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1.
J Diabetes Complications ; 34(11): 107691, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32883566

RESUMO

AIMS: Patients with diabetes, including those with foot complications, are at highest risk for severe outcomes during the COVID-19 pandemic. Diabetic foot ulcers (DFU) present additional challenges given their superimposed risk for severe infections and amputations. The main objectives were to develop a triage algorithm to effectively risk-stratify all DFUs for potential complications, complying with social distancing regulations, preserving personal protective equipment, and to assess feasibility of virtual care for DFU. METHODS: Longitudinal study during the COVID-19 pandemic performed at a large tertiary institution evaluating the effectiveness of a targeted triage protocol developed using a combined approach of virtual care, electronic medical record data mining, and tracing for rapid risk stratification to derive optimal care delivery methods. 2868 patients with diabetes at risk for foot complications within last 12 months were included and rates of encounters, hospitalizations, and minor amputations were compared to one year prior. RESULTS: The STRIDE protocol was implemented in 1-week and eventually included 2600 patients (90.7%) demonstrating effective triage. During normal operations, 40% (938 of 2345) of all visits were due to DFUs and none were performed virtually. After implementation, 98% face-to-face visits were due to DFU, and virtual visits increased by 21,900%. This risk stratified approach led to similar low rates of DFU-related-hospitalization and minor amputation rates 20% versus 24% (p > 0.05) during and prior the pandemic, respectively. CONCLUSIONS: Implementation of STRIDE protocol was effective to risk-stratify and triage all patients with diabetic foot complications preventing increase in hospitalization and amputations while promoting both social and physical distancing.


Assuntos
Algoritmos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pé Diabético/prevenção & controle , Controle de Infecções/organização & administração , Pneumonia Viral/epidemiologia , Podiatria , Protocolos Clínicos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Estudos Longitudinais , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Triagem
4.
Enferm. clín. (Ed. impr.) ; 30(2): 72-81, mar.-abr. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193274

RESUMO

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


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Conhecimentos, Atitudes e Prática em Saúde , Autocuidado/estatística & dados numéricos , Pé Diabético/prevenção & controle , Medição de Risco/métodos , Inquéritos e Questionários , Entrevistas como Assunto , Estudos Transversais
5.
PLoS One ; 15(4): e0224010, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32324739

RESUMO

AIMS: To assess the effect of data-driven custom-made footwear concepts on plantar pressure relief to prevent diabetic foot ulceration. METHODS: Twenty-four neuropathic diabetic patients at high risk of foot ulceration were measured for in-shoe plantar pressures during walking in four data-driven custom-made footwear conditions, an athletic shoe and an off-the-shelf non-therapeutic shoe. Two evidence-based footwear conditions (Shoe-A; Insole-A) follow a scientific-based design protocol, are handmade, and use in-shoe plantar pressure guided optimization. One evidence-based insole condition (Insole-B) uses a barefoot plantar pressure and 3D foot shape-based computer-assisted design and manufacturing (CADCAM) routine. And one insole condition (Insole-C) uses a barefoot and in-shoe plantar pressure and 3D foot shape-based CADCAM design and optimization routine. Patient satisfaction was scored on walking comfort, shoe fit, weight and appearance. RESULTS: All data-driven footwear conditions significantly reduced metatarsal head peak pressure compared with the non-therapeutic shoe (17-53% relief). Shoe-A and Insole-A showed the lowest metatarsal head peak pressures (mean 112-155 kPa, 90-98% of cases <200 kPa), significantly lower than for Insole-B and Insole-C (mean 119-199 kPa, 52-100% <200 kPa). Patient satisfaction was not significantly different between footwear concepts. CONCLUSIONS: This study proves the offloading efficacy of a scientific-based, handmade, and in-shoe plantar pressure data-driven approach to custom-made footwear design, and advocates its implementation to optimize diabetic footwear for plantar foot ulcer prevention.


Assuntos
Pé Diabético/reabilitação , Órtoses do Pé/normas , Sapatos/normas , Idoso , Pé Diabético/prevenção & controle , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Pressão
6.
J Wound Care ; 28(12): 808-816, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31825772

RESUMO

OBJECTIVE: Diabetes is one of the most widespread diseases in Germany. Common complications are diabetic foot ulcers (DFU), which are associated with a cost-intensive treatment and serious adverse events, such as infections, amputations. This cost-effectiveness analysis compares two treatment options for patients with DFU: a TLC-NOSF dressing versus a neutral dressing, assessed through a European double-blind randomised controlled trial (RCT), Explorer. METHODS: The evaluation of the clinical outcomes was associated to direct costs (costs for dressings, nursing time, hospitalisation etc.) of both dressings, from the perspective of the statutory health insurance in Germany. Due to the long mean healing time of a DFU, the observation period was extended from 20 to 100 weeks in a Markov model. RESULTS: After 20 weeks, and with complete closure as a primary endpoint, the model revealed direct treatment costs for DFU of €2,864.21 when treated with a TLC-NOSF dressing compared with €2,958.69 with the neutral control dressing (cost-effectiveness: €6,017.25 versus €9,928.49). In the Markov model (100 weeks) the costs for the TLC-NOSF dressing were €5,882.87 compared with €8,449.39 with the neutral dressing (cost-effectiveness: €6,277.58 versus €10,375.56). The robustness of results was underlined by several sensitivity analyses for varying assumptions. The frequency of weekly dressing changes had the most significant influence in terms of parameter uncertainty. CONCLUSION: Overall, the treatment of DFU with a TLC-NOSF dressing is supported from a health economic perspective, because both the treatment costs and the cost-effectiveness were superior compared with the neutral wound dressing.


Assuntos
Antiulcerosos/uso terapêutico , Curativos Hidrocoloides , Diabetes Mellitus Tipo 2 , Pé Diabético/prevenção & controle , Sacarose/análogos & derivados , Antiulcerosos/administração & dosagem , Antiulcerosos/economia , Curativos Hidrocoloides/economia , Curativos Hidrocoloides/normas , Análise Custo-Benefício , Pé Diabético/enfermagem , Método Duplo-Cego , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sacarose/administração & dosagem , Sacarose/economia , Sacarose/uso terapêutico , Resultado do Tratamento
9.
Rev Prat ; 69(6): 616-619, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626416

RESUMO

The off-loading of diabetic foot ulcers is the most urgent and theoretically the easiest treatment to implement. Its effectiveness has been proven for decades by randomized controlled studies on neuropathic ulcers that heal with a cast in an average of 6 weeks with a high level of evidence. Total contact casts are not widely used throughout the world, although it is the standard treatment. Off-loading shoes are certainly effective but only if they are worn. It is the prescriber's challenge to obtain maximum compliance that makes it possible to avoid infections and secondary amputations that are totally avoidable most of the time and only related to the delay in optimal care, of which off loading is the essential part.


Assuntos
Pé Diabético , Suporte de Carga/fisiologia , Cicatrização , Amputação , Moldes Cirúrgicos , Pé Diabético/prevenção & controle , Pé Diabético/terapia , Humanos , Pressão , Sapatos
12.
BMJ Open Diabetes Res Care ; 7(1): e000696, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31423317

RESUMO

Objective: Daily remote foot temperature monitoring is an evidence-based preventive practice for patients at risk for diabetic foot complications. Unfortunately, the conventional approach requires comparison of temperatures between contralaterally matched anatomy, limiting practice in high-risk cohorts such as patients with a wound to one foot and those with proximal lower extremity amputation (LEA). We developed and assessed a novel approach for monitoring of a single foot for the prevention and early detection of diabetic foot complications. The purpose of this study was to assess the sensitivity, specificity, and lead time associated with unilateral diabetic foot temperature monitoring. Research design and methods: We used comparisons among ipsilateral foot temperatures and between foot temperatures and ambient temperature as a marker of inflammation. We analyzed data collected from a 129-participant longitudinal study to evaluate the predictive accuracy of our approach. To evaluate classification accuracy, we constructed a receiver operator characteristic curve and reported sensitivity, specificity, and lead time for four different monitoring settings. Results: Using this approach, monitoring a single foot was found to predict 91% of impending non-acute plantar foot ulcers on average 41 days before clinical presentation with a resultant mean 4.2 alerts per participant-year. By adjusting the threshold temperature setting, the specificity could be increased to 78% with corresponding reduced sensitivity of 53%, lead time of 33 days, and 2.2 alerts per participant-year. Conclusions: Given the high incidence of subsequent diabetic foot complications to the sound foot in patients with a history of proximal LEA and patients being treated for a wound, practice of daily temperature monitoring of a single foot has the potential to significantly improve outcomes and reduce resource utilization in this challenging high-risk population.


Assuntos
Pé Diabético/diagnóstico , Pé Diabético/prevenção & controle , Monitorização Fisiológica/métodos , Medição de Risco/métodos , Temperatura Cutânea , Seguimentos , Humanos , Estudos Longitudinais , Prognóstico , Indução de Remissão
13.
J Wound Care ; 28(8): 543-547, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31393799

RESUMO

Implementation of evidence-based care is central to achieving good results. In the UK, this involves implementing guidance from the National Institute for Health and Care Excellence (NICE). Here, Tracy Cowan, JWC consultant editor, reports on a conference that outlined recently published NICE guidance on UrgoStart for treating leg ulcers and diabetic foot ulcers, and described how to incorporate this into everyday practice to drive significant cost savings and improve patient outcomes.


Assuntos
Pé Diabético/prevenção & controle , Úlcera da Perna/prevenção & controle , Guias de Prática Clínica como Assunto , Humanos , Reino Unido , Cicatrização
14.
Trials ; 20(1): 521, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31439007

RESUMO

BACKGROUND: Early detection of diabetic foot ulcerations (DFUs) can avoid or delay any progression into more severe stages, which may require limb amputation or lead to infectious sequelae and death. However, frequent clinical screening would be too intrusive and costly, and self-examination may be hampered by concomitant diseases and social disabilities. In addition, it requires professional knowledge and experience using specialized devices. Researchers reported that skin temperature monitoring could reduce the risk of DFUs in high-risk patients. The main research objects in this field are effective and convenient means of temperature measurement, accurate and reasonable early warning mechanisms, and timely and appropriate interventions. This trial aims to investigate the effectiveness of daily home-based foot temperature measurements in the prevention of DFUs with the aid of intelligent sensor-equipped insoles combined with photo documentation. METHODS/DESIGN: In this open-label, prospective, randomized, 24-month trial, 300 patients with diabetes mellitus (type 1 or 2) and severe diabetic peripheral neuropathy (vibration sensation ≤ 4/8), aged 18-85 years, will be recruited and assigned to control and intervention groups in a ratio of 1:1. Main inclusion criteria to be eligible for study participation encompass in particular risk group 2 or 3 for the development of DFUs using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Feet [IWGDF]) and the ability to use a mobile phone. INTERVENTIONS: Participants in both groups will receive education about regular foot care at the beginning of the study (visit 0). In the intervention group, every patient will receive a pair of slippers with the inserted sensor-equipped insole as well as a smartphone with the corresponding smartphone application (Smart Prevent Diabetic Feet Application). The insole is a tool that records the temperature variabilities of the plantar foot. Patients will measure their foot temperature twice a day at home with a time interval > 4 h during the entire course of the study (24 months). The measured data will be initially analyzed and visualized, and further transferred to a remote server that allows the physician to perform specific interpretations. In case of temperature differences > 1.5 °C between left and right corresponding sites lasting > 32 h (assigned alarm level 4), the physician will start an intervention phase, which requires the patient to reduce daily activities and relax his feet for five days. At the same time, photo documentation is encouraged to be performed by the patient. Possibly, additional visits to a private doctor or clinical examinations will be arranged for the patient during this intervention period. OUTCOMES: The primary outcome is foot ulceration, evaluated by a physician, and occurring at any point during the study. DISCUSSION: This study addresses principal aspects in the prevention of DFUs. First, the sensor-equipped insole will be evaluated for daily performance in home-based measurements of foot temperatures. Second, a telemedicine structure is tested that evaluates sensor data automatically and proposes suitable intervention measures under the supervision of a physician. Third, predictive models for DFUs will be built using the collected sensor data allowing for interpretations, which in the future may support medical care providers. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00013798 . Registered on 18 January 2018.


Assuntos
Pé Diabético/prevenção & controle , Pé Diabético/fisiopatologia , Fotografação/instrumentação , Tecnologia de Sensoriamento Remoto , Sapatos , Temperatura Cutânea , Telemedicina/instrumentação , Termografia/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Telefone Celular , Pé Diabético/diagnóstico , Pé Diabético/etiologia , Diagnóstico Precoce , Desenho de Equipamento , Feminino , , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Valor Preditivo dos Testes , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Adulto Jovem
15.
Diabetes Metab Syndr ; 13(2): 1255-1260, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336474

RESUMO

OBJECTIVE: The present study aimed at evaluating the effectiveness of an educational intervention via mobile cells on foot care knowledge and foot care practices in patients with type 2 diabetes. MATERIAL AND METHODS: This is an interventional quasi-experimental study carried out in 4 community health centers in Andimeshk City in Iran in 2017. Of 160 patients 80 cases were randomly assigned as intervention group and 80 patients as the control one. A three-section questionnaire completed by a face-to-face interviewing used for data collection before and after the intervention and three months after the education. Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1c) tests were done for both groups in a single laboratory before and three months after training. RESULTS: The mean age of patients in intervention group was 48.11 ±â€¯9.7 and control group was 47.3 ±â€¯7.9 years. The awareness of the patients related to diabetes foot care, in the intervention group after the training significantly improved (P < 0.001). The mean scores of preventive behaviors of diabetic foot significantly increased in the intervention group (P < 0.001). CONCLUSION: The findings indicate that educational intervention based on short message service (SMS), resulting in improve foot care knowledge, foot care practices and metabolic control in patients with diabetes type 2.


Assuntos
Diabetes Mellitus Tipo 2/reabilitação , Pé Diabético/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Envio de Mensagens de Texto/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Pé Diabético/epidemiologia , Pé Diabético/psicologia , Feminino , Seguimentos , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Prognóstico , Autocuidado , Inquéritos e Questionários
16.
Diabetes Metab Syndr ; 13(2): 913-923, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336545

RESUMO

BACKGROUND: Therapeutic footwear is built on a model of patient's foot, for people with diabetes suffering with neuropathy. Can the footwear helps to improve plantar pressure in neuropathic foot? This study focussed on available data on therapeutic footwear as an intervention for improving and offloading plantar pressure in neuropathic diabetic foot. METHODS: Relevant scientific literature in PubMed, Medline and Google Scholar published between 2000 and 2017 were searched. The keywords searched were therapeutic footwear, plantar pressure, neuropathic foot, rocker sole, ulcer healing and offloading of plantar pressure. Articles on randomized controlled trials, observational, cohort, feasibility and factorial studies were reviewed. RESULTS: One hundred and twenty five (125) articles were identified. The article comprised of 6 randomized controlled trials, 2 observational, 1 cohort, 1 feasibility and 1 factorial study met the inclusion criteria and were critiqued with a total enrolment of 1380 study subjects. CONCLUSIONS: The review of the collated literature demonstrated that, therapeutic footwear can improve the healing of neuropathic diabetic foot ulcer by redistributing plantar pressure. However, the efficacy of therapeutic footwear requires the inclusion of technical features that should not be compromised from the design to the production of the footwear.


Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus/fisiopatologia , Pé Diabético/prevenção & controle , Neuropatias Diabéticas/prevenção & controle , Órtoses do Pé/estatística & dados numéricos , Sapatos , Complicações do Diabetes/etiologia , Pé Diabético/etiologia , Neuropatias Diabéticas/etiologia , Humanos , Cicatrização
17.
J Foot Ankle Res ; 12: 35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31244900

RESUMO

Objective: This study focussed on pressure relieving orthotic insoles designed for retail footwear and people with diabetes and at risk of first forefoot ulceration. The aim was to investigate whether the pressure relieving effects of a customised metatarsal bar and forefoot cushioning are sensitive to bar location and shape, and material choice. Research design and methods: Patient-specific foot shape was used to design an orthotic insole, with metatarsal bar location and shape customised according to plantar pressure data. Changes in forefoot plantar pressure were investigated when 60 people with diabetes and neuropathy walked in nine variants of the orthotic insole. These comprised three variations in proximal/distal location of the customised metatarsal bar and three different metatarsal head offloading materials. Results & conclusions: The most frequent reductions in pressure occurred when the anterior edge of the metatarsal bar was placed at 77% of the peak pressure values, and its effects were independent of the choice of EVA or Poron offloading material. In the flat insole, 61% of participants had one or more metatarsal head areas with pressure above the 200 KPa, reducing to 58% when adopting generic orthotic design rules and 51% when using the best orthotic insole of the nine tested. Our results confirm that plantar pressure relief is sensitive to orthotic insole design decisions and individual patient feet.


Assuntos
Pé Diabético/prevenção & controle , Desenho de Equipamento/métodos , Órtoses do Pé , Úlcera do Pé/prevenção & controle , Sapatos , Idoso , Feminino , Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Caminhada/fisiologia
18.
Diabetes Metab Syndr ; 13(3): 2152-2157, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235150

RESUMO

INTRODUCTION: Diabetic foot disease has been considered as an important complication of diabetes mellitus. The main risk factor to cause diabetic foot disease is peripheral neuropathy. Diabetic foot disease usually started from diabetic foot ulceration, it would develop to diabetic foot infection and amputation even death when conducting the poor prognosis and management of diabetic foot ulceration. Despite this, incidence of diabetic foot disease is still increasing and is therefore potentially under-recognized, under-diagnosed and under-treated all over the word, especially in the US. The aim of this study is to clarify the needs of the adults at risk and health care providers in diagnosis and treatment of diabetic foot disease in the US. METHODS: Cochrane library, bibliographic databases, American Diabetes Association website and DFS questionnaire website have been used to search the relevant literature of diabetic foot disease among adults in the US. Additionally, conducting subgroup analysis to review the relevant literature. RESULTS: The findings of this health needs assessment described that diabetic foot disease in the adults is higher in men than women in the US. American Indian achieved the highest prevalence of diabetic foot disease, in comparison to other ethnic groups. Meanwhile, age has been defined as an important factor to influence the diabetic foot disease rate. Diagnosing properly is important, in accordance with understanding the etiopathogenesis of diabetic foot disease for health professionals. A comprehensive Foot Examination has been established and developed by the American Diabetes Association (ADA). It has been used widely with the characters of easy conducting and rapid performance. Moreover, treatment of DFUs with becaplermin gel obtained the lower cost and the larger clinical benefit when comparing the traditional wound care.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus/fisiopatologia , Pé Diabético/diagnóstico , Pé Diabético/prevenção & controle , Determinação de Necessidades de Cuidados de Saúde , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Pé Diabético/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estados Unidos/epidemiologia
19.
Br J Community Nurs ; 24(Sup6): S15-S19, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31166791

RESUMO

Ageing leads to a number of skin changes that not only place an older adult at risk of tissue damage, but can present as peri-wound problems for those with existing wounds, for example, incontinence-associated and moisture-associated dermatitis in individuals with pressure ulcers. Older adults with venous disease experience skin changes concomitant with venous hypertension, making the skin more at risk of breakdown, specifically the common complications of lipodermatosclerosis and venous eczema. In individuals with diabetic foot disease, skin changes related to autonomic neuropathy mean patients can experience dry skin that cracks easily, placing them at higher risk of infection. Common to all individuals with wounds requiring some sort of dressing is the risk of medical adhesive-related skin injury, where dressing application and removal need to be of the utmost priority to reduce the risk of injury. This article discusses some of the common peri-wound skin considerations in patients with chronic wounds.


Assuntos
Bandagens , Serviços de Saúde para Idosos , Higiene da Pele , Úlcera Cutânea/prevenção & controle , Idoso , Enfermagem em Saúde Comunitária , Dermatite/enfermagem , Dermatite/prevenção & controle , Pé Diabético/enfermagem , Pé Diabético/prevenção & controle , Feminino , Humanos , Úlcera da Perna/enfermagem , Úlcera da Perna/prevenção & controle , Masculino , Úlcera Cutânea/enfermagem
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