Rehabilitation technology for self-care: Customised foot and ankle exercise software for people with diabetes.

AIMS: To develop and validate the content of a free web-based software (desktop and mobile applications) for the self-management of and customised foot-ankle exercises for people with diabetes and diabetic neuropathy. METHODS: The development of the programme was based on gamification principles and addressed three main areas: foot care recommendations; self-assessment of feet according to the main complications of diabetic neuropathy; and customised foot-ankle exercises to strengthen muscles, increase the range of motion and improve functionality. The content was validated using the Delphi methodology and a quantitative approach in two rounds with diabetes specialists (n = 9) and users with diabetes (n = 20). A 70% approval rate was considered sufficient in the second round for final validation purposes. The data analysis was conducted using descriptive statistics, absolute and relative frequencies and the content-validity index (CVI). RESULTS: Among specialists, the CVI was 0.812 after the first round, and final approval was 100% after the second round. Among users, the CVI was 0.902 in the first round, and the final approval was 97%. CONCLUSION: This free access web software was developed based on the high agreement rating between specialists and users and has the potential to prevent complications arising from diabetic polyneuropathy. It allows for self-monitoring and promotes personalised exercises, following a preventive model that can be applied in primary and secondary care services as a complementary treatment for chronic complications. However, further steps to validate the software in a larger population are recommended.

Evolución del pie diabético en los grados 4 y 5 de la clasificación de Wagner / Evolution of the diabetic foot graded 4 and 5 in Wagner's classification scale

Introducción: Las úlceras del pie diabético en estadio 4 y 5 de Wagner constituyen lesiones crónicas avanzadas con deterioro vascular, de pronóstico reservado y predicen riesgo de amputación superior a 90 por ciento.Objetivo: Describir la evolución del pie diabético en los grados 4 y 5 de la clasificación de Wagner.Métodos: Estudio descriptivo, retrospectivo, en el Hospital "Manuel Fajardo" desde junio 2011 hasta mayo 2016. La muestra estuvo constituida por 46 pacientes; se les aplicó Heberprot-P® y se asoció cámara hiperbárica al pie diabético complicado. Las variables estudiadas fueron: edad, sexo, factores de riesgo, tiempo de evolución de la diabetes mellitus, nivel anatómico de ausencias de pulsos, escala de Wagner, evolución de la lesión, cámara hiperbárica, porcentaje de granulación y semanas de tratamiento.Resultados: Habían 22 (47,8 por ciento) pacientes mayores de 67 años de edad, el sexo masculino fue el más afectado 38 (82,6 por ciento); la hipertensión arterial y el hábito de fumar fueron los factores de riesgo más frecuentes; 32 pacientes con más de 20 años de evolución de la diabetes mellitus. La ausencia de pulso poplíteo se observó en 37 pacientes. Con pie diabético en estadio 4 y 5 de Wagner hubo 31 (67,3 por ciento) y 15 (32,6 por ciento) pacientes respectivamente; 24 mostraron infección sobreañadida, de ellos 20 usaron cámara hiperbárica, 7 fracasos al tratamiento, 3 amputaciones infracondilia y 4 supracondilia. Epitelizaron al 100 por ciento 33 pacientes y 6 evolucionan satisfactoriamente.Conclusiones: El pie diabético en estadios terminales evoluciona favorablemente con Heberprot-P® y cámara hiperbárica(AU)

Introduction: The diabetic foot ulcers classified as 4 and 5 grades in Wagner´s classification scale are advanced chronic vascular lesions with a worse prognosis and they predict a risk of amputation over 90 percent.Objectives: To describe the evolution of the 4th and 5th grade diabetic foot in the Wagner classification scale.Methods: A retrospective and descriptive study was conducted in a sample of 46 patients at ¨Manuel Fajardo¨ hospital from June 2011 to May 2016. These patients were treated with Heberprot-P® and hyperbaric chamber therapy was added to manage complicated diabetic foot. The study variables were age, gender, risk factor, length of time with diabetes mellitus, anatomical level of pulse absence, Wagner's classification scale, ulcer evolution, hyperbaric chamber, granulation percentage and number of weeks of treatment.Results: There were 22 (47.8 percent) patients aged over 67 years, males were the most affected with 38 individuals (82.6 percent), hypertension and smoking were the most frequent risk factors and 32 patients had suffered from diabetes for more than 20 years. The popliteal pulse was not found in 37 patients. Thirty one (67.3 percent) and 15 (32.6 percent) patients showed diabetic foot graded 4 and 5, respectively. Twenty four patients showed added infection, 20 of them were treated with hyperbaric chamber, 7 patients did not succeed in treatment, 4 underwent supracondylar and 3 infracondylar amputations. Thirty three patients reached 100 percent epithelization and 6 recovered satisfactorily.Conclusions: The diabetic foot classified as terminal staging may present favorable evolution with the use of Heberprot-P® and hyperbaric chamber(AU)

Evolución del pie diabético en los grados 4 y 5 de la clasificación de Wagner / Evolution of the diabetic foot graded 4 and 5 in Wagner's classification scale

Introducción: Las úlceras del pie diabético en estadio 4 y 5 de Wagner constituyen lesiones crónicas avanzadas con deterioro vascular, de pronóstico reservado y predicen riesgo de amputación superior a 90 por ciento. Objetivo: Describir la evolución del pie diabético en los grados 4 y 5 de la clasificación de Wagner. Métodos: Estudio descriptivo, retrospectivo, en el Hospital "Manuel Fajardo" desde junio 2011 hasta mayo 2016. La muestra estuvo constituida por 46 pacientes; se les aplicó Heberprot-P® y se asoció cámara hiperbárica al pie diabético complicado. Las variables estudiadas fueron: edad, sexo, factores de riesgo, tiempo de evolución de la diabetes mellitus, nivel anatómico de ausencias de pulsos, escala de Wagner, evolución de la lesión, cámara hiperbárica, porcentaje de granulación y semanas de tratamiento. Resultados: Habían 22 (47,8 por ciento) pacientes mayores de 67 años de edad, el sexo masculino fue el más afectado 38 (82,6 por ciento); la hipertensión arterial y el hábito de fumar fueron los factores de riesgo más frecuentes; 32 pacientes con más de 20 años de evolución de la diabetes mellitus. La ausencia de pulso poplíteo se observó en 37 pacientes. Con pie diabético en estadio 4 y 5 de Wagner hubo 31 (67,3 por ciento) y 15 (32,6 por ciento) pacientes respectivamente; 24 mostraron infección sobreañadida, de ellos 20 usaron cámara hiperbárica, 7 fracasos al tratamiento, 3 amputaciones infracondilia y 4 supracondilia. Epitelizaron al 100 por ciento 33 pacientes y 6 evolucionan satisfactoriamente. Conclusiones: El pie diabético en estadios terminales evoluciona favorablemente con Heberprot-P® y cámara hiperbárica(AU)

Introduction: The diabetic foot ulcers classified as 4 and 5 grades in Wagner´s classification scale are advanced chronic vascular lesions with a worse prognosis and they predict a risk of amputation over 90 percent. Objectives: To describe the evolution of the 4th and 5th grade diabetic foot in the Wagner classification scale. Methods: A retrospective and descriptive study was conducted in a sample of 46 patients at ¨Manuel Fajardo¨ hospital from June 2011 to May 2016. These patients were treated with Heberprot-P® and hyperbaric chamber therapy was added to manage complicated diabetic foot. The study variables were age, gender, risk factor, length of time with diabetes mellitus, anatomical level of pulse absence, Wagner's classification scale, ulcer evolution, hyperbaric chamber, granulation percentage and number of weeks of treatment. Results: There were 22 (47.8 percent) patients aged over 67 years, males were the most affected with 38 individuals (82.6 percent), hypertension and smoking were the most frequent risk factors and 32 patients had suffered from diabetes for more than 20 years. The popliteal pulse was not found in 37 patients. Thirty one (67.3 percent) and 15 (32.6 percent) patients showed diabetic foot graded 4 and 5, respectively. Twenty four patients showed added infection, 20 of them were treated with hyperbaric chamber, 7 patients did not succeed in treatment, 4 underwent supracondylar and 3 infracondylar amputations. Thirty three patients reached 100 percent epithelization and 6 recovered satisfactorily. Conclusions: The diabetic foot classified as terminal staging may present favorable evolution with the use of Heberprot-P® and hyperbaric chamber(AU)

Aspectos sociales de la aplicación del Heberprot-P en el servicio de Angiología del Hospital Manuel Ascunce Doménech / Social aspects of the application of the Heberprot-P in the Angiology service at Manuel Ascunce Domenech Hospital

En la actualidad Cuba desarrolla un Programa de Atención Integral al Paciente con Úlcera de Pie Diabético (UPD) mediante el uso del Heberprot-P, esencial para disminuir la amputación y la discapacidad. El trabajo tiene el objetivo de realizar un diagnóstico sobre la aplicación del Heberprot-P en el Servicio de Angiología del Hospital Provincial Universitario Manuel Ascunce Domenech de Camagüey. Se realizaron encuestas a pacientes para identificar necesidades sentidas relacionadas con el tratamiento y para las actitudes manifiestas, y se hicieron entrevistas al personal médico y de enfermería. El diagnóstico permitió corroborar la necesaria investigación con enfoque social del servicio de salud escogido a nivel territorial. Destaca elevar el trabajo de captación de pacientes desde el nivel primario de salud para garantizar un mayor alcance del programa, así como la trascendencia del apoyo familiar y la relación profesional de la salud- paciente a fin de lograr la calidad requerida (AU)

At present Cuba is developing a program concerning the care of patient with ulcer of the diabetes foot by means of Heberprot-P essential to reduce the amputation and disability. The aim of this paper is to carry out a diagnosis about social aspects of the application of the Heberprot-P in the Angiology service at Manuel Ascunce Domenech Hospital in Camaguey. Some surveys were carry out to identify certain needs related with the treatment and the attitude shown and on the other hand some interview were made to the medical and nursing staff. The diagnosis allowed to verify the need of the research with social approach. The paper highlight how to incorporate patients from the primary health level, in order this program has a higher scope and the importance of the family support and the professional relationship to accomplish the quality required (AU)

From treatment to preventive actions: improving function in patients with diabetic polyneuropathy.

Diabetic polyneuropathy is an insidious and long-term complication of this disease. Synergistic treatments and preventive actions are crucial because there are no clear boundaries for determining when health professionals should intervene or what intervention would best avoid the consequences of neuropathy. Until now, most therapies to any diabetic individual were applied only after the patient's limb was ulcerated or amputated. The loss of muscle and joint functions is recognized as the main cause of plantar overloading. However, if foot and ankle exercises are performed following the early diagnosis of diabetes, they can enable the patient to maintain sufficient residual function to interact with the environment. This article summarizes the current knowledge about the musculoskeletal deficits and biomechanical alterations caused by neuropathy. It also describes the potential benefits of foot and ankle exercises for any diabetic patient that is not undergoing the plantar ulcer healing process. We concentrate on the prevention of the long-term deficits of neuropathy. We also discuss the main strategies and protocols of therapeutic exercises for joints and muscles with deficits, which are applicable to all diabetic patients with mild to moderate neuropathy. We describe further efforts in exploiting the applicability of assistive technologies to improve the adherence to an exercise program. Following the contemporary trends towards self-monitoring and self-care, we developed a software to monitor and promote personalized exercises with the aim of improving autonomous performance in daily living tasks. Initiatives to prevent the complications of functional diabetes are highly recommended before it is too late for the patient and there is no longer an opportunity to reverse the tragic consequences of neuropathy progression.

Resultados del Heberprot-P® en pacientes con úlceras de pie diabético / Results of Heberprot-p® in patients with diabetic foot ulcers

Fundamento: el síndrome del pie diabético representa una de las complicaciones crónicas de mayor morbilidad y discapacidad en los pacientes diabéticos en la actualidad. Las altas tasas de amputaciones causan un importante grado de invalidez con un elevado costo económico y social. Se ha evidenciado que la administración del Heberprot-P® estimula la formación de tejido de granulación en el lecho de las úlceras y el cierre por segunda intención.Objetivo: describir resultados del Heberprot-P® en pacientes con úlceras de pie diabético en el Policlínico Raúl Sánchez, de la provincia Pinar del Río.Métodos: se realizó un estudio descriptivo prospectivo de 23 pacientes con diagnóstico de úlcera de pie diabético, de enero de 2014 a febrero de 2015 en el Policlínico Raúl Sánchez de la provincia Pinar del Río, a los que se les aplicó factor de crecimiento epidérmico por vía intralesional. Se estudiaron los pacientes teniendo en cuenta la edad, el sexo, los antecedentes patológicos- personales, el grado de afectación según la clasificación de Wagner, la dosis y el número de aplicaciones, la evaluación de la respuesta y los efectos adversos.Resultados: en la serie estudiada predominaron los pacientes comprendidos entre los 50 y 59 años de edad (47,8 por ciento), el sexo femenino (60,9 por ciento) y la diabetes tipo 2; el mayor número de aplicaciones fue en la úlcera plantar grado II; se logró una granulación completa en el 78,2 por ciento de los casos y parcial en el 17,3 por ciento; no hubo necesidad de amputaciones ni fallecimiento de pacientes.Conclusiones: con la aplicación del Heberprot-P® se ha logrado una evolución favorable en la mayoría de los casos y se logró mantener la integridad del miembro y su funcionalidad en la mayoría de los pacientes(AU)

Background: diabetic foot syndrome is one of the chronic complications that cause more morbidity and disability in diabetic patients nowadays. High amputation rates cause a significant degree of disability along with a high social and economic cost. It has been showed that the use of Heberprot-p® stimulates granulation tissue formation in the ulcer bed and the closing by second intention.Objective: to describe the results of Heberprot-P® in patients with diabetic foot ulcers in Raúl Sánchez Policlinic, Pinar de Río.Methods: a descriptive, prospective study of 23 patients with the diagnosis of diabetic foot ulcer was conducted from January 2014 to February 2015 in Raúl Sánchez Policlinic, Pinar del Río. The patients were applied epidermal growth factor intralesionally. The patients were studied taking into account age, sex, personal-pathological history, severity degree according to Wagners classification, the dose and the number of applications, the evaluation of the response and the side effects.Results: patients aged between 50 and 59 (47, 8 percent) predominated in the studied series, as well as female sex (60, 9 percent) and diabetes mellitus type II. The greater number of applications was in plantar ulcers degree II. A whole granulation was achieved in the 78, 2 percent of the cases and a partial granulation in the 17, 3 percent. There was not need of amputations and none of the patients died.Conclusions: with the use of Heberprot-P®, a favorable evolution has been achieved in most of the cases and the integrity of the limb has been kept as well as its function in most of the patients(AU)

Evolución de lesiones complejas en el pie diabético con uso de Heberprot-P® / Evolution of complex lesions in the diabetic foot using Heberprot-P®

Fundamento: el pie diabético es una de las complicaciones crónicas de la diabetes mellitus más temidas, debido al riesgo de amputaciones de los miembros inferiores y el daño psico- social que acarrea. Existen zonas propensas a lesiones desfavorables, como la región calcánea y áreas extensas con toma plantar.Objetivo: valorar la evolución de lesiones complejas en el pie diabético con el uso de Heberprot-P.Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo a los pacientes ingresados en el Hospital Provincial Universitario Manuel Ascunce Domenech con el diagnóstico de pie diabético que presentaban lesiones complejas, entre junio de 2013-abril 2014. El universo estuvo constituido por 48 pacientes; la muestra no probabilística fue de 36 pacientes que reunieron los criterios de inclusión y exclusión establecidos. La información obtenida se procesó mediante el programa estadístico SPSS-11,5 para Windows y estadística descriptiva con distribución de frecuencia y porcientos. Los resultados del estudio se expusieron en tablas.Resultados: se encontró que el sexo más afectado fue el femenino, con un intervalo de edades de 56-65 años; el diagnóstico etiológico de pie diabético fue el neuroinfeccioso, la extremidad inferior con mayor afectación fue el pie derecho, la clasificación de Wagner de grado 3 fue la que más casos incluyó. La investigación obtuvo un desenlace exitoso de 33 casos cerrados.Conclusiones: la finalidad del manejo de las úlceras en el pie diabético es prevenir la amputación y mantener una buena calidad de vida. El Heberprot-P es un producto que modifica el criterio de amputación y una opción valiosa tanto para el paciente como para el médico (AU)

Background: diabetic foot is one of the most alarming chronic complications of diabetes mellitus because of the risk of amputations of the inferior limbs and the psycho-social damage that entails. There are areas prone to unfavourable lesions like the calcaneus region and the plantar area.Objective: to evaluate the evolution of complex lesions in diabetic foot with the use of Heberprot-P.Methods: a descriptive, longitudinal, retrospective study was made to the patients admitted in the Manuel Ascunce Domenech Provincial Hospital with the diagnosis of diabetic foot between June 2013 and April 2014. The patients presented complex lesions. The universe was composed of 48 patients. The non-probabilistic sample included 36 patients who matched the established inclusion and exclusion criteria. The information obtained was processed by means of the statistical program SPSS-11.5 for Windows and the descriptive statistics with distribution of frequencies and percents. The results of the study were exposed in tables.Results: it was found that female was the most affected sex with a higher incidence in the age group 56-65. The etiological diagnosis of diabetic foot was neuroinfectious. The most affected inferior limb was the right foot. Wagner classification of level 3 included most of the cases. The research had a successful outcome with 33 closed cases.Conclusions: the purpose of handling with diabetic foot ulcers is to prevent amputation and keeping a good quality of life. Heberprot-P is a product that modifies the amputation criteria and is a valuable option for the patient and the doctor(AU)

Off-label prescriptions in diabetic foot / Prescrições off-label em pé diabético

Prescription of a drug outside of the indications for which it was originally approved by regulators is internationally known as "off-label" prescription. We describe off-label treatments for the diabetic foot reported in international scientific literature. This is a qualitative and descriptive bibliographical review based on the results of a search of the Medline international database. The criteria for review were publication between January 1985 and November 2013, and the MeSH (Medical Subject Heading) keywords "off-label use" OR "off-label" OR "off-label prescribing" plus "diabetic foot" were input on the search form. Nine studies were selected that contained information about off-label treatments for the diabetic foot. We conclude that the practice of off-label prescribing has potential benefits. In some situations an off-label prescription is the only treatment available for patients, either because a more targeted drug does not exist, or because other methods of treatment are ineffective or unavailable due to patient intolerance...

A prescrição de um medicamento sem as indicações para as quais a droga foi originalmente aprovada por órgãos reguladores é internacionalmente conhecida como prescrição off-label. Descrevemos a terapia off-label em pé diabético, relatada na literatura científica internacional, por meio de uma revisão bibliográfica qualitativa, descritiva, através de pesquisa na base de dados internacional Medline, para seleção dos artigos. Os critérios para revisão foram publicações entre janeiro de 1985 e novembro de 2013, sendo as palavras-chave MeSH "off-label use" OR "off-label" OR "off-label prescribing" plus "diabetic foot" – colocadas no formulário de busca. Foram selecionados nove artigos com informações sobre a terapia off-label em pé diabético. Conclui-se que a prática de prescrição off-label possui benefícios potenciais em muitas situações. Em algumas circunstâncias, uma prescrição off-label é o único tratamento disponível, seja por não existir uma droga específica, seja porque outros métodos de tratamento são ineficazes ou não disponíveis por intolerância...

Impacto social de una Tecnociencia: Heberprot-P / Social impact of a Technoscience: Heberprot-P

El desarrollo acelerado de la ciencia y la técnica ha proporcionado nuevos conocimientos, entre ellos los relacionados con la biología molecular y celular y particularmente con el descubrimiento del factor de crecimiento epidérmico y su capacidad para estimular la formación de tejido de granulación y acelerar la reepitelización en las úlceras del pie diabético. Los Estudios Sociales de la Ciencia y la Tecnología constituyen un campo caracterizado por la heterogeneidad de tendencias que han ido configurando un enfoque más integral, interdisciplinario y responsable de la reflexión sobre la actividad científico-tecnológica. El artículo tiene como objetivo fundamentar el impacto social del Heberprot-P como fruto de una Tecnociencia, mediante un análisis teórico del tema(AU)

The quick development of science and technology has provided new knowledge about different matters, such as those related with the molecular and cellular biology and particularly with the discovery of the factor of epidermal growth and its capacity to stimulate the formation of granulation tissue and to accelerate the re-epithelisation in ulcers of diabetic foot. The Social Studies of Science and Technology constitute a field characterized by heterogeneity of tendencies that have been giving shape to a more integral and interdisciplinary focus responsible for the reflection on the scientific-technological activity. This article is aimed at basing the social impact of Heberprot-P as a result of a technoscience, by means of a theoretical analysis on the topic(AU)

Terapéutica ambulatoria con Heberprot-P en pacientes con úlceras de pie diabético / Outpatient therapy with Heberprot-P in patients with diabetic foot ulcers

Se realiza un estudio para determinar los resultados de la terapéutica ambulatoria con Heberprot-P en cinco Policlínicos del municipio Guantánamo, desde agosto del 2011 hasta 31 de julio del 2012. El universo de estudio está comprendido por 84 pacientes diagnosticados con úlcera del pie diabético (isquémica o neuroinfecciosa), tratados de forma ambulatoria con Heberprot-P por el grupo multidisciplinario de atención al paciente diabético. Las variables estudiadas son: edad, sexo, respuesta al tratamiento, reacciones adversas y localización de la lesión. Predominaron las edades entre 51 y 60 años, del sexo femenino. La mayoría de los pacientes obtiene una respuesta total al tratamiento. El dolor fue el efecto indeseable más frecuente de los pacientes. Se concluye que el Heberprot-P es un fármaco eficaz y seguro para acelerar la curación de las úlceras del pie diabético y prevenir la amputación(AU)

A study was performed to determine the results of outpatient therapy with Heberprot-P in five polyclinics of Guantanamo, from August 2011 to July 31, 2012. The study group is comprised of 84 patients diagnosed with diabetic foot ulcers (ischemic or neuroinfection), treated as outpatients with Heberprot-P by the multidisciplinary care team diabetic patient. The variables were studied: age, sex, and response to treatment, adverse reactions and location of the lesion. As Predominated age between 51 and 60 years old, female. Most of the patients obtained a complete response to treatment. Pain was the most frequent undesirable effect of patients. As a conclusion, Heberprot-P is an effective and safe treatment to accelerate the healing of diabetic foot ulcers and prevent amputation

Effects of a combined strengthening, stretching and functional training program versus usual-care on gait biomechanics and foot function for diabetic neuropathy: a randomized controlled trial.

BACKGROUND: Polyneuropathy is a complication of diabetes mellitus that has been very challenging for clinicians. It results in high public health costs and has a huge impact on patients' quality of life. Preventive interventions are still the most important approach to avoid plantar ulceration and amputation, which is the most devastating endpoint of the disease. Some therapeutic interventions improve gait quality, confidence, and quality of life; however, there is no evidence yet of an effective physical therapy treatment for recovering musculoskeletal function and foot rollover during gait that could potentially redistribute plantar pressure and reduce the risk of ulcer formation. METHODS/DESIGN: A randomised, controlled trial, with blind assessment, was designed to study the effect of a physiotherapy intervention on foot rollover during gait, range of motion, muscle strength and function of the foot and ankle, and balance confidence. The main outcome is plantar pressure during foot rollover, and the secondary outcomes are kinetic and kinematic parameters of gait, neuropathy signs and symptoms, foot and ankle range of motion and function, muscle strength, and balance confidence. The intervention is carried out for 12 weeks, twice a week, for 40-60 min each session. The follow-up period is 24 weeks from the baseline condition. DISCUSSION: Herein, we present a more comprehensive and specific physiotherapy approach for foot and ankle function, by choosing simple tasks, focusing on recovering range of motion, strength, and functionality of the joints most impaired by diabetic polyneuropathy. In addition, this intervention aims to transfer these peripheral gains to the functional and more complex task of foot rollover during gait, in order to reduce risk of ulceration. If it shows any benefit, this protocol can be used in clinical practice and can be indicated as complementary treatment for this disease. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01207284.

Pé em risco: prevençäo das complicaçöes secundárias ao dibetes / Foot at risk: prevention of secondaries complications in diabetis

O diabetes melitus é uma doença de caráter hereditário, plurimetabólico que compromete a produçäo e absorçäo de insulina pelo organismo. Assim sendo, o portador de diabetes requer aprendizagens e habilidades no seu estilo de vida, podendo os profissionais da saúde promover estas condiçöes, contudo, dando liberdade para o paciente estabelecer suas próprias açöes. O trabalho da enfermagem junto ao portador de diabetes é de sensibilizá-lo para a prática do autocuidado tendo em vista que na maioria das vezes suas açöes para a saúde dependem exclusivamente do seu interesse, conhecimento e preocupaçäo com seu bem estar. O autocuidado com os pés depende do grau de motivaçäo, conhecimento e disciplina que os pacientes se propöem a cumprir ao longo do tempo. O trabalho em equipe contribui e dinamiza a qualidade de assistência. Entretanto, devemos elaborar propostas de educaçäo que envolva os pacientes e ofereça condiçöes das metas a serem atingidas. O conhecimento global do diabetes, suas interaçöes e perspectivas de futuro devem estar bem fundamentados entre a equipe de profissionais e pacientes. A busca do narco teórico possibilitou maior fundamentaçäo na construçäo do conhecimento tendo como finalidade o autocuidado como meio de prevenir futuras complicaçöes, bem como, criar novas estratégias terapêuticas e metas para a continuidade da proposta deste trabalho

Uso da estesiometria e biotesiometria para o diagnóstico de polineuropatia periférica do diabete melito e do pé diabético em risco de ulceração neuropática

No presente estudo buscou-se: avaliar o desempenho da estesiometria e biotesiometria, separadamente e em conjunto, no diagnóstico da polineuropatia periférica sensitiva e motora do diabete melito; caracterizar os resultados que se obtém na estesiometria quando o paciente examinado é considerado em risco para o desenvolvimento da úlcera neuropática. Foram estudados 26 indivíduos hígidos(mulheres e homens com idade variando entre 15 e 61 anos) e 30 pacientes diabéticos(15 mulheres e 15 homens, com idade variando entre 23 e 73 anos). A sensibilidade cutânea à pressão de 10 gramas, obtida com o monofilamento 5.07 de Semmes-Weinstein foi avaliada por seis vezes em 9 pontos diferentes das regiões plantares dos pés dos pacientes.