Diabetic neuropathy: pathophysiology and prevention of foot ulcers.

Diabetic neuropathy, which affects 60% to 70% of those with diabetes mellitus, is one of the most troubling complications for persons with diabetes, often leading to foot ulcers and potentially to lower limb amputations, both of which are preventable. The physiologic, structural, and functional changes associated with diabetic neuropathy and foot ulcers are discussed. Advanced practice nurses are in a unique position to implement strategies for the prevention of serious and debilitating complications from diabetic neuropathy, including foot assessment, education, and specialist referrals. Research evidence is given to support the use of the Semmes-Weinstein monofilaments to evaluate decreased plantar sensation, a common precursor to ulceration. Ongoing patient and family education can emphasize the importance of preventive self-care measures. Referrals for specialist care and therapeutic footwear can be made by advanced practice nurses. If begun early, these interventions can prevent foot ulcers from diabetic neuropathy, thereby improving the quality of life and reducing healthcare costs for this chronic disease.

Chronic amiodarone use decreases implantable cardioverter defibrillator shock efficacy

To evaluate the effect of amiodarone on implantable cardioverter defibrillator efficacy, we compared first shock conversion rates for ventricular fibrillation in 113 patients who received amiodarone to those in 641 patients who did not receive the drug. All patients received a CPI VENTAK P2 implantable cardioverter defibrillator. The first shock conversion rate for spontaneous ventricular fibrillation was lower for patients taking amiodarone (62 por cento vs 88 por cento. p < 0.01). Multivariate anysis selected amiodarone use (odds ratio 5.3) and lower first shock energy (odds ratio 0.9) as predictors of first shock failure. Conclusions: amiodarone use was associated with decreased implantable cardioverter defibrillator shock efficacy.