The effect of oral hydrotherapy on risk reduction of diabetic feet ulcer among people with type-2 diabetes mellitus

Diabetic feet ulcer is four times more likely to be found in patients who suffer from diabetes mellitus than in those who don't. Diabetic feet ulcer is one of chronic complications of diabetes mellitus which causes defects even deaths. Diabetes mellitus in one of the ten most frequent diseases in Indonesia. According to Riskesdas (Riset Kesehatan Dasar - Basic Health Research), the increment number of patients with diabetes mellitus from 2007 up to 2013 is 330,512.1 The research is aimed to find out the effect of oral hydrotherapy on risk reduction of diabetic feet ulcer in patients with type-2 diabetes mellitus. The research was done by applying quasi-experimental design (pre-test and post-test design with control group). By total population sampling, there were 68 respondents who participated. About 34 of the respondents were in experimental group at Dr. Soediran Mangun Sumarso of Wonogiri, and 34 respondents were patients who had check-ups at RS PKU Muhammadiyah of Surakarta. The research result shows that oral hydrotherapy can minimize risk reduction of diabetic feet ulcer in patients with type-2 diabetes mellitus significantly with p-value of 000.0 (α=0.005)

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ADIE - Nursing Interventions of Diabetic Foot Ulcer: An Integrative Review of the Literature.

BACKGROUND AND AIMS: Diabetic foot ulcer is recognized as a consequence of peripheral neuropathy and peripheral arterial disease amid individuals with diabetes. As is well known, this situation still remains a crucial problem in nursing practice. Available studies describing an algorithm of inter- related nursing interventions concerned with diabetic foot ulcers are limited. Therefore, this integrative review was aimed to present evidence-based practice for overcoming the complications of diabetic foot ulcer as well as preventing lower extremity amputation. METHODS: This integrative review retrieved scientific literature from PubMed, CINAHL, ProQuest, SAGE Publishing and ScienceDirect databases as published from 2008 to 2017. Thirty-seven studies that met the inclusion criteria were included in this study. RESULTS: Our findings present that neurologic and circulatory assessments were considered as primary steps prior to conducting interventions. Formulating a diagnosis based upon the assessment results is a principal part to determine appropriate interventions. Multiple experimental studies displayed the effectiveness of certain interventions consist of applying wound cleansing, advanced modern wound dressing, topical therapy, offloading, intensive diabetes education and advanced treatment modalities. Hemoglobin A1c, high-density lipoprotein, procalcitonin, the potential of hydrogen of wound fluid, wound size, neurological and circulatory status were determined as the outcomes measurement which must be correctly evaluated. CONCLUSION: This review contributes an algorithm for intervening diabetic foot ulcer thereby generating the given name: ADIE (Assessment, Diagnosis, Interventions, and Evaluation). A collaborative care amid multidisciplinary diabetes team is needed for implementing along with evaluating the feasibility of the study findings. Moreover, active family participation also plays a crucial role to achieve successful management of diabetic foot ulcer at home.

Conocimiento enfermero sobre prevención, diagnóstico y cuidados de las úlceras de extremidad inferior en un área sanitaria / Nursing knowledge about prevention, diagnosis and care of lower extremity ulcers in a Health Area

Objetivo: Determinar el grado de conocimiento de recomendaciones basadas en la evidencia sobre cuidados de úlceras de extremidad inferior (UEI) que tratan las enfermeras que trabajan en el Área Sanitaria de Ferrol. Analizar su relación con la formación continuada. Metodología: Estudio descriptivo, transversal y observacional mediante cuestionario diseñado ad hoc entre mayo y junio de 2015. La población de estudio la constituyeron enfermeras que trabajaban en hospital, atención primaria o centro sociosanitario que posea concierto en suministro de productos de cura en ambiente húmedo. Se obtiene autorización del CEIC de Galicia. Resultados: Participaron 205 enfermeras (66% de la población a estudio). Un 62% ha realizado algún curso de formación sobre UEI en los últimos 5 años. Todas manifiestan que se debe tener en cuenta la calidad de vida de estos pacientes; un 5,9% utiliza la herramienta validada para su valoración. El 94,1% considera útil una "app" sobre UEI en algún dispositivo electrónico. Las variables con capacidad independiente para predecir el conocimiento sobre UEI son conocer las guías de práctica clínica, saber calcular el índice tobillo-brazo y los valores para detectar claudicación intermitente; esta última es la más decisiva. Conclusiones: A pesar de la formación recibida, existen áreas en las que es necesario incidir. Mejorar su capacitación es imprescindible para asegurar la calidad en la atención de las personas que las padecen. Se objetiva la necesidad sentida de los profesionales respecto a la creación de una aplicación como herramienta de ayuda en la toma de decisiones

Aim: Determine the degree of knowledge about recommendations based on care evidence, of lower-extremity ulcers by nurses working in the Health Area of Ferrol. Analyze the relationship with continuous training. Methods: Descriptive, cross-sectional and observational study through a questionnaire designed ad hoc between May and June 2015. The study population were nurses that worked in the Hospital, Primary Care and Socio-Health Center that had a concert in products supply of wound healing in humid environment. The study has been approved by the Clinical Research Ethics Committee of Galicia. Results: 205 nurses have participated (66% of the population to study). 62% have done a training course of leg ulcers for the last 5 years. All of them shows that the quality of life of these patients must be considered; 5.9% use the validated tool for their assessment. 94.1% consider useful an app of leg ulcer in some electronic device. The variables with independent ability to predict the knowledge about LowerExtremity Ulcers are know the clinical practice guidelines, know how to calculate the Arm-Ankle Index and the values to detect intermittent claudication, being the last one the most decisive. Conclusions: Despite the training received there are areas in which it is necessary to influence. Improving their training is essential to ensure the quality of care for people who suffer from them. The felt need of the professionals regarding the creation of an application as a help tool in making decisions is objectified

Implementation of the Champions for Skin Integrity model to improve leg and foot ulcer care in the primary healthcare setting.

AIMS: To facilitate evidence-based leg and foot ulcer management through implementation of the Champions for Skin Integrity model to education in primary health care in Australia. BACKGROUND: Leg and foot ulcers are frequently seen wounds in general practice and wound care the most frequently performed activity by practice nurses. The literature reports the lack of evidence-based leg and foot ulcer assessment, management and prevention strategies in this setting, and previous research in regard to confidence and knowledge has indicated that general practice health professionals have the greatest need for education in wound care. DESIGN: Pre-post, nonequivalent group research design. METHODS: The Champions for Skin Integrity model of evidence-based wound management utilised strategies including workshops, development of Champions and use of resources. Pre- and post-implementation health professional surveys and patient clinical audits were completed. Descriptive statistics were calculated for all variables. Paired t tests identified statistically significant differences between the pre/post staff survey data. STROBE guidelines for reporting were followed (See Appendix S1). RESULTS: One hundred nine general practice healthcare professional staff attended the workshops. Significant outcomes were noted in increased levels of confidence in ability to assess, manage and prevent all types of leg and foot ulcers, as well as to apply evidence-based practice and change management following workshops. Pre- and post-skin audits also indicated an increase in evidence-based practices. CONCLUSION: Implementation of Champions for Skin Integrity strategies in this sample of primary healthcare professionals in general practice fostered a positive change in evidence-based wound management, assessment and prevention. RELEVANCE TO CLINICAL PRACTICE: The Champions for Skin Integrity model has supported increases in evidence-based practices in treatment and management of wounds in primary healthcare professionals, similar to the positive outcomes gained in the aged care setting. This is likely to lead to positive outcomes for those with wounds in this setting.

Caso clínico: pie diabético complicado / Clinical case: complicated diabetic foot ulcer

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Técnica de momificación con clorhexidina en pie con gangrena húmeda / Mummification technique with chlorhexidine in a foot with humid gangrene

La necrosis, muerte celular de un tejido vivo, se produce por falta de aporte sanguíneo. En las extremidades inferiores esta falta de aporte sanguíneo puede dar lugar a una isquemia gangrenosa. En los casos de necrosis irreversibles puede usarse como técnica terapéutica la momificación, también llamada autoamputación. Se trata de una técnica sencilla y económica, pero que requiere de unos conocimientos previos. El objetivo es evitar la infección, evitar la humedad y limitar la lesión de la úlcera con curas con clorhexidina al 2%

Necrosis, the cellular death of a live tissue, occurs by lack of blood supply. In lower limbs, this lack of blood supply can lead to gangrenous ischemia. Mummification, also called self-amputation, can be used as therapeutic technique in cases of irreversible necrosis. This is a simple and economical technique, but it requires some previous training. The objective is to prevent infection, avoid humidity, and limit the ulcer lesion by using treatment with chlorhexidine 2%

Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial.

OBJECTIVE: Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU). METHOD: A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients' stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial. RESULTS: Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152; p<0.001) who developed a total of 19 heel PUs. CONCLUSION: We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU.

Tratamiento de úlceras infectadas de pie diabético. Efectividad clínica de un apósito de fibra de alginato e hidrocoloide, con plata. Análisis de resultados de una serie de casos / Treatment of infected diabetic foot ulcers clinical effectiveness of a dressing of alginate and hydrocolloid, with silver fiber. Analysis of results of a series of cases

Introducción. Niveles altos de carga bacteriana han demostrado una influencia negativa en la cicatrización de las úlceras. El uso de apósitos antimicrobianos con plata puede controlar el nivel de carga bacteriana de las heridas. El objetivo de este estudio fue evaluar la respuesta terapéutica de un apósito de fibra de alginato e hidrocoloide, con plata, en úlceras infectadas de pie diabético. Material y métodos. Se analizó una serie de casos de 6 pacientes con úlceras de pie diabético, sin enfermedad vascular periférica y diagnosticadas de colonización crítica y/o infección local mediante la recogida de signos clínicos inflamatorios. Los pacientes fueron tratados durante un período mínimo de 2 semanas. Se analizó el porcentaje de reducción del área de la úlcera desde el día de la inclusión hasta la retirada del apósito antimicrobiano. Resultados. El tratamiento tuvo una mediana de 5 semanas con una duración mínima de 2 y máxima de 6. La mediana del porcentaje de reducción de la superficie de las heridas fue de 47,7% (rango: 0,5%-90%). La media del porcentaje de reducción de la lesión a las 2 semanas fue del 58% y a la tercera semana del 67,14%. Todos los pacientes habían disminuido sus dimensiones a las 3 semanas de tratamiento de forma significativa (p<0,05). Conclusión. El uso de un apósito de fibra de alginato e hidrocoloide, con plata, favorece la cicatrización de las úlceras de pie diabético con infección local, reduciendo los signos clínicos inflamatorios de forma significativa en un período de 3 semanas (AU)

Introduction: High levels of bacterial load have shown a deleterious influence on wound healing. Using antimicrobial dressings can control ulcers’ bioburden. The aim of our study was to evaluate the improving of infected diabetic foot ulcers due an alginate’s fiber and hydrocolloid silver dressing. Material and Methods: We analysed a case series of 6 patients with diabetic foot ulcers without peripheral vascular disease and diagnosed from critical colonization and / or local infection according the presence of inflammation clinical signs. Patients were treated for a minimum period of two weeks. We analysed the percentage reduction in ulcer area from the day of enrolment to antimicrobial dressing removal. Results: The duration of treatment had a median of 5 weeks with a minimum of 2 weeks and up to 6. The median percentage of area reduction of the wounds was 47.7% (range: 0.5%-90%). The mean percentage reduction on the lesion was 58% from 2 weeks and 67.14% at 3 weeks. All patients had reduced significantly their size at 3 weeks from beginning of treatment (p<0.05). Conclusion: The use of an alginate’s fiber and hydrocolloid silver dressing promotes healing on diabetic foot ulcers with local infection, reducing the inflammatory clinical signs significantly over a period of three weeks (AU)

Preventing and managing heel pressure ulceration: an overview.

Heel pressure ulcers are the second most common site for pressure ulceration; although their assessment and treatment can be complex, and they often require additional consideration over and above core principles of pressure ulcer prevention and management. Recent international pressure ulcer prevention and treatment guidelines developed jointly in Europe and the USA have provided greater clarity by achieving international consensus on how to care for patients at risk of heel pressure ulceration, and also on the management of such patients if a pressure ulcer develops. Health professionals should embrace these guidelines and embed them in their everyday clinical practice and within local guidance and protocols to ensure that patients are provided with evidence-based care supported by international collaboration and agreement.

Cuidado del pie diabético. Importancia de la educación / Diabetic foot care. Importance of education

La diabetes es la enfermedad crónica más prevalente en el momento actual. Se estima que, aproximadamente, 250 millones de personas en todo el mundo la padecen, lo que representa el 5,9% de la población adulta. Según un estudio publicado recientemente en España, la prevalencia de la diabetes tipo 2 es del 12% [1]. Las complicaciones cardiovasculares asociadas producen un elevado coste social y sanitario [2] reduciendo de forma significativa la calidad de vida de los pacientes y de sus familias, y constituyen la primera causa de mortalidad en los países desarrollados. Las relacionadas con el pie diabético tienen un coste económico más elevado, ya que consumen aproximadamente un 20% de los recursos destinados a la atención de estos pacientes [3]. Cada año más de un millón de personas en todo el mundo sufre una amputación de la pierna debido a esta condición. Entre el 50 y el 70% de las no traumáticas corresponde a pacientes con diabetes [3]. La mayoría va precedida de una úlcera. Los factores más importantes relacionados con el desarrollo de estas úlceras son la pérdida de la sensibilidad por neuropatía, pequeños traumatismos, deformidades en los pies y enfermedad vascular periférica. Según datos de la Federación Internacional de la Diabetes, un 15% de las personas con diabetes, desarrollará úlceras en los pies a lo largo de su vida. Intervenciones dirigidas hacia su prevención como el control exhaustivo, la educación de las personas con diabetes y sus familiares, así como de los profesionales de la salud, han demostrado reducir las amputaciones de extremidades inferiores entre un 50 y un 85% [4, 5](AU)

Diabetes is the most prevalent chronic disease at present. It is estimated that approximately 250 million people worldwide have diabetes, representing 5.9% of the adult population. According to a study published recently in Spain, the prevalence of type 2 diabetes varies between 10 and 15%. Cardiovascular complications associated with the disease produce a high social and health costs significantly reducing the quality of life of patients and their families and are the leading cause of death in developed countries. Compli-cations of diabetes with higher economic costs are the «diabetic foot», which consume about 20% of resources devoted to the care of these patients. Each year more than 1 million people worldwide suffer from a leg amputation due to this condition. Between 50% and 70% of non-traumatic amputations occur in patients with diabetes. Most of these amputations are preceded by a foot ulcer. The most important factors related to the development of these ulcers are loss of sensation due to neuropathy, minor trauma, foot deformity and peripheral vascular disease. According to the International Diabetes Federation, 15% of people with diabetes will develop foot ulcers during their lifetime. Interventions aimed at preventing foot ulcers in patients such as the comprehensive control, education of people with diabetes and their families as well as health professionals, have been shown to reduce lower extremity amputations by 50% and 85%(AU)

Reducir la maceración de úlceras exudativas del pie diabético. Utilidad de una película barrera no irritante (Cavilon®) / Reducing skin maceration in exudative diabetic foot ulcers

Introducción: el exceso de exudado y su consecuente maceración constituye una de las causas de retraso en la cicatrización en las úlceras de pie diabético. El objetivo de nuestro estudio es demostrar la efectividad en la reducción de la maceración de la piel perilesional en úlceras exudativas de pie diabético aplicando una película barrera no irritante Cavilon® 3M® (PBNI). Material y métodos: estudio observacional que incluye 40 pacientes (29; 72,5% varones) diabéticos con úlceras exudativas de pie diabético y maceración perilesional, en los que se evalúa durante 30 días la efectividad de la aplicación de una PBNI para el control de la maceración y la evolución clínica de las lesiones. Resultados: a los 30 días de tratamiento el 70% de las lesiones presentó unos bordes sanos o con exudado bajo, con una mejoría significativa con respecto a las condiciones iniciales (día 0 n=8 vs día 30 n=28 p<0,05). La evolución de las variables clínicas relacionadas con la úlcera también fue favorable a lo largo del estudio. La presencia de tejido esfacelado mayor al 60% de la superficie de la úlcera en el día cero aparecía en 17 casos frente a dos en el día 30 (p<0,001). La aparición de tejido granulación pasó de 13 casos que presentaban más del 50% de fondo granulado de la úlcera el día de inclusión a 25 el día 30 (p<0,001). Discusión: la aplicación de un PBNI en el tratamiento de la maceración de úlceras exudativas de pie diabético demostró ser efectiva(AU)

Introduction: highly exudate and maceration is one of the causes of delay in diabetic foot ulcers healing. The purpose of our study was to demonstrate the effectiveness in the periwound skin maceration reduction with the use of no-sting barrier film (NSBF) (3M'99 Cavilon'99). Material and Methods: observational study, which includes 40 patients with diabetes (29, 72,5% males) who suffer diabetic foot ulcers with maceration and exudate. It was evaluated the application of NSBF during 30 days and its correlation with maceration control and clinical wounds progress. Results:70% of the ulcers were showed healthy edge or lower exudates after 30 days of treatment (Day 0 n=8 vs Day 30 n=28 p<0,05). Good evolutions of clinical variables were recorded through the study. Fibrin tissues upper 60% of the ulcer area were recorded in 17 cases at day 0 versus 2 cases in day 30 (p<0,001). Granulation tissue presence turned of 13 cases with upper 50% in wound bed at day 0 versus 25 cases at the end of the study (p<0,001). Discussion: the use of NSBF for the maceration management of highly exudates diabetic foot ulcers was demonstrated effective(AU)

Reducir la presión en las zonas de antepié y talón mediante los apósitos Allevyn Gentle, Gentle Border y Gentle Border Heel / Reducing the pressure on heel and foot sole areas by means of allevyn gentle, gentle border and gentrle border heel dressing

Introducción: El estudio de la distribución plantar de presiones permite detectar posibles sobrepresiones en zonas de la planta del pie que podrían ocasionar disconfort o incluso lesiones. La utilización de apósitos constituye una medida para el manejo adecuado de aquellas en la prevención y tratamiento de las úlceras por presión. Material y métodos: Se diseñó un estudio experimental para calcular el nivel de presión con y sin los apósitos Allevyn Gentle y Allevyn Gentle Border en el antepié y Allevyn Gentle Border Heel en el talón de cinco personas sanas. Las mediciones se realizaron con el pie descalzo y con los diferentes apósitos controlando la velocidad de marcha para conseguir cadencias de marcha homogénea. Para determinar las presiones en el antepié y el talón se utilizó un sistema de plantillas instrumentadas, Biofoot/IBV V6.0. Resultados: La presencia del Allevyn Gentle Border Heel en el talón produjo una reducción de las presiones del orden del 45% para las medias y del 42% para las máximas (p <0.05). Allevyn Gentle Border y Allevyn Gentle en el antepié consiguieron una reducción de la presión media de un 27% y del 23-25% para la presión máxima (p<0.05). Discusión: Aunque nuestro estudio tiene algunas limitaciones, como la valoración basada en voluntarios sanos y marcha con pie descalzo, podemos establecer que los apósitos estudiados presentaron un efecto reductor local de la presión en el pie (talón o antepié) durante el ciclo de la marcha(AU)

The study of plantar pressure distribution allows detecting possible overpressure in areas of the foot that could cause discomfort or even injury. The use of dressings is a possible measure for for proper management of pressure to prevent and treat pressure sores. Materials and methods: An experimental study was designed to calculate the pressure level with and without the use of Allevyn dressing: Allevyn Gentle and Gentle Border in the forefoot, and Allevyn Gentle Border Heel in the Heel of five healthy people. The measurements were performed with bare feet and with different dressings controlling gait speed to achieve uniform cadences. Biofoot/IBV V6.0., a system of instrumented insoles, was used to determine pressure in the forefoot and the heel. Results: Allevyn Gentle Border Heel reduced 45% the average pressure and 42% the maximum pressure (p <0.05). Allevyn Gentle and Allevyn Gentle Border reduced 27% the average pressure and 23%-25% maximum pressures (p <0.05) Discussion: Although our study has some limitations, such as the valuation based on healthy volunteers and walking with bare feet, we can establish that dressings studied, had a local lowering effect of pressure on the foot (heel and forefoot) during the gait cycle(AU)

Abordaje de una úlcera por presión con tendón expuesto / How to treat a bed sore with a tendon exposed

Las úlceras por presión (UPP) suponen un serio problema social, de salud y legal ya que implican serias consecuencias en la calidad de vida de la persona afectada y sus cuidadores, además de un enorme gasto sanitario, tanto a nivel de recursos materiales como humanos. Se expone el caso de una mujer de 84 años de edad, con una UPP estadio IV con tendón expuesto, cuyo abordaje interdisciplinar e integral desde Atención Primaria de Salud consiguió la resolución de la herida en 59 días(AU)

Bed sores are a serious social, health and legal problem since they imply serious consequences for the quality of life of the person affected and his/her caretakers; besides they create an enormous sanitary cost, both at the level of material as well as human resources. The author describes the case of an 84 year-old woman who has a stage IV bed sore with a tendon exposed; the interdisciplinary and integral treatment of her case by the Primary Health Care Center succeeded in curing her wound in 59 days(AU)