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Vol. 30. Issue 2.
Pages 89-98 (March - April 2020)
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Vol. 30. Issue 2.
Pages 89-98 (March - April 2020)
Original Article
Evaluation of the risk of diabetic peripheral neuropathy: Design and validation of the NeuDiaCan nursing screening procedure
Valoración del riesgo de neuropatía periférica diabética: diseño y validación del procedimiento para cribado enfermero NeuDiaCan
Carlos E. Martínez-Albertoa,
Corresponding author
, P. Ruymán Brito-Britoa, Domingo A. Fernández- Gutiérreza, Patricia Cabrera-Garcíab, Alfonso M. García-Hernándezc, Sara Darias-Curvoc, Armando Aguirre-Jaimed
a Gerencia de Atención Primaria de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
b Servicio de Endocrinología, Complejo Hospitalario Universitario de Canarias, Servicio Canario de la Salud, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
c Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de la Laguna, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
d Departamento de Salud Pública de la Universidad Europea de Canarias, miembro de Laureate International Universities, Instituto de Investigación en Cuidados del Ilustre Colegio de Enfermeros de Santa Cruz de Tenerife, Santa Cruz de Tenerife, Spain
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Figures (2)
Tables (4)
Table 1. Initial components of the initial tentative procedure for nursing assessment of diabetic peripheral neuropathy and its corresponding scores.
Table 2. Sensitivity and validity of criteria by concordance with the confirmed diagnosis of diabetic peripheral neuropathy by electromyography of the components of the nursing procedure for the assessment of diabetic peripheral neuropathy in primary care after its second simplification.
Table 3. Sensitivity, specificity, predictive values and yield of the nursing procedure for assessing diabetic peripheral neuropathy in primary care, NeuDiaCan, optimal cut-off points obtained according to Youden’s criteria.
Table 4. Final version of the NeuDiaCan Nurse Assessment Procedure for Diabetic Peripheral Neuropathy in Primary Care.
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Abstract
Objective

To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care.

Methods

The study was carried out in three phases. 1) Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation; 2) Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability; 3) Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability.

Results

The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values.

Conclusions

NeuDiaCan as a nursing screening procedure for Diabetic Peripheral Neuropathy in Primary Care is valid, reliable and easy to use.

Keywords:
Diabetic neuropathies
Diabetic foot
Validation studies
Nursing assessment
Primary health care
Resumen
Objetivo

Diseñar y validar un procedimiento enfermero de cribado de la Neuropatía Periférica Diabética en Atención Primaria.

Método

El estudio se llevó a cabo en tres fases. 1) Construcción de un banco de ítems para conformar el procedimiento con una puntuación de salida que describiera la situación clínica del paciente; 2) Prueba y reducción del procedimiento tentativo inicial sobre una muestra de 50 pacientes usuarios de consultas enfermeras comunitarias, eliminando los componentes con baja fiabilidad inter-intra enfermeras; 3) Validación de la versión del procedimiento obtenida en el paso anterior sobre una muestra de 106 pacientes. Cálculo de validez y fiabilidad eliminando componentes con baja validez de criterio respecto a los resultados de la electromiografía diagnóstica utilizada como patrón de referencia. Se estimaron puntos de corte para el empleo del procedimiento como herramienta de cribado, valores predictivos, rendimiento, consistencia interna y fiabilidad inter-intra enfermera.

Resultados

El procedimiento tentativo inicial constó de 12 componentes que fueron reducidos a 10. En el proceso de validación de esta segunda versión el procedimiento se simplificó nuevamente, quedando conformado por 6 componentes, con un punto de corte de 2,5 en su escala de salida, punto en el que alcanza valores adecuados de sensibilidad y predictivos negativos para emplearlo como instrumento de cribado. Para este punto de corte la fiabilidad inter-intra enfermeras, validez de criterio y validez predictiva alcanzaron valores aceptables.

Conclusiones

NeuDiaCan como procedimiento de cribado enfermero de la Neuropatía Periférica Diabética en Atención Primaria resulta válido, fiable y de fácil empleo.

Palabras clave:
Neuropatías diabéticas
Pie diabético
Estudios de validación
Evaluación en Enfermería
Atención Primaria de Salud

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