Escala de conocimientos sobre úlceras de pie diabético CUPD-35: elaboración y propiedades psicométricas en enfermeras de Colombia / Diabetic Foot Ulcer Knowledge Scale CUPD-35: development and psychometric properties on Colombian nurses

Introducción: Las enfermeras tienen un papel esencial en la prevención y en el manejo de las úlceras de pie diabético, por lo que es importante su formación para que tengan conocimientos actualizados. Disponer de escalas para medir de forma fiable estos conocimientos es de utilidad para los programas formativos. Objetivo: Elaborar y obtener propiedades psicométricas de una escala para medir los conocimientos de enfermeras sobre prevención y tratamiento de úlceras de pie diabético. Metodología: Primera fase de elaboración de los ítems de la escala y validación de contenido por panel de expertos. Segunda fase de prueba de campo mediante encuesta a una muestra de 500 enfermeras de hospital y clínicas de heridas en Colombia. Se realizó un análisis mediante modelos de Rasch y validación de constructo mediante test en grupos conocidos. Resultados: La versión inicial de la escala con 48 ítems tuvo adecuada validez de contenido. Tras la prueba de campo y el análisis Rasch se obtuvo la versión final con 35 ítems (CUPD-35) con buenos índices de ajuste y alta fiabilidad (0,97). La puntuación media de conocimientos en esta muestra de enfermeras fue de 28,2 (un 80,2% de la máxima puntuación), lo que indica un buen nivel de conocimientos. Conclusiones: La escala CUPD-35 es un instrumento fiable y válido para medir conocimientos sobre úlceras de pie diabético en enfermerashispanohablantes.(AU)

Introduction: Nurses play an essential role in the prevention and treatment of diabetic foot ulcers, so it is important that they are trained to achieve up-to-date knowledge. Appropriate and reliable tools to measure knowledge are useful for planning training programmes. Objective: To develop and obtain the psychometric properties of a new scale to measure nurses’ knowledge of diabetic foot ulcers prevention and treatment. Methodology: A first phase of item development and content validation by an expert panel. A second phase with a survey of a sample of 500 nurses in Colombia working in hospitals or wound clinics. Analysis using Rasch models and assessment of construct validity by a test of known groups. Results: The initial 48-item version of the scale showed adequate content validity. The survey and Rasch analysis resulted in the final version with 35 items (CUPD-35) with good fit indices and high reliability (0.97). The mean knowledge score of this sample of nurses was 28.2 (80.2% of the maximum score), which means a good level of knowledge. Conclusions: The CUPD-35 scale is a reliable and valid tool for measuring knowledge of diabetic foot ulcers in Spanish-speaking nurses.(AU)

Relação interpessoal no cuidado de enfermagem a pessoas com diabetes tipo 2 / Interpersonal relationships in the nursing care of people with type 2 diabetes / Relación interpersonal en el cuidado de enfermería a personas con diabetes tipo 2

Objetivo: analisar a efetividade da relação interpessoal no cuidado de enfermagem e sua relação com as práticas de autocuidado geral e com os pés em pessoas com diabetes tipo 2. Método: estudo transversal, analítico, realizado em um Hospital Universitário, com 150 pessoas com diabetes tipo 2 que responderam ao Questionário relação interpessoal no cuidado de enfermagem, questionário de atividades de autocuidado com diabetes e questionário da avaliação da adesão ao autocuidado com os pés. Resultados: os resultados mostraram que a efetividade da relação interpessoal no cuidado variou de moderada a alta. Os escores do questionário mostraram significância comorbidades nefropatia, acidente vascular encefálico, aderir à dieta e receber orientações sobre cuidados som os pés. Conclusão: a relação interpessoal no cuidado efetiva pode fortalecer a criação de vínculos, a confiança e verbalização de sentimentos, contribuindo para melhoria na educação em diabetes e para adesão de comportamentos de autocuidado.

Objectives: to analyze the effectiveness of the interpersonal relationship in nursing care and its relationship with general self- care and foot care in people with type 2 diabetes. Method: this cross-sectional, analytical study was conducted at a University Hospital with 150 people with type 2 diabetes who answered the Interpersonal Relationship in Nursing Care Questionnaire, a questionnaire on self-care activities with diabetes, and a questionnaire to assess adherence to feet self-care. Results: the results showed that the effectiveness of the interpersonal relationship in care ranged from moderate to high. The questionnaire scores were significant with nephropathy comorbidities, cerebrovascular accident, diet adherence, and receiving foot care guidance. Conclusion: interpersonal relationships in effective care can strengthen bonding, trust, and verbalization of feelings, improving diabetes education and adherence to self-care behaviors.

Objetivos:analizar la efectividad de la relación interpersonal en el cuidado de enfermería y su relación con las prácticas generales de autocuidado y con los pies en personas con diabetes tipo 2. Método: estudio transversal, analítico, realizado en un Hospital Universitario, con 150 personas con diabetes tipo 2 que respondieron el Cuestionario de Relación Interpersonal en el Cuidado de Enfermería, cuestionario sobre actividades de autocuidado con diabetes y cuestionario para la evaluación de adherencia al autocuidado con los pies. Resultados:los resultados mostraron que la efectividad de la relación interpersonal en el cuidado varió de moderada a alta. Los puntajes del cuestionario mostraron significación con las comorbilidades de la nefropatía, el accidente cerebrovascular, la adherencia a la dieta y recibir orientación sobre el cuidado de los pies. Conclusión:la relación interpersonal en el cuidado efectivo puede fortalecer la creación del vínculo, la confianza y la verbalización de los sentimientos, contribuyendo para una mejoría en la educación en diabetes y la adherencia a las conductas de autocuidado.

Intervenciones para la exploración del pie en pacientes diabéticos, en Atención Primaria: Una revisión sistemática de Guías de Práctica Clínica / Interventions for foot examination in diabetic patients in primary care: a review of clinical practice guidelines

Objetivo principal: Identificar la mejor evidencia disponible sobre inter venciones efectivas para la exploración y estratificación del PD. Metodología: Revisión de Guías de Práctica Clínica con recomendacio nes acerca de la exploración y estratifi cación del PD. Resultados principales: Recopi lamos las intervenciones que son más efectivas para diagnosticar precozmente el PD en A.P recogidas de 10 GPC. In cluyen la evaluación visual de los pies, la valoración de la neuropatía diabética pe riférica mediante monofilamento de Semmes-Weinstein de 10 g, diapasón de 128 Hz y exploración del reflejo aquíleo, y la valoración de la enfermedad arterial periférica mediante la palpación de pul sos periféricos y determinación del índice tobillo brazo. Posteriormente estratifica ción del riesgo de desarrollar un PD. Conclusión principal: La monitori zación de las extremidades inferiores debe formar parte de los planes de cui dados de los pacientes diabéticos. Se deberían establecer unidades especiali zadas en atención al PD y poder derivar desde AP a estos pacientes (AU)

Interventions for foot examination in diabetic patients in Primary Care: A review of Clinical Practice Guidelines Main objective: To identify the best available evidence on effective in terventions in the exploration and diag nosis of DF. Methodology: Review of the Clini cal Practice Guidelines with recommen dations on the exploration and stratifica tion of DF. Main results: We compiled the interventions that are most effective for early diagnosis of DF in P.C collected in 10 CPG. They include visual assessment of their feet, assessment of diabetic pe ripheral neuropathy using a 10-g Sem mes-Weinstein monofilament, 128-Hz tuning fork, and Achilles reflex testing, assessment of peripheral arterial disease by palpation of peripheral pulses, and determination of the ankle arm index Subsequently, risk stratification of deve loping DF. Main conclusion: Monitoring of the lower extremities should be part of the care plans for diabetic patients. Spe cialized units should be established for DF care and these patients should be able to be referred from PC (AU)

Osteomyelitis, diabetic foot ulcers and the role of the community nurse.

Community nurses face numerous challenges in both diagnosing and effectively treating their patients. The diabetic patient has complex needs requiring a holistic approach. With a reported increase in diabetic patients, and a possible decline in some routine screening following Covid-19 pandemic, complications in diabetic patients are likely to rise. It is estimated that 25% of diabetic patients will develop a diabetic foot ulcer (DFU), with a reported 43% of DFU already infected at first presentation to a health professional. NICE categorise the level of infection in DFU based on standardised assessments such as SINBAD. A high categorised DFU has the possibility of osteomyelitis. It is imperative that osteomyelitis is treated immediately to achieve positive outcomes, benefitting the patients' health and wellbeing in addition to reducing the financial implications to the NHS.

Conocimiento, actitud y práctica sobre pie diabético en pacientes o sus cuidadores en cirugía vascular / Knowledge, attitude and practice about diabetic foot in patients or their caregivers in Vascular Surgery

OBJETIVOS: Identificar el nivel de conocimiento, actitud y práctica orientada a la prevención del pie diabético en personas ingresadas o sus cuidadores principales en la Unidad de Cirugía Vascular. METODOLOGÍA: Se realizó un análisis estadístico descriptivo transversal. Las variables analizadas fueron: conocimiento, actitud y comportamientos relacionados con el cuidado del pie diabético. Desde diciembre de 2016 a diciembre de 2017, un equipo de enfermeras facilitó un cuestionario durante el ingreso de los pacientes en la Unidad de Cirugía Vascular, el cual no se había utilizado anteriormente con población española. RESULTADOS: El tamaño de la muestra se calculó con el objetivo de conseguir 189 personas. Un total de 172 respondió el cuestionario. En la dimensión de conocimiento, la media fue de 6,56 sobre 10 (DE = 2,05). El nivel de conocimiento de un 58,2% fue medio. En la dimensión de actitud, la media fue de 4,42 sobre 5 (DE = 0,95). Un 93% declaró tener actitud favorable hacia el autocuidado de sus pies. En la dimensión de práctica orientada a la prevención, la media fue de 5,45 (DE = 2,55). El 51,5% realizó una práctica media de autocuidado del pie diabético. CONCLUSIONES: Las personas poseían conocimientos medios de los cuidados del pie diabético. Al preguntarles por su actitud, esta fue favorable. Contrasta con el nivel de comportamiento en la práctica de autocuidado, que en la mitad de la muestra fue de carácter medio, repartiendo en partes iguales la buena práctica con la escasa práctica de autocuidado

BACKGROUND: To identify the level of knowledge, attitude and practice oriented to the prevention of diabetic foot in hospitalized persons or their main caregivers in the Vascular Surgery Unit. METHODS: A transversal descriptive statistical analysis was carried out. The variables analyzed were: knowledge, attitude and behavior related to the care of the diabetic foot. A team of six nurses, provided a questionnaire during the period of admission of patients from December 2016 to December 2017, which had not previously been used with Spanish population. RESULTS: The sample size was calculated in order to get 189 people. A total of 172 people answered the questionnaire. In the Knowledge Dimension, the mean was (6.56) out of 10 (SD = 2.05). The level of knowledge of 58.2% was medium. In Attitude, the average was 4.42 out of 5 (SD = 0.95). 93% say they are favorable towards self-care of their feet. In Practice oriented to prevention, the average was 5.45 (SD = 2.55). 51.5% perform an average self-care practice of diabetic foot. CONCLUSIONS: The people in the study had average knowledge of diabetic foot care. When asked about their attitude, this was favorable. It contrasts with the level of behavior in the practice of self-care, which in the middle of the sample was of average character, distributing in equal parts the good practice with the scarce practice of self-care

Radiofrecuencia en la cicatrización de heridas crónicas. Una revisión en hospital de media estancia / Radiofrequency in the healing process in chronic wounds. A review in a half-stay hospital

Las heridas crónicas son un problema de salud significativo. Parece que la estimulación eléctrica produce una reducción significativamente mayor en el área de superficie y cicatrización más completa de las úlceras de difícil cicatrización y de evolución tórpida en comparación con la terapia habitual, sin vendaje compresivo. OBJETIVOS: Evaluar el efecto que la radiofrecuencia a baja intensidad y con efectos no térmicos tiene sobre los diferentes componentes del mecanismo del proceso de cicatrización. METODOLOGÍA: Para el tratamiento, se utilizó un dispositivo de tecarterapia (CAPENERGY C200). Se aplicaron un total de 10 sesiones de radiofrecuencia con una periodicidad de 1 vez a la semana con una potencia del 60% y una frecuencia de 1,2 MHz durante 30 minutos. RESULTADOS: La presencia de edema, observada en todos los pacientes en la región de la extremidad inferior, desapareció en 30 de los 36 pacientes (Wilcoxon p = 0,004). Este resultado fue confirmado por ultrasonido. El edema celular subcutáneo medio disminuyó en 1,73 cm (Friedman p = 0,000). La temperatura del área tomada antes y después del tratamiento se incrementó en un promedio de 1,4 °C. Estas diferencias son estadísticamente significativas (Wilcoxon p = 0,000). CONCLUSIONES: La radiofrecuencia parece que puede reducir el largo proceso de cicatrización de las lesiones de evolución tórpida, y nos encontramos con unas diferencias significativas a lo largo del tratamiento y con una reducción progresiva en las mediciones de las lesiones y mayor rapidez en la cicatrización de las heridas complejas

Chronic wounds are a significant health problem. Electrical stimulation seems to produce a significantly greater reduction in surface area and more complete healing of difficult-to-heal and poorly healing ulcers compared to standard therapy without compressive bandaging. OBJECTIVES: To evaluate the effect that radiofrequency at low intensity and with non-thermal effects has on the different components of the mechanism of the healing process. METHODOLOGY: A tecartherapy device (CAPENERGY C200) was used for the treatment. A total of 10 radiofrequency sessions were applied once a week with a power of 60% and a frequency of 1.2 MHz for 30 minutes. RESULTS: The presence of oedema, observed in all patients in the lower extremity region, disappeared in 30 of the 36 patients (Wilcoxon p = 0.004). This result was confirmed by ultrasound. The mean subcutaneous cellular oedema decreased by 1.73 cm (Friedman p = 0.000). The temperature of the area taken before and after treatment increased by an average of °C. These differences are statistically significant (Wilcoxon p = 0.000). CONCLUSIONS: Radiofrequency appears to be able to reduce the long healing process of torpidly evolving lesions, and we found significant differences throughout the treatment and a progressive reduction in lesion measurements and faster healing of complex wounds

Validação de instrumento para investigação do conhecimento de enfermeiros sobre pé diabético / Validación del instrumento para la investigación del conocimiento de enfermeros sobre pie diabético / Validation of an instrument to investigate nurses' knowledge on diabetic foot

RESUMO Objetivo: construir e validar um instrumento para investigação do conhecimento de enfermeiros da Atenção Primária à Saúde sobre pé diabético. Método: estudo metodológico realizado de janeiro a junho de 2017, que seguiu o Modelo de Elaboração de Escalas Psicométricas de Pasquali, em três etapas: teórica, empírica e analítica. Para validação de conteúdo, adotou-sea técnica de Delphi em dois momentos, com a participação de 10 juízes. A validade de construto foi realizada por 73 enfermeiros que atuavam nos serviços de APS do município de Campina Grande-PB. Aos dados, aplicou-se o Índice de Validação de Conteúdo (IVC). Resultados: construiu-se o "Questionário de Investigação do Conhecimento do Enfermeiro sobre Pé Diabético (QICEPeD)" com 47 itens organizados em 12 domínios de conhecimentos sobre a temática. Após a segunda rodada de avaliação dos juízes, todos os itens atingiram escores máximos de concordância (IVC = 1,00). A análise da confiabilidade e da consistência interna total do instrumento foi considerada elevada (α=0,860). Conclusão: o instrumento QICEPeD foi considerado válido, quanto ao conteúdo e construto, podendo ser utilizado para avaliar o conhecimento de enfermeiros da Atenção Primária sobre pé diabético.

RESUMEN Objetivo: construir y validar un instrumento para la investigación del conocimiento de enfermeros de la Atención Primaria de la Salud (APS) sobre pie diabético. Método: estudio metodológico realizado de enero a junio de 2017, que siguió el Modelo de Elaboración de Propiedades Psicométricas de Pasquali, en tres etapas: teórica, empírica y analítica. Para la validación de contenido, se adoptó el método de Delphi en dos momentos, con la participación de 10 jueces. La validez del constructo fue realizada por 73 enfermeros que actuaban en los servicios de APS del municipio de Campina Grande-PB-Brasil. Para los datos, se aplicó el Índice de Validez de Contenido (IVC). Resultados: se construyó el "Cuestionario de Investigación del Conocimiento del Enfermero sobre Pie Diabético (CICEPeD)" con 47 ítems organizados en 12 dominios de conocimientos sobre la temática. Después de la segunda ronda de evaluación de los jueces, todos los elementos alcanzaron puntajes máximos de concordancia (IVC=1,00). El análisis de la confiabilidad y de la consistencia interna total del instrumento fue considerado alto (α=0,860). Conclusión: el instrumento CICEPeD fue considerado válido, en cuanto al contenido y constructo, pudiendo ser utilizado para evaluar el conocimiento de enfermeros de la Atención Primaria sobre pie diabético

ABSTRACT Objective: to construct and validate an instrument to investigate the knowledge of Primary Health Care nurseson diabetic foot. Method: methodological study carried out from January to June 2017, followed the Development Model for Psychometric Scales by Pasquali, in three stages: theoretical, empirical and analytical. In order to validate the content, the Delphi technique was adopted in two moments, with the participation of 10 judges. Construct validity was performed by 73 nurses who worked in PHC services in the municipality of Campina Grande-PB. The Content Validation Index (CVI) was applied to the data. Results: the "Questionnaire for Investigating Nurses' Knowledge on Diabetic Foot (QICEPeD, as per its Portuguese acronym)" was constructed with 47 elements organized into 12 domains of knowledge on the topic. After the second round of judges' assessment, all elements reached maximum agreement scores (CVI = 1.00). The analysis of the instrument's reliability and total internal consistency was considered high (α=0.860). Conclusion: the QICEPeD instrument was considered valid, in terms of content and construct, and can be used to assess the level of knowledge of Primary Care nurses on diabetic foot.

Quality of life assessment in chronic wound patients using the Wound-QoL and FLQA-Wk instruments.

OBJECTIVES: To evaluate changes in the quality of life of patients with chronic wounds. METHODS: Quantitative research with a cross-sectional design performed with 100 patients with chronic wounds from a university hospital and a Basic Health Unit in southern Brazil. The mean values of the domains of the instruments Wound Quality of Life (Wound-QoL) and Freiburg Life Quality Assessment Wound were compared with sociodemographic variables of age, sex and education. RESULTS: The average age of the participants was 60.98 years old; 41% (n = 41) had diabetic ulcers and 83% (n = 83) treated the wounds for more than 24 months. The total quality of life value was below the mean with 37.50/100 with (Wound-QoL) and 44.20/100 with (FLQA-Wk). The variables of gender, and educational level were not correlated with either of the two instruments used to assess the quality of life. The age variable was significantly correlated with the satisfaction item of the FLQA-Wk. CONCLUSIONS: The quality of life of patients with chronic wounds was considered poor. The age variable was correlated with the satisfaction domain, showing that the older the age, the lower the satisfaction. The use of instruments to evaluate the quality of life of patients with chronic wounds may help an effective treatment plan.

I Cannot Afford Off-loading Boots: Perceptions of Socioeconomic Factors Influencing Engagement in Self-management of Diabetic Foot Ulcer.

This study aimed at uncovering the factors influencing individuals' ability to engage in self-management of diabetic foot ulcer (DFU) and presenting a theoretical model depicting these factors and the outcomes. We used constructivist grounded theory methodology to guide this study and recruited 30 participants with an active DFU attending a wound care clinic in Ontario, Canada. The study's findings indicate that participants' engagement in self-management of DFU was influenced by internal and external factors. While some factors contributed to enhance participants' engagement in everyday self-management, others seemed to have prevented them from achieving engagement and hence the desired DFU outcomes.

Honey dressings for diabetic foot ulcers: overview of evidence-based practice for novice researchers.

This article explores how nurses can use evidence-based practice to appraise the rationale and evidence for specific nursing procedures or practices. A literature review of published evidence on honey dressings for diabetic foot ulcers was conducted by a novice researcher (lead author) under the supervision of a lecturer (second author). A methodology was followed to construct an answerable research question and to guide the search and retrieval of evidence. The strengths and limitations of a selected study were appraised, and its implications for practice considered. This article highlights an area of practice that warrants further attention and demonstrates the use of evidence-based practice to consider the quality and utility of clinical research.

Preliminary Experience with Conservative Sharp Wound Debridement by Nurses in the Outpatient Management of Diabetic Foot Ulcers: Safety, Efficacy, and Economic Analysis.

Background: Treatment of diabetes costs the United States an estimated $245 billion annually; one-third of which is related to the treatment of diabetic foot ulcers (DFUs). We present a safe, efficacious, and economically prudent model for the outpatient treatment of uncomplicated DFUs. Methods: 77 patients (mean age = 54 years, range 31 to 83) with uncomplicated DFUs prospectively enrolled from September 2008 through February 2012. All patients received an initial sharp debridement by one of two orthopaedic foot and ankle fellowship trained surgeons. Ulcer dressings, offloading devices, and debridement procedures were standardized. Patients were evaluated every two weeks by research nurses who utilized a clinical management algorithm and performed conservative sharp wound debridement (CSWD). Results: Average time to clinical healing was 6.0 weeks. There were no complications of CSWD performed by nurses. The sensitivity for the timely identification of wound deterioration was 100%, specificity = 86.49%, PPV = 68.75% and NPV = 100% with an overall accuracy of 89.58%. The estimated cost savings in this model by having nurses perform CSWD was $223.26 per encounter, which, when extrapolated to national estimates, amounts to $1.56 billion to $2.49 billion in potential annual savings across six to ten-week treatment periods, respectively. Conclusion: CSWD of DFUs by nurses in a vertically integrated multidisciplinary team is a safe, effective, and fiscally responsible clinical practice. This clinical model on a national scale could result in significant healthcare savings. Surgeons and other licensed independent practitioners would have more time for evaluating and treating more complex and operative patients; nurses would be practicing closer to the full extent of their education and training as allowed in most states.Level of Evidence: III.

Knowledge and attitude of nurses towards diabetic foot care in a secondary health care centre in Malaysia.

INTRODUCTION: Nurses play a vital role in the care and prevention of ulcers in patients with diabetic foot. Patient education, prevention of ulcers and rehabilitation are some of the vital aspects that nurses provide on a daily basis. Thus, good knowledge and attitude of nurses towards diabetic foot ulcers and its care will ensure better patient care. OBJECTIVES: The aim is to study the level of knowledge and attitude of nurses towards diabetic foot ulcers and its care in Hospital Segamat, Malaysia. METHODS: A validated questionnaire was used between February 2019 to May 2019 covering area such as demography, predisposing factors of ulcer formation, characteristics of ulcers, complications of ulcers, and attitude towards diabetic foot care. RESULTS: A total of 101 nurses took part and 57% of the participants scored poorly in the knowledge section of the questionnaire. In all 72% had scored poorly when asked regarding complications of diabetic foot ulcers; 49.5% of the nurses had positive attitude towards diabetic foot care; and 79.3% thought that care for diabetic foot ulcer is timeconsuming. Majority of them think that their colleagues are the main source of information. All demographic variables were deemed to be confounders with the knowledge and attitude of nurses towards diabetic foot ulcers and its care. CONCLUSIONS: Nurses in this centre had poor knowledge towards diabetic foot ulcers and its care. None of the variable studied were correlated with the level know knowledge. Good or poor knowledge of nurses does not correspond equally to good or poor attitude towards diabetic foot ulcers care. More frequent formal training of diabetic foot care would be needed to ensure better knowledge.

Módulo educativo en ambiente virtual de aprendizaje en Diabetes Mellitus / Educational module in a virtual learning environment on Diabetes Mellitus / Módulo educativo em ambiente virtual de aprendizagem em Diabetes Mellitus

INTRODUCCIÓN: Los profesionales de enfermería necesitan ser capacitados y cualificados para atender a las personas con diabetes y uno de los aspectos considerado como fundamental para esa capacitación es el conocimiento de los recursos tecnológicos indicados para el desarrollo del proceso de enseñanza-aprendizaje, como informática, internet, hipermedia, multimedia, y las diversas herramientas de interacción y comunicación. OBJETIVOS: Los objetivos de este estudio fueron desarrollar un módulo educativo sobre pie diabético en Ambiente Virtual de Aprendizaje - AVA en la plataforma Moodle para estudiantes de enfermería y someter el programa a la evaluación de los alumnos. MÉTODO: Se trata de un estudio descriptivo transversal, realizado con 31 estudiantes. El módulo educativo fue desarrollado como curso distribuido en cuatro capítulos versando sobre pie diabético. Después del curso los alumnos evaluaron el módulo utilizando instrumento validado conteniendo aspectos pedagógicos (contenido, interacción y actividades) y aspecto técnico (calidad de la interfaz) del AVA. RESULTADOS: Las características obtenidas consideradas como favorables al aprendizaje fueron "contenido" (91,6%), "actividades" (85,8%) y "calidad de la interfaz" (89,7%). La característica "interacción" fue la que obtuvo menor índice (52,7%). CONCLUSIÓN: Considerando la mayoría de las características evaluadas, concluimos que Moodle se mostró una herramienta eficaz de enseñanza. En cuanto a la característica "interacción", es necesario perfeccionar las cuestiones que afectan a las actividades programadas, estas son el foro y chat para propiciar una mayor relación entre los participantes

INTRODUCTION: Nursing professionals need to be trained and qualified to care for people with diabetes, where one of the aspects considered as fundamental for this training is the knowledge of the technological resources indicated for the development of the teaching-learning process, such as computer science, internet, hypermedia, multimedia, besides the various tools of interaction and communication. OBJECTIVE: The objectives of this study were to develop an educational module about diabetic foot in a Virtual Learning Environment - VLE in the Moodle platform for nursing students and to submit the program to the evaluation of the students. METHOD: It is a cross-sectional descriptive study, carried out with 31 students. The educational module was developed as a course distributed in four chapters dealing with diabetic foot. After the course, the students evaluated the module using a validated instrument containing pedagogical aspects (content, interaction and activities) and technical aspect (interface quality) of VLE. RESULTS: The characteristics that were considered favorable to learning were "content" (91.6%), "activities" (85.8%) and "interface quality" (89.7%). The "interaction" characteristic was the one that obtained the lowest rate (52.7%). CONCLUSION: By considering most of the evaluated characteristics, we conclude that Moodle has proved to be an effective teaching tool. Regarding the "interaction" characteristic, it is necessary to improve the questions that involve the scheduled activities, such as forum and chat, in order to provide a greater relationship among the participants

INTRODUÇÃO: Os profissionais de enfermagem necessitam ser capacitados e qualificados para o atendimento às pessoas com diabetes e um dos aspectos considerado como fundamental para essa capacitação é o conhecimento dos recursos tecnológicos indicados para o desenvolvimento do processo de ensino-aprendizagem, como informática, internet, hipermídia, multimídia, e as diversas ferramentas de interação e comunicação. OBJETIVOS: Os objetivos deste estudo foram desenvolver um módulo educativo sobre pé diabético em Ambiente Virtual de Aprendizagem - AVA na plataforma Moodle para estudantes de enfermagem e submeter o programa à avaliação dos alunos. MÉTODO: Trata-se de um estudo descritivo transversal, realizado com 31 estudantes. O módulo educativo foi desenvolvido como curso distribuído em quatro capítulos versando sobre pé diabético. Após o curso os alunos avaliaram o módulo utilizando-se instrumento validado contendo aspectos pedagógicos (conteúdo, interação e atividades) e aspecto técnico (qualidade da interface) do AVA. RESULTADOS: As características obtidas consideradas como favoráveis à aprendizagem foram "conteúdo" (91,6%), "atividades" (85,8%) e "qualidade da interface" (89,7%). A característica "interação" foi a que obteve menor índice (52,7%). CONCLUSÃO: Considerando-se a maioria das características avaliadas, concluímos que o Moodle se mostrou uma ferramenta eficaz de ensino. Já em relação à característica "interação", torna-se necessário aprimorar as questões que envolvam as atividades programadas, tais como fórum e chat para propiciar uma maior relação entre os participantes

Polimorfismos asociados con la susceptibilidad para pie diabético: una revisión integrafiva / Polymorphism associated with diabetic foot susceptibility: a integrative review

INTRODUCCIÓN: La presencia del pie diabético es una complicación frecuente en la persona que vive con diabetes. En su etiopatogenia confluyen factores conductuales, ambientales y el control de la enfermedad; no obstante, se reconoce la influencia de factores genéticos en su desarrollo y evolución. OBJETIVO: Sistematizar la asociación de los polimorfismos genéticos como riesgo para el desarrollo de pie diabético a través de la producción científica indexada. METODOLOGÍA: Revisión bibliográfica de los años 2010 a 2018; se realizó mediante la búsqueda sistemática en las bases de datos PubMed, Scopus, CONRICYT y WOS. Los descriptores fueron tres: "polymorphism" AND "diabetic foot" OR "foot ulcer diabetic". Se incluyeron artículos a texto completo en inglés con metodología de casos y controles, y que midieran estadísticamente factores de riesgo mediante la odds ratio y los riesgos relativos. Se utilizó la plataforma FLC 2.0 para evaluar la calidad del estudio. RESULTADOS: 13 artículos cumplieron con los criterios de inclusión; se identificaron 9 polimorfismos como factores para la aparición de pie diabético: HIF-1α, MCP-1-2518A/G, TLR9-1237 T/C, MAPK14 rs80028505, LOX G473A, gen FokI del receptor VDR, MMPs-1562C>T, TCF7L2, HIF-1α p582s y 4 como factores protectores: VEGF rs699947, VEGF-634G/C, eNOS Glu298Asp y VEGF 2578 C/A. CONCLUSIÓN: La susceptibilidad, gravedad y aparición del pie diabético está asociado con factores genéticos implicados en distintos mecanismos fisiopatológicos

INTRODUCTION: Diabetic foot is a frequent complication in patients with diabetes. The risk factors associated with its development and evolution are related to the behavioral, environmental and disease control characteristics, however, the influence of genetic factors in the development of this complication has been recognized. OBJECTIVE: To analyze the available evidence on the association of genetic polymorphisms in the risk of presenting diabetic foot. METHODOLOGY: Articles were reviewed in English, not older than 10 years, with a methodology of cases and controls that statistically measure risk factors through odds ratio and relative risk. Therefore the search was performed in databases such as PubMed, Scopus, CONRICYT and WOS with maximum date until January 31, 2018. Controlled descriptors "polymorphism" AND "diabetic foot" OR "foot ulcer diabetic" were applied. The FLC 2.0 platform was used to evaluate the quality of the study. RESULTS: Thirteen articles were selected, there being 9 polymorphisms with risk factors such as HIF-1α, MCP-1-2518A/G, TLR9-1237 T/C, MAPK14 rs80028505, LOX G473A, FokI gene of the VDR receptor, MMPs-1562C>T, TCF7L2, HIF-1α p582s and 4 protective factors such as VEGF rs699947, VEGF-634G/C, eNOS Glu298Asp and VEGF 2578 C/A. CONCLUSION: The susceptibility, severity and appearance of diabetic foot they are associated with genetic factors that are involved in different physiopathological mechanisms

Abordaje multiprofesional del paciente con úlcera de pie diabético y presencia de osteomielitis. Casos clínicos / Multidisciplinary approach of the patient with diabetic foot ulcer and presence of osteomyelitis. Clinical cases

La osteomielitis del pie diabético puede presentar al clínico grandes desafíos diagnósticos y terapéuticos. La infección en pacientes con úlceras de pie diabético ocasiona una gran morbimortalidad. Las tasas de mortalidad, sobre todo cardiovascular, tras una úlcera y la amputación son muy elevadas, casi un 60% de las personas fallecen en el transcurso de 5 años tras una amputación y casi un 40% en el caso de las úlceras. El objetivo del artículo es describir el procedimiento con el que se aborda la osteomielitis en pacientes con úlceras de pie diabético a través de un equipo multiprofesional. METODOLOGÍA: A través de dos casos clínicos, se expone el planteamiento quirúrgico y médico para el abordaje de la osteomielitis. RESULTADOS: La resolución tanto de la osteomielitis como de la cicatrización de la úlcera se apoya tanto en la especialización de los profesionales a nivel clínico como en garantizar la continuidad asistencial en los niveles de atención existentes, evitando la variabilidad y garantizando la prestación de los recursos necesarios de manera eficiente. CONCLUSIONES: El abordaje quirúrgico o médico de la osteomielitis precisa de un equipo cualificado que pueda plantear ambas estrategias de atención, consiguiendo la resolución del caso

Osteomyelitis of the diabetic foot can present the clinician with great diagnostic and therapeutic challenges. Infection in patients with diabetic foot ulcers causes great morbidity and mortality. Mortality rates, especially cardiovascular, after an ulcer and amputation are very high, almost 60% of people die within 5 years after amputation and almost 40% in the case of ulcers. The objective of the article is to describe the procedure with which osteomyelitis is approached in patients with diabetic foot ulcers through a multiprofessional team. METHODOLOGY: Through two clinical cases, the surgical and medical approach for the osteomyelitis approach is exposed. RESULTS: The resolution of both osteomyelitis and ulcer healing relies both on the specialization of professionals at a clinical level, and on ensuring continuity of care at existing levels of care, avoiding variability and guaranteeing the provision of Necessary resources efficiently. CONCLUSIONS: The surgical or medical approach of osteomyelitis requires a qualified team that can propose both strategies of care, obtaining the resolution of the case

The characteristics and impact of hard-to-heal wounds: results of a standardised survey.

The effective management of hard-to-heal wounds has increasingly important implications for those who provide wound care services within healthcare systems. The burden of wounds in the population continues to grow, as does the demand for wound care, against a backdrop of cost constraints and increasing expectations. The need to improve both outcomes and efficiency in wound care is therefore paramount and the time taken to heal wounds is an important factor in determining both. Survey methodology was used to collect data across 10 community wound care providers in the UK, Ireland, Finland, Norway and Denmark between February and August 2017. This allowed for analysis of wounds and their characteristics, dressing selection and nursing practice across a typical wound caseload. Data from 1057 wounds demonstrates that the characteristics and consequences of hard-to-heal wounds are different from improving wounds. However, wounds are, in general, treated in the same way, irrespective of whether they are hard-to-heal or improving, suggesting that the healing status of a wound is not a major factor in treatment selection. Early intervention to return hard-to-heal wounds to a healing trajectory may be a useful approach to improving efficiency in wound care.

Foot Self-Care Experiences Among Patients With Diabetes: A Systematic Review of Qualitative Studies.

Research that explores foot self-care practices and clinical foot care recommendations for persons with diabetes mellitus is limited. PURPOSE: The aim of this systematic review was to understand the gaps between the American Diabetes Association clinical recommendations on preventive foot self-care and perceptions of and actions taken by patients with diabetes and diabetic foot ulcers (DFUs). METHODS: PubMed, the Cumulative Index of Nursing and Allied Health Literature, Cochrane Online Library, Psychological Information Database, and Google Scholar were systematically searched for qualitative research literature published in English from January 1, 2001, to October 21, 2016, using the MeSH terms diabetes mellitus, diabetic foot ulcers, foot care, experiences, and perception to examine the experiences of patients with diabetes regarding foot self-care practices. Publications were screened for inclusion according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and The Standard for Reporting Qualitative Research was used to appraise trustworthiness and publication bias. Publication details (author, year, title, country in which the study was conducted, and the type of publication), study aims, design (study methodology, method of sampling, and analysis method), and participant details were abstracted to Excel sheets for analysis of foot self-care experiences and to determine common themes (foot self-care issues) among patients with diabetes. RESULTS: Of the 14 publications identified, 9 (that included 113 patients with diabetes [95 with or history of DFUs and 18 with no DFUs] and 28 health care professionals [14 podiatrists, 8 physicians, and 6 registered nurses]) met the inclusion criteria for analysis. Research included 4 qualitative descriptive design studies, 2 descriptive phenomenology studies, 1 grounded theory study, 1 interpretive phenomenology study, and 1 exploratory qualitative design study. Four (4) studies were found to lack transparency, and 7 studies did not address trustworthiness. The common themes identified were the high clinical and lifestyle burden of DFUs, poor foot self-care knowledge, perception barriers and resistance, adoption of self-management practices, and discordance between patient and provider impressions and expectations. CONCLUSION: Several barriers to optimal foot care in persons with diabetes with and without foot ulcers were identified and may be explained and addressed by considering the Health Belief Model. Clinical interventions should be individualized to identify and address patient-specific barriers to optimal foot self-care. Future clinical studies are needed to examine the outcomes of individualized interventions.

Nurses' Perspective of Treating Patients With an Amputation Due to Diabetic Foot Syndrome.

BACKGROUND: Expert nurses must provide both physical and emotional care to patients with diabetic foot syndrome (DFS) who require an amputation. This includes helping patients and families to cope with this situation, while ensuring the maximum level of comfort. PURPOSE: The aim of this study was to explore the perspective of expert nurses on the needs and hospital care of people requiring an amputation due to DFS. METHOD: This was a qualitative multicenter study involving 8 hospitals in Spain and Portugal. In-depth interviews with expert nurses were transcribed verbatim to enable content analysis. RESULTS: Twenty-four expert nurses were interviewed about their knowledge and experience of treating patients with diabetic foot disease. Two themes emerged from the qualitative analysis: (1) poor self-care and the disease trajectory, and (2) effective hospital care. CONCLUSIONS: The results of this study highlight the key role that expert nurses play in the care of patients with DFS. Expert nurses considered that amputation leaves the individual physically and psychologically vulnerable, especially upon discharge from hospital. It is therefore essential to provide these patients with comprehensive and multidisciplinary care that includes emotional support.

Wound Nursing Now: liderando la prevención, cuidados e investigación del pie diabético / Wound Nursing Now: leading the prevention, care and research on diabetic foot

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