Pancreatic exocrine insufficiency in diabetes is associated with autonomic dysfunction.

OBJECTIVES: Pancreatic exocrine insufficiency (PEI) is prevalent in diabetes. Pathophysiological theories imply autoimmune destruction, lack of trophic effects of insulin or impaired neuronal stimulation, but the relationship between PEI and autonomic dysfunction is largely unknown. In a pilot study, we aimed to investigate if patients with diabetes and PEI had impaired autonomic function. METHODS: We measured faecal elastase in 59 patients with type 1 or 2 diabetes, using a cut-off-value <200 µg/g to define PEI. Based on faecal elastase results, patients were stratified into matched case (n = 8) and control groups (n = 13). We used heart rate variability, baroreflex sensitivity and orthostatic hypotension tests to assess autonomic dysfunction. RESULTS: All baroreflex sensitivity parameters were reduced in cases with PEI compared with controls (all p < .05). The heart rate variability parameters root mean square of successive RR interval differences (p = .05) and high frequency (p = .04) were also reduced. We found no difference in orthostatic hypotension between the groups. CONCLUSIONS: In this first-of-its-kind study, we found that diabetes patients with PEI had reduced autonomic function compared with matched controls. Although numbers are small, results support the hypothesis that autonomic dysfunction could be a contributor to PEI in diabetes.

Instrument Manufacturing: Implications for Perioperative Teams.

The development of surgical instruments began thousands of years ago and continues to evolve. National and international government agencies regulate the manufacturing of instruments in some cases, and the differing regulations can affect instrument quality. Although stainless steel contains an alloy of iron and chromium with other metal and nonmetal materials, its composition can vary; this variation may cause instruments to function differently than expected. The manufacturing process for surgical instruments is complex, and perioperative nurses should understand the process to assist with purchasing decisions. When making these decisions, perioperative nurses should partner with surgeons, sterile processing department personnel, and the manufacturers' representatives to discuss the scope of use and plans for reprocessing. Surgical instruments' functionality can affect procedure efficiency, patient outcomes, and surgeon satisfaction. Knowledge about surgical instrument manufacturing should help perioperative teams provide safer care for their patients.

Common breaks in sterile technique: clinical perspectives and perioperative implications.

Prevention of health care-associated infections, specifically surgical site infections, is a fundamental responsibility of the perioperative team. Breaks in sterile technique can and do occur, even for the most conscientious perioperative practitioners. Surgical site infections are associated with unnecessary patient pain and suffering and increased lengths of hospital stay and health care costs. Prevention of surgical site infections, therefore, takes on great significance in today's dynamic health care environment. Key responsibilities of perioperative nurses are to recognize and correct common breaks in sterile technique that are made in preparation for and during a surgical procedure and to implement methods to prevent future occurrences.