relevancia = 0,94) para la obtención de datos, que incluyó la recogida de información sobre: nombre, localización, año de creación, organismo responsable y ámbito de localización de las unidades. Resultados: Un total de 75 posibles unidades candidatas a estudio fueron detectadas en los tres escalones de muestreo realizados. Se reclutaron 44 unidades para el estudio, si bien dos debieron ser retiradas. Finalmente, se incluyó un total de 42 unidades en el primer censo de unidades de heridas en el territorio español. Conclusiones: El número de unidades de heridas en nuestro país es bajo, y existe gran disparidad con respecto a su distribución geográfica por comunidades. Además, estas estructuras están sujetas a muchos cambios. Esto conlleva la desaparición y aparición de unidades de heridas con relativa rapidez, aunque parece que es un sistema organizativo cada vez más aceptado en España, existiendo un número creciente de estas estructuras organizativas en nuestro país

Introduction: Despite the growing interest in wound care units as an organizational model for the provision of services to people with chronic wounds, we do not have information about the number, distribution, functioning and characteristics of these structures in Spain. Objectives: To identify the units of specialized care of chronic wounds in our country and to carry out the first census of these. Methodology: Observational study of a descriptive cross-sectional type. A non - probabilistic sampling system was made up of three sampling steps. A questionnaire specifically designed for this purpose (CVI-Total for Pertinence = 0.96 and CVI-Total for Relevance = 0.94) was used to obtain dates, which included the collection of information on: Name, Location, Year of creation, Agency responsible and Scope of the units. Results: A total of 75 possible candidate units were detected in the three sampling stages. 44 units were recruited for the study, although 2 units had to be retired. Finally, a total of 42 units were included in the first census of wound units in Spain. Conclusions: The number of wound units in Spain is low, with a great disparity with respect to their geographical distribution by regions. In addition, these structures are subject to many changes. This leads to the disappearance and appearance of wounded units relatively quickly, although it seems to be an increasingly accepted organizational system in Spain, with an increasing number of these organizational structures in our country

Humanos , Ferimentos e Lesões/epidemiologia , Censos/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Unidades Hospitalares/estatística & dados numéricos , Estudos Observacionais como Assunto/métodos , Estudos Transversais/métodos , Estudos Transversais/estatística & dados numéricos , Inquéritos e Questionários
Gerokomos (Madr., Ed. impr.) ; 28(3): 151-157, sept. 2017. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-169000


A través de una revisión narrativa, los autores revisan elementos clave relacionados con la historia de las úlceras por presión y su contexto, desde la Edad Antigua, el Renacimiento, el siglo xix hasta la edad moderna

Through a narrative review, the authors review key facts related with the history of pressure ulcers and their framework, from ancient age, Renaissance, xix's century up to the modern age

Humanos , História Antiga , História do Século XVI , História do Século XIX , História do Século XX , Lesão por Pressão/epidemiologia , Lesão por Pressão/história , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/história , Idoso Fragilizado/estatística & dados numéricos
Gerokomos (Madr., Ed. impr.) ; 28(2): 83-87, jun. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-165743


Las lesiones por presión son un importante problema de salud con una gran repercusión epidemiológica y un gran impacto a nivel de salud y calidad de vida que genera importantes costes para las personas, instituciones y sistemas de salud. A pesar de la importancia económica del problema de las lesiones por presión, prácticamente no existe información sistematizada acerca de las diferentes dimensiones de su coste. Para cubrir esta falta de información se planteó la realización de una revisión integrativa acerca de la dimensión económica del problema de las lesiones por presión. Se han identificado y analizado 89 documentos con información económica acerca del problema de las lesiones por presión. La información se ha sistematizado basándose en los siguientes apartados: tiempo necesario para la cicatrización, impacto en las estancias hospitalarias, costes relacionados con la seguridad de los pacientes, impacto en los grupos relacionados de diagnóstico, coste total, coste por episodio, por tipo de tratamiento, de las complicaciones, de las demandas legales, de los años de vida ganados ajustados a calidad de vida, en pacientes lesionados medulares y con otras condiciones, y los costes de medidas preventivas

Pressure Lesions are an important health problem with a great epidemiological impact that affects the health status and quality of life producing important expenses for persons, healthcare institutions and health systems. There is not available systematized information about the different cost components of pressure lesions although the important economic dimension of such problem. In order to cover this lack of systematized information we performed an integrative review about the economic dimension of pressure lesions. We have identified and analyzed 89 documents with economic information about pressure lesions problem. Information has been systematized according with the next categories: time for healing, cost of additional hospital stays, costs related with safety of patients, DRG costs, total cost of treatment, episode’s cost, by type of treatment, related with complications, QALYs, costs in spinal cord patients and in patients with other conditions and global prevention costs

Humanos , Lesão por Pressão/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , Cicatrização , Segurança do Paciente/economia , Anos de Vida Ajustados por Qualidade de Vida , Avaliação em Saúde/métodos
Gerokomos (Madr., Ed. impr.) ; 27(4): 161-167, dic. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-160108


Hoy en día, la seguridad de los pacientes es una prioridad para los sistemas de salud. Las úlceras por presión son un importante problema de salud que produce daño en los pacientes y que son evitables en un alto porcentaje de casos. Se revisan en el presente artículo aspectos conceptuales y metodológicos acerca de las úlceras por presión como problema de seguridad de los pacientes, su impacto entre los diferentes eventos adversos, así como diferentes iniciativas institucionales acerca de estas dentro del contexto de la seguridad de los pacientes y los eventos adversos

Nowadays patient’s safety is a priority for Healthcare Systems. Pressure Ulcers are an important health problem that produce harm in patients and are avoidable in a high percentage of cases. We review in the current paper conceptual and methodological issues related with pressure ulcers as a safety problem in patients, their impact between the different adverse events as well as different institutional approaches about pressure ulcers in the framework of the safety of patients and adverse events

Humanos , Lesão por Pressão/epidemiologia , Efeitos Adversos de Longa Duração/epidemiologia , Segurança do Paciente , Fatores de Risco , Gestão da Segurança/organização & administração , Lesão por Pressão/prevenção & controle
BMC Nurs ; 15: 58, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27752238


BACKGROUND: Chronic venous insufficiency, in its final stage can cause venous ulcers. Venous ulcers have a prevalence of 0.5 % to 0.8 % in the general population, and increases starting at 60 years of age. This condition often causes increased dependency in affected individuals, as well as a perceived reduced quality of life and family overload. Local Treating chronic venous ulcers has 2 components: topically healing the ulcer and controlling the venous insufficiency. There is evidence that compressive therapy favours the healing process of venous ulcers. The studies we have found suggest that the use of multilayer bandage systems is more effective than the use of bandages with a single component, these are mostly using in Spain. Multilayer compression bandages with 2 layers are equally effective in the healing process of chronic venous ulcers as 4-layer bandages and are better tolerated and preferenced by patients. More studies are needed to specifically compare the 2-layer bandages systems in the settings where these patients are usually treated. METHOD/DESIGN: Randomised, controlled, parallel, multicentre clinical trial, with 12 weeks of follow-up and blind evaluation of the response variable. The objective is to assess the efficacy of multilayer compression bandages (2 layers) compared with crepe bandages, based on the incidence of healed venous ulcers in individuals treated in primary care nursing consultations, at 12 weeks of follow-up. The study will include 216 individuals (108 per branch) with venous ulcers treated in primary care nursing consultations. The primary endpoint is complete healing at 12 weeks of follow-up. The secondary endpoints are the degree of healing (Resvech.2), quality of life (CCVUQ-e), adverse reactions related to the healing process. Prognosis and demographic variables are also recorder. Effectiveness analysis using Kaplan-Meier curves, a log-rank test and a Cox regression analysis. The analysis was performed by intention to treat. DISCUSSION: The study results can contribute to improving the care and quality of life of patients with venous ulcers, decreasing healing times and healthcare expenditure and contributing to the consistent treatment of these lesions. TRIAL REGISTRATION: This study has been recorded in the Clinical site with the code NCT02364921. 17 February 2015.

Gerokomos (Madr., Ed. impr.) ; 27(1): 27-32, mar. 2016. graf, tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-154723


Objetivo: evaluar un suplemento nutricional específico, Balnimax(R) (ácido alfa-lipoico, L-arginina, L-metionina, complejo de vitamina B, vitamina E y selenio) junto con la práctica clínica diaria en la cicatrización de las úlceras por presión y úlceras de etiología venosa. Material y método: se llevó a cabo un estudio multicéntrico, prospectivo, de medidas repetidas en un solo grupo y postautorización en pacientes con úlceras por presión y úlceras de etiología venosa sin signos clínicos de infección local, que fueron tratados durante 8 semanas. Las medidas se registraron al inicio y en las semanas 2, 4, 6 y 8. Los pacientes recibieron una cápsula oral dos veces al día, con las comidas. La medida de resultado principal fue el porcentaje de reducción en el tamaño de la herida. Además, se estudió la cicatrización completa. El tamaño de la muestra se determinó para comparar los resultados frente a un valor de referencia. Se requería un total de 127 pacientes para detectar una diferencia igual o superior al 15% en la reducción del área. Se asumió como porcentaje de reducción de referencia un 57%. Además, se estimó un 10% de pérdidas en el seguimiento. Resultados: Se incluyeron y finalizaron el estudio 112 pacientes con 133 heridas (un 16,0% tuvieron dos o más lesiones), con una media de edad de 74,2 ± 12,0 (mediana: 77, extremos: 35-94). Un 69,8% eran mujeres, la mayoría pacientes ambulatorios (98,4%). En un 9% se utilizaron moduladores de las proteasas y solo en un 27,2% se aplicó un vendaje compresivo multicapa. Un total de 58 (43,6%) úlceras cicatrizaron durante el periodo del estudio. La evolución del tamaño de la herida y su porcentaje de reducción fueron estadísticamente significativos (p ≤ 0,001), disminuyendo a lo largo del tiempo. Hubo diferencias estadísticamente significativas entre los resultados del estudio y el valor de referencia (p ≤ 0,001). Conclusiones: a pesar de las posibles limitaciones metodológicas por ser un estudio en un solo grupo, el complemento estudiado parece tener un efecto sobre la cicatrización. Los resultados son mejores que los publicados previamente con otros suplementos nutricionales o frente a la cura en ambiente húmedo por sí sola

Objective: To evaluate a specific oral nutritional supplement, Balnimax(R) (alfa-lipoic acid, L-arginine, L-methionine, vitamin B complex, vitamin E and selenium) along with daily clinical practice on the healing of pressure and venous leg ulcers. Method: a multicentre, prospective, single-group, repeated measures and post-authorization study was carried out with pressure and venous leg ulcers’ patients without signs of local infection, to be treated for up to 8 weeks. Measures were recorded at baseline, 2, 4, 6 and 8 weeks. The patients received a tablet orally twice daily with meals. The primary outcome variable was the percentage of wound size reduction. We also analysed the complete healing. The sample size calculation was determined to compare the results against a reference value. 127 subjects would be required to detect a difference equal to or above 15%. It was assumed that the percentage of wound reduction was 57%. We estimated a loss rate of up to 10%. Results: 112 patients with 133 wounds were included and finished the study (16.0% had 2 or more wounds), with a mean age of 74.2±12.0 (median: 77, extremes: 35-94). 69.8% were women, most of them ambulatory patients (98.4%). In 9% proteases modulators were used and in only 27.2% was applied a multilayer compression therapy. 58 (43.6%) ulcers healed during the study period. The evolution of wound size and percentage reduction was, statistically significant (p ≤ 0.001), decreasing over time period. It was a statistical significant difference (p ≤ 0.001) between the results and the reference value. Conclusions: Despite the possible methodological flaws due to a single-group study, the supplement studied seems to be an effect over healing. The results are better than previous published with other nutritional supplements or with moist wound healing only

Humanos , Suplementos Nutricionais , Cicatrização/fisiologia , Lesão por Pressão/dietoterapia , Úlcera da Perna/dietoterapia , Úlcera Varicosa/dietoterapia , Resultado do Tratamento , Inibidores de Proteases/uso terapêutico
Gerokomos (Madr., Ed. impr.) ; 26(3): 104-108, sept. 2015. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-150467


Objetivo: Analizar la bibliografía publicada en relación con los factores que influyen en la adherencia al tratamiento de la terapia compresiva en las personas con úlceras venosas. Método: Se ha realizado una revisión bibliográfica, consultando PubMed, BioMed Central, Library Cochrane Plus, CUIDEN, LILACS, IBECS, IME, SciELO, CINAHL, desde enero del 2003 a mayo de 2013. Resultados: Se han encontrado dieciséis documentos que cumplen los criterios de inclusión. Existen factores que influyen en la adherencia al tratamiento relacionados con los pacientes, profesionales e instituciones. Conclusiones: Se debe considerar el carácter crónico de las úlceras venosas y realizar las intervenciones, teniendo en cuenta las preferencias, conocimientos y habilidades tanto propias como de los pacientes

Objective: To analyze the literature published in relation to the factors that influence adherence to compression therapy in people with venous ulcers. Method: We carried out a literature review, PubMed, BioMed Central, Cochrane Library Plus, CUIDEN, LILACS, IBECS, IME, SciELO, CINAHL, from January 2003 to May 2013. Results: There were sixteen documents that meet the inclusion criteria. It was found factors that influence adherence to treatment due to patients, professionals and institutions. Conclusions: Health professionals should consider the chronicity of venous ulcers and make interventions, taking into account the preferences, knowledge and skills both belonging to patients

Humanos , Úlcera Varicosa/terapia , Bandagens Compressivas , Cooperação do Paciente , Fatores de Risco , Motivação
Gerokomos (Madr., Ed. impr.) ; 25(4): 162-170, dic. 2014. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-134305


Objetivos: 1) establecer la prevalencia de úlceras por presión (UPP) en hospitales, centros sociosanitarios (CSS) y atención primaria en España; 2) determinar la frecuencia de UPP nosocomiales (generadas durante la estancia en hospitales o CSS), y 3) describir las características de los pacientes y de las lesiones identificadas. Métodos: encuesta epidemiológica, transversal, mediante cuestionario dirigido a profesionales que trabajen en centro sanitarios y sociosanitarios, públicos o privados, en España. Realizada entre el 1 de marzo y el 31 de mayo de 2013. Variables: descripción de los centros, población ingresada o atendida y pacientes con UPP, características demográficas y clínicas de los pacientes. Se calcula prevalencia bruta y prevalencia media para cada uno de los tres niveles asistenciales. Resultados: se obtuvieron 509 cuestionarios válidos, un 66,7% son de hospitales, un 21,6% de atención primaria y un 16,7% de CSS. Las cifras de prevalencia obtenidas son: en hospitales, en adultos 7,87% (IC 95%: 7,31-8,47%); en unidades pediátricas de hospitales, 3,36% (IC 95%: 1,44-7,61%); en CSS, 13,41% (IC 95%: 12,6-14,2%), y en atención primaria, 0,44% (IC 95%: 0,41-0,47%) entre mayores de 65 años y 8,51% (IC 95%: 7,96-9,1%) entre pacientes en programas de atención domiciliaria. La prevalencia es más alta en unidad de cuidados intensivos (UCI), llegando al 18%. Son UPP nosocomiales un 65,6% del total y solo un 29,4% se han producido en los domicilios. El mayor porcentaje de las lesiones es de categoría 2, con un tiempo de evolución de 30 días (mediana) y un área de 6 cm2 (mediana). Conclusiones: la prevalencia de UPP en España no ha disminuido en 2013 respecto a años anteriores, e incluso se ha duplicado en los CSS. En hospitales, las UCI son las unidades con mayor prevalencia. En los CSS, hay una prevalencia más alta en los privados frente a los públicos. Casi dos tercios de todas las UPP son de origen nosocomial (hospitales o CSS), lo que indica un fallo en la prevención de estas lesiones

Aim: 1) To determine the prevalence of pressure ulcers (PU) at hospitals, nursing homes (NH) and the community in Spain; 2) To determine the frequency of nosocomial PU (those acquired during patients’ stay at hospital or NH), y 3) To describe the characteristics of the patients and ulcers. Methods: Cross-sectional survey with a questionnaire aimed to nurses working at hospitals, nursing homes and primary care, both publics and privates, in Spain. Date: from 1st March to 31th May in 2013. Variables: Description of the centres, number of in-patients or residents at NH and number of patients with PU, demographic and clinical characteristics of the patients. For each one of the 3 settings, crude prevalence and average prevalence was calculated. Results: 509 valid questionnaires were obtained; 66.7% from hospitals; 21.6% from community care and 16.7% from nursing homes. Prevalence percentages: at hospitals, adults: 7,87% (CI95%: 7,31-8,47%); paediatric units, 3,36% (CI95%: 1,44-7,61%); nursing homes 13,41% (CI95%: 12,6-14,2%); and community care, 0,44% (CI 95%: 0,41-0,47%) among older than 65 years and 8,51% (CI95%: 7,96-9,1%) among people in home care programs. The Intensive Care Units (ICU) have the highest prevalence, reaching the 18%. On the whole, 65.5% of the PU are nosocomials and only the 29.4% were developed at homes. The majority of the lesions are classified in category 2. The duration of 30 days (as median) and the area was of 6 cm2 (median). Conclusions: In Spain, the prevalence of PU is not decreasing, from previous studies; and even it has doubled in nursing homes. At hospitals, the ICU are the places with highest prevalence. When considering the nursing homes, the private ones have higher prevalence than the public ones. Two-thirds of the PU has a nosocomial origin (hospitals or nursing homes), what could mean a failure in prevention

Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Lesão por Pressão/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Espanha/epidemiologia , Estudos Epidemiológicos , Atenção Primária à Saúde/estatística & dados numéricos , Pacientes Domiciliares/estatística & dados numéricos