Estudio comparativo de la transmisión de la presión ejercida por la tuberosidad posterior del calcáneo en los apósitos de espuma de poliuretano

Las úlceras por compresión en el talón son las segundas más prevalentes dado que esta localización anatómica presenta unas características inherentes que la hacen más vulnerable a la isquemia. La prevención de estas úlceras, al igual que en cualquier problema de salud, es el principal caballo de batalla en el ámbito clínico asistencial, ya sea a nivel hospitalario o en la comunidad. La aplicación de apósitos de espuma de poliuretano con formas adaptadas al talón es una realidad clínica, que tiene como objetivo prevenir este tipo de lesiones. Esta realidad asistencial concuerda con multitud de guías de práctica clínica publicadas en España. No obstante, tanto en publicaciones de organismos internacionales, dedicados al estudio específico de las úlceras por compresión, como en las revisiones sistemáticas realizadas por entidades como la fundación Cochrane, no se recomienda el uso de estos dispositivos en el ámbito de la prevención de úlceras por presión. Esta situación obliga a contrastar la información publicada sobre la capacidad de amortiguación de las fuerzas físicas implicadas en la aparición de las úlceras por compresión por los apósitos de espuma de poliuretano. En vista de las claras diferencias metodológicas entre los estudios que evalúan la transmisión de fuerzas de presión en el talón por parte de los apósitos de espuma de poliuretano, surge la necesidad de comprobar si estos productos son realmente efectivos para la disminución de la presión transmitida por la tuberosidad posterior del calcáneo. Con este objetivo se ha elaborado un protocolo de estudio para el que se ha creado un modelo artificial que reproduce las presiones ejercidas en el talón, medidas en voluntarios de un rango de edad muy amplio (26-90 años). Los materiales comparados han sido seleccionados entre los apósitos más utilizados en la práctica asistencial así como en los artículos de referencia (Allevyn® Heel, Mepilex® Heel, Biatain® Talón y Askina® Heel). Con motivo de poder comparar los resultados obtenidos por los apósitos evaluados, se ha introducido como material de control una espuma de células abiertas. Dicha espuma se usa principalmente como material de absorción de presión e impacto, aplicándose en soportes plantares destinados a la prevención de las úlceras neuropáticas del pie diabético (Poron®). De otro lado, dado que estos apósitos se aplican durante horas y días, se necesita conocer cómo reaccionan a la fatiga mecánica a la que son sometidos, por lo que se ha utilizado la prueba de estrés UNE-EN ISO 1856:2001 “Materiales poliméricos celulares flexibles. Determinación de la deformación remanente por compresión” (ISO 1856:2000). Tanto el modelo artificial como la plataforma de presiones utilizada para las mediciones, han pasado por un proceso de validación en el que se han obtenido unos resultados excelentes, con un “Coeficiente de Correlación Interclase” de 0,881 y 0,982 respectivamente (p<0,001). La prueba de estrés a demostrado su efectividad desarrollando una reducción de la capacidad de amortiguación de la presión en todos los materiales evaluados, con una significación estadística de p<0,001. Tras realizar las mediciones previas y posteriores a la prueba de estrés, en todos los casos el material de control ha demostrado un comportamiento muy superior a los apósitos evaluados con una significación estadística de p<0,001. Teniendo en cuenta que los apósitos evaluados no son capaces de disminuir la presión máxima como la espuma control, ninguno podrá conseguir una protección equiparable frente a la compresión. Por todo lo expuesto, existiendo materiales como la espuma de control, no se puede recomendar el uso de los apósitos evaluados como elementos de prevención frente a las fuerzas de compresión en el talón

Differences and Similarities in Neuropathy in Type 1 and 2 Diabetes: A Systematic Review

Background: Diabetic neuropathy is defined as the dysfunction of the peripheral nervous system in diabetic patients. It is considered a microvascular complication of diabetes mellitus. Its presence is associated with increased morbidity and mortality. Although several studies have found alterations at somatic motor, sensory levels and at the level of autonomic nervous system in diabetic patients, there is not a systematic approach regarding the differences in neuropathy between the major variants of diabetes, e.g., type 1 and 2 diabetes at both neurological and molecular level. Data sources: we systematically (Medline, Scopus, and Cochrane databases) evaluated the literature related to the difference of neuropathy in type 1 and 2 diabetes, differences in molecular biomarkers. Study characteristics: seventeen articles were selected based on pre-defined eligibility criteria. Conclusions: both superficial sensitivity (primarily thermal sensitivity to cold) and deep sensitivity (such as vibratory sensitivity), have been reported mainly in type 2 diabetes. Cardiac autonomic neuropathy is one of the diabetic complications with the greatest impact at a clinical level but is nevertheless one of the most underdiagnosed. While for type 1 diabetes patients most neuropathy alterations have been reported for the Valsalva maneuver and for the lying-to-standing test, for type 2 diabetes patients, alterations have been reported for deep-breathing test and the Valsalva test. In addition, there is a greater sympathetic than parasympathetic impairment, as indicated by the screening tests for autonomic cardiac neuropathy. Regarding subclinical inflammation markers, patients with type 2 diabetes showed higher blood levels of inflammatory markers such as high-sensitivity C-reactive protein, proinflammatory cytokines IL-6, IL-18, soluble cell adhesion molecules and E-selectin and ICAM-1, than in type 1 diabetes patients. By contrast, the blood levels of adiponectin, an adipocyte-derived protein with multiple paracrine and endocrine activities (anti-inflammatory, insulin-sensitizing and proangiogenic effects) are higher in type 1 than in type 2 diabetic patients. This review provides new insights into the clinical differences in type 1 and 2 diabetes and provide future directions in this research field

Relationship between deep and superficial sensitivity assessments and gait analysis in diabetic foot patients

Peripheral neuropathy is a prevalent complication of diabetes that can lead to gait impairment and its adverse consequences. This study explored the potential utility of different parameters of gait analysis using a single sensor unit as a simple tool to detect peripheral neuropathy in 85 diabetic patients (DP) with diabetic foot in whom different somato-sensitivity tests in the feet were performed. Gait spatiotemporal parameters were examined by sensor inertial measurement placed in the lumbar area, while the superficial sensitivity pathway was assessed by nociception tests and deep sensitivity was examined by light touch-pressure and vibration sensitivity tests. Correlations between each sensory test and gait parameters were analysed in a logistic regression model in order to assess if gait parameters are associated with two different sensory pathways. Impaired deep sensory pathways were significantly (P < .05) correlated with lower gait speed, reduced cadence, smaller stride length, longer stance periods, and a higher risk of falling on the Tinetti Scale, while all gait parameters were significantly (P < .01) correlated with the superficial sensory pathway. Type 2 diabetics have significantly (P < .05) higher impairment in vibratory sensitivity than type 1 diabetics, and the years with diabetes mellitus (DM) diagnosis have a significant (P < .05) association with reduced vibration sensitivity. These findings indicate relationships between the deep sensory pathway and gait impairments in DP measured by inertial sensors, which could be a useful tool to diagnose gait alterations in DP and to evaluate the effect of treatments to improve gait and thus the risk of falls in diabetic patients

Knowledge and Attitudes towards Palliative Care : Validation of the Spanish Version of Questionnaire on Palliative Care for Advanced Dementia

Background: Palliative care is essential in the care of people with advanced dementia, due to the increasing number of patients requiring care in the final stages of life. Nurses need to acquire specific knowledge and skills to provide quality palliative care. The questionnaire on Palliative Care for Advanced Dementia (qPAD) is useful for assessing knowledge and attitudes toward palliative care, but its adaptation to the Spanish language and analysis of its effectiveness and usefulness for the Spanish culture is lacking. Objective: To report on the Spanish language adaptation and psychometric analysis of the qPAD. Methods: The Questionnaire on Palliative Care for Advanced Dementia Spanish version (qPAD-SV) was obtained from a process that included translation, back-translation, comparison with other language versions, expert review, and pilot study. Content validity, criterion validity, and reliability of the questionnaire were analyzed. The difficulty and discrimination indices of items composing the knowledge subscale were also calculated. Results: Adequate content validity index obtained after the analysis of qPAD-SV by a heterogeneous group of experts was found (overall CVI = 0.96; 0.95 for the Knowledge subscale and 0.99 for the Attitudes subscale). Significant correlations with the Palliative Care Knowledge test (rho = 0.368, p < 0.001) and Self-Efficacy in Palliative Care Scale (rho = 0.621, p < 0.001) show an adequate criterion validity. Cronbach's alpha coefficients for the Knowledge subscale (0.60) and the Attitudes subscale (0.91) supported the reliability of the qPAD-SV. The questionnaire had an overall difficulty index of 0.71, with three items that could be considered difficult or very difficult, and eleven items that could be considered very easy. Discussion: Although it shows internal consistency, validity, and difficulty indices similar to those obtained by qPAD versions in other languages, a reformulation of the items with lower content validity or discrimination indices and those that show difficulties in their comprehension is an aspect to be taken into account to improve this tool. Conclusions: The qPAD-SV is a useful instrument in Spanish to measure the knowledge of Spanish nurses in palliative care and is suitable for international comparisons

Changes in Salivary amylase and glucose in diabetes : a scoping review

Background and Objective: Diabetes mellitus (DM) is a common long-term disease which can be related with salivary amylase levels. DM has recently been associated with salivary amylase diagnostics that could further impair diagnoses in the diabetic population, as well as being an interesting alternative to traditional methods of determine glucose levels. The main advantage of this method is related to the fact that it is a fast diagnostic method. The DM population experiences changes to their metabolism which affects their salivary parameters, making this an alternative procedure for diagnosis and follow-up of the illness due to the non-invasive nature of salivary analyzes. The objective of this review is to summarize the evidence regarding the changes in salivary amylase and glucose levels, and their relationship with blood markers of glycemic control used in clinical settings such as blood glucose and glycated hemoglobin. The differences in salivary amylase levels depending on the method of saliva collection under fasting or non-fasting conditions. The changes in salivary amylase depends on the type of diabetes, the type of insulin treatment or the quality of glycemic control. Conclusions: Salivary amylase concentration is increased in diabetic patients in most of the studies and salivary glucose concentration in all studies in both fasting and non-fasting (post-prandial) conditions. Salivary amylase and glucose concentration represent potential non-invasive biomarkers to evaluate glycemic control and clinical management of diabetic patients, although it is necessary to evaluate the influence of potential modulating factors such as age, duration diseases, sex and the effects of pharmacological treatments in these outcomes which remained to be elucidated

Convergent and discriminative validity of the Frail-VIG index with the EQ-5D-3L in people cared for in primary health care

Background The Frail-VIG frailty index has been developed recently. It is an instrument with a multidimensional approach and a pragmatic purpose that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. Our aim was to investigate the convergent and discriminative validity of the Frail-VIG frailty index with regard to EQ-5D-3L value. Methods We carried out a cross-sectional study in two Primary Health Care (PHC) centres of the Catalan Institute of Health (Institut Català de la Salut), Barcelona (Spain) from February 2017 to January 2019. Participants in the study were all people included under a home care programme during the study period. No exclusion criteria were applied. We used the EQ-5D-3L to measure Health-Related Quality of Life (HRQoL) and the Frail-VIG index to measure frailty. Trained PHC nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient and multiple linear regression analyses. Results Four hundred and twelve participants were included in this study. Frail-VIG score and EQ-5D-3L value were negatively correlated (r = − 0.510; P < 0.001). Non-frail people reported a substantially better HRQoL than people with moderate and severe frailty. EQ-5D-3L value declined significantly as the Frail-VIG index score increased. Conclusions Frail-VIG index demonstrated a convergent validity with the EQ-5D-3L value. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with better and worse HRQoL. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index

Profiles of Frailty among Older People Users of a Home-Based Primary Care Service in an Urban Area of Barcelona (Spain): An Observational Study and Cluster Analysis

Background: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. Methods: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. Results: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. Conclusions: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs

Influencia del aceite de coco en enfermos de alzhéimer a nivel cognitivo.

La enfermedad de Alzheimer es a día de hoy la demencia neurodegenerativa con mayor prevalencia en el primer mundo. Este hecho, unido a la falta de tratamiento farmacológico que cure la enfermedad, hace que se estudien nuevas estrategias terapéuticas no farmacológicas como es la administración de nutrientes. En este sentido, destaca la posible influencia del aceite de coco como fuente energética alternativa, capaz de frenar la muerte neuronal que se produce de modo progresivo en esta enfermedad. Objetivos: valorar el impacto del aceite de coco a nivel cognitivo en pacientes de Alzheimer, y concretamente en las áreas de orientación, lenguaje-construcción, fijación, cálculo-concentración y memoria. Métodos: estudio prospectivo, longitudinal, cualitativo, analítico y experimental a través de un ensayo clínico, donde se seleccionaron a 44 pacientes con Alzheimer de la zona de la Ribera (Comunidad Valenciana), de los cuales a la mitad se le administró durante 21 días, 40 ml diarios de aceite de coco repartidos entre desayuno (20 ml) y comida (20 ml). Antes y después de la administración del aceite, se les valoró a través del test cognitivo Mini-Examen Cognoscitivo, para determinar los posibles cambios. Resultados: en los enfermos que tomaron el aceite de coco se observó una mejora cognitiva tras finalizar la intervención, siendo estadísticamente significativa en las áreas de orientación y lenguaje-construcción. Conclusiones: el aceite de coco parece mejorar la capacidad cognitiva de los enfermos de Alzheimer, variando la intensidad de la misma en función del área cognitiva

Multidimensional instruments with an integral approach to identify frailty in community-dwelling people: protocol for a systematic psychometric review

Introduction An increasing number of investigations highlight the complex nature of frailty; therefore, the use of multidimensional assessment instruments could be useful in clinical decision-making. Frail people are found mainly in the community setting which is why this is the ideal environment for early screening and intervention. For this purpose, it is necessary to have valid, time-effective and easy-to-use frailty assessment instruments. The aim of this review is to critically appraise, compare and summarise the quality of the measurement properties of all multidimensional instruments with an integral approach to identify frailty in community-dwelling people. Methods and analysis Medline, Psychological Information Database (PsycINFO) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from their inception dates. We will also conduct searches in databases of grey literature. No limits will be applied for language. A highly sensitive validated search filter will be used for finding studies on measurement properties. An additional search including the names of the instruments found in the initial search will also be undertaken. Studies aiming at the development of a measurement instrument, the evaluation of one or more measurement properties or the evaluation of its interpretability will be included. The instrument should have an integral approach (physical, psychological and social) and it should measure all three domains. The context of use should be a community setting. Two reviewers independently will screen the references and assess the risk of bias by consensus-based standards for the selection of health measurement instruments checklist. To assess the overall evidence for the measurement properties of the identified instruments, the results of the different studies, adjusted for their methodological quality, will be combined. Ethics and dissemination Ethical approval and patient consent are not required as this is a psychometric review based on published studies. The results of this review will be disseminated at conferences and published in an international peer-reviewed journal. PROSPERO registration number CRD42019120212

Errores en el tratamiento de heridas de larga evolución

Participación del profesor Vicente Tormo Maicas en la sesión plenaria ''Errores frecuentes en el manejo de heridas'', del II Congreso de la Sociedad Española de Heridas, en Febrero de 2012. El audio ''desaparece'' entre los minutos 00:24-01:34 aproximadament