Objective: To apply an intensive and multidisciplinary education protocol in order to decrease, improve, delay or cancel the beginning of neuropathy and the manifestation of lesions in diabetic patients. Methodology: This is a cross-sectional descriptive study carried out at the Diabetes Mellitus Outpatient Clinic and Ward of Santa Marcelina Hospital in Porto Velho. This research was based on cases of patients with Diabetes and Diabetics with Leprosy. The criteria used to include the patients were: being treated with insulin therapy, not to be amputated, being on high medication of the leprosy at the moment of the evaluation and to present nutritional risk classification by the screening. The population was divided into two groups of fifteen patients: eight diabetic patients, four male and four female. Seven diabetics associated with leprosy were 4 males and 3 females. The monofilament test (Semmes-Weinstein 10 g) was used as the classification basis. Results and Discussion: Group A, called the intensive care group, began diabetes education work with medical, nutritional and rehabilitation guidelines by a multidisciplinary team for an average period of 15 days in the ward and after discharged with biweekly monitoring. Group B, called conventional care, received the same guidelines in outpatient care and the monitoring followed the quarterly protocol. Both groups were evaluated and reassessed for a period of 180 days in the outpatient clinic. Group A consisted of 8 (100%) patients, 4 (50%) diabetics and 4 (50%) diabetics and leprosy patients. Conclusion: Intensive education in diabetes showed an improvement in the sensitivity, healing and nutritional status of the patients, leading to an improvement in quality of life and disability level, reducing or delaying the beginning of neurological complications. The protocol intensive method demonstrated a 100% improvement in patients in group A.
The health care service in hospitalized patients of Santa Marcelina Hospital treats patients with wounds of different etiologies (Leprosy, cutaneous leishmaniasis, diabetes mellitus, arterial hypertension, peripheral venous insufficiency, pressure ulcer) [
We know that the skin is the largest organ of the human being. Many times to keep the untouched skin and free from injury it is necessary to use different strategies. Therefore, this protocol provides several ways to prevent breakage of skin integrity avoiding the formation of a wound, without compromising its functions and not endangering the patient. The modern treatment is efficient and effective in achieving the entire scarring process of the lesion, with reduction of healing time, the cost of treatment and the risk of complications. Besides the best moist environment [
| Intensive Education | Level of Care | ||
|---|---|---|---|
| Evaluated and Reassessed | Group A 8 (100%) | Group B 7 (100%) | |
| 6 (75%) Patients presented improvement in the degree of sensitivity and progressed by screening without nutritional risk. | 1 (14.2%) patient had improvement. With nutritional risk | ||
| 2 (25%) patients abandoned treatment. | 2 (28.57%) patients is listed as stable. With nutritional risk | ||
| 3 (42.85%) patients with worsening status. With nutritional risk with care tertiary level | |||
| 1 (14.2%) patient abandoned treatment. | |||
| From 15 (100%) patients of study, 1 (6.6%) referring to Group A, progressed to amputation | |||
entire process of tissue remodeling. The characteristics of this best dressing have already been described by [
The strengthening of clinical research in Brazil implies the growth or consolidation of new knowledge. Brazil still has important endemics in its epidemiological context: leprosy, among others [
The healing process is directly related to the individual’s nutritional status, since several nutrients participate in the formation of new tissues [
With a mission to provide an excellent health solution, in the light of ethical, humanitarian and Christian values whose core values are Faith, Hope and Love. Forty years later, each battle can be considered a great victory, since Santa Marcelina Hospital now has 100 beds, distributed in forty beds for the surgical area and sixty beds for the medical clinic area and other Specialty Outpatient Clinic; Radiology Clinic; Clinical Laboratory; Endoscopy; Ultrasound; Urology; Neurology; Physiotherapy and Rehabilitation; Orthopedics-Neurolysis, preventive
| Group A | Recommendation | Intensive Education | Food Source |
|---|---|---|---|
| Action | |||
| Amino acids | Inflammatory phase, homeostasis proliferative phase, coagulation, activation of the local immune response | Rice, beans, wheat germ, barley, milk associated with oats, peas. | |
| VITAMIN A―750 µg | Proliferative phase, remodeling phase Regulates epidermal development; Increases the speed of collagen synthesis, deficiency: susceptibility to infections | Liver, egg yolk, green leaves like broccoli and spinach, carrot and melon | |
| VITAMIN B―3 mg | Remodeling phase Deficiency: skin dryness | Liver, dairy products, fish | |
| VIT. C―100 to 300 mg | Proliferative phase Development of collagen, improvement of tensile strength | Citrus fruits, strawberry, pineapple, guava, melon, kiwi and vegetables. | |
| VIT. K―75 µg | Inflammatory phase homeostasis, coagulation, activation of the local immune response | Liver, vegetable oils, dark green leafy vegetables such as cabbage and spinach | |
| Ferro―15 mg | Proliferative phase production of collagen | Liver, red meat, poultry, fish, egg yolk | |
| Zinc―12 - 15 mg | Proliferative phase Collagen formation, protein synthesis | Red meat, fish, poultry, liver, milk and dairy products, whole grains | |
| Copper―10 - 12 mg | Inflammatory phase, remodeling phase Antioxidant, elastin synthesis and collagen maturation | Poultry, liver, oysters, nuts, dried fruit, seafood, bread and meat | |
| Protein―42 - 84 mg | Inflammatory phase, proliferative phase, remodeling phase. Revascularization, synthesis and formation of collagen | Meat, fish, eggs, cheeses. |
and corrective; Endocrinology; Auditory Center; Reference of Prosthetics; General and Vascular Surgery.
The Hospital has a clinical staff composed of thirty-two medical doctors, with the diverse specialties fields. They range from plastic surgeries, pediatric surgeries, and orthopedic surgeries, vascular surgeries, also clinical care and much more, including that it continues to be a status of reference point in the hospital treatment of Leprosy, Diabetes and wounds.
It is a cross-sectional searching classified as descriptive because it is related to the investigation of a population defined in community, and will serve as the basis for the formulation of other researches, studies or hypotheses that can be searched. Regarding the approach, the research was a qualitative type because subjective order propositions have been admitted as well as interpretations of the authors and was still quantifiable. This research was conducted at Santa Marcelina Hospital, located at BR-364. KM-17, towards Cuiabá, outpatient clinics and Diabetes Mellitus ward. This study was based on cases of patients with Diabetes and Diabetics with Leprosy. The study demonstrates in a real way the care that must be taken in the treatment, in the approach and in the contact with the patient, demanding that the professional practice be conducted in an ethical way and above all things human values are respected [
Adult male and female patients diagnosed with infected and uninfected wounds confirmed by clinicians of Santa Marcelina Hospital and were hospitalized for at least 30 days. Being on insulin therapy, not having amputations, being on high medication of leprosy at the time of the evaluation and presenting a nutritional risk classification by screening. From March 2013 to August 2013, the population was divided into two groups of fifteen patients: eight diabetic patients, four male and four female. Seven diabetics associated with leprosy were 4 males and 3 females.
The monofilament test was used as the classification base (Semmes-Weinstein 10 g).
The collection and processing of data will be defined according to statistical standards. The techniques that will be used are: Method/WHO for Sensitivity Assessment, Application of Nutritional Anamnesis, Social Aspects, Medical Diagnosis, Measurement Information Collection, Direct and Indirect Anthropometric Measurements, Laboratory Data, Systems Assessment, Regular Feeding or 24-Hour Reminder, Food Consumption Frequency and Nutritional Diagnosis.
In order that the dietary intake did not influence the amount of nutrient found in the serum and plasma, a sample of 10 ml of blood was collected at the time of admission, the individual was fasted, considered as the first collection and after 15 days the second obeying the same initial protocol. As for visceral protein indicators, plasma proteins and extra-vascular fluids represent approximately 3% of total body proteins whereas proteins of the visceral organs constitute approximately 10%. When compared to other methods of evaluating the protein-calorie status, plasma protein measurements are fast, more accurate, cheaper and very useful for the nutrition professional, especially in the institutional health care setting.
Group A, called the intensive care group, began work on diabetes education with medical, nutritional and rehabilitation guidelines by a multidisciplinary team for an average period of 15 days in the ward and after medical discharge with biweekly monitoring. Group B, called conventional care, received the same guidelines in outpatient care and medical monitoring followed the quarterly protocol. Both groups were evaluated and reevaluated for a period of 180 days in the outpatient clinic [
This research highlights, once again, the importance of integration among the specialties in order to benefit the patient improving their quality of life. Therefore, experimental models of multidisciplinary clinic outpatient of clinics should be encouraged in clinical practice to promote a more comprehensive care on different functional aspects. Intensive education in diabetes showed an improvement in the sensitivity, healing and nutritional status of the patients, leading to an improvement in quality of life and disability, reducing or delaying the inception of neurological complications. The intensive form of the protocol demonstrated a 100% improvement in patients in group A.
Leite, O., Oliveria, V., Rodrigues, A., Albuquerque, T., Carvalho, A., Gaspar, L., Falqueti, A., de Sá, L.B.P.C. and Arbex, A.K. (2017) Diabetes Mellitus, Leprosy: Intensive Education Protocol in Foot at Risk, Santa Marcelina Hospital, Amazon, Brazil. Open Journal of En- docrine and Metabolic Diseases, 7, 52-58. http://dx.doi.org/10.4236/ojemd.2017.71006