The older adult with diabetes: peripheral neuropathy and walking for health.

The rate at which older individuals are being diagnosed with diabetes is increasing. Therefore, the ability of older persons with diabetes to successfully age in place is of concern for health care professionals. Diabetic peripheral neuropathy can cause changes to the foot and ankle such as loss of protective sensation, joint dislocations and fractures, and formation of cracks and fissures. With special attention to their needs, practitioners can tell older people with diabetes that walking for health can be safe and without problems and can contribute to their ability to spend the rest of their lives in their own home.

Weight-Bearing Exercise and Foot Health in Native Americans.

Diabetes contributes to sensory peripheral neuropathy, which has been linked to lower limb abnormalities that raise the risk for foot ulcers and amputations. Because amputations are a reason for pain and hospitalization in those with diabetes, it is of critical importance to gain insight about prevention of ulcer development in this population. Although the American Diabetes Association (ADA) now recommends that individuals with neuropathy can engage in moderate-intensity weight-bearing activity (WBA), they must wear appropriate footwear and inspect their feet daily. The physical forces and inflammatory processes from WBA may contribute to plantar characteristics that lead to ulcers. The purpose of this study was to compare neuropathic status and foot characteristics in Native Americans according to WBA classification. The t tests for unequal sample sizes found that exercisers had more difficulty sensing baseline temperature than nonexercisers, except at the right foot (all p values < .05). By dividing groups into no/low risk and high risk for ulcer, a majority showed no/low risk according to touch and vibration sense. Exercisers demonstrated higher surface skin temperature gradients at the first metatarsal head, a plantar site where wounds tend to form. The more consistently exercisers performed, the higher the plan-tar pressures were at the right second (r = .24, p = .02) and third metatarsal heads (r = .26, p = .01). Findings from this investigation do not refute current ADA recommendations and further intervention studies are needed that are longitudinal and measures WBA more accurately.

Effect of viscoelastic properties of plantar soft tissues on plantar pressures at the first metatarsal head in diabetics with peripheral neuropathy.

Diabetic foot ulcers are one of the most serious complications associated with diabetes mellitus. Current research studies have demonstrated that biomechanical alterations of the diabetic foot contribute to the development of foot ulcers. However, the changes of soft tissue biomechanical properties associated with diabetes and its influences on the development of diabetic foot ulcers have not been investigated. The purpose of this study was to investigate the effect of diabetes on the biomechanical properties of plantar soft tissues and the relationship between biomechanical properties and plantar pressure distributions. We used the ultrasound indentation tests to measure force-deformation relationships of plantar soft tissues and calculate the effective Young's modulus and quasi-linear viscoelastic parameters to quantify biomechanical properties of plantar soft tissues. We also measured plantar pressures to calculate peak plantar pressure and plantar pressure gradient. Our results showed that diabetics had a significantly greater effective Young's modulus and initial modulus of quasi-linear viscoelasticity compared to non-diabetics. The plantar pressure gradient and biomechanical properties were significantly correlated. Our findings indicate that diabetes is linked to an increase in viscoelasticity of plantar soft tissues that may contribute to a higher peak plantar pressure and plantar pressure gradient in the diabetic foot.

Reliability and limitations of the durometer and PressureStat to measure plantar foot characteristics in Native Americans with diabetes.

Neuropathy with excessive weight-bearing activity may lead to foot changes that place it at risk for ulceration. Information about instruments to measure plantar skin hardness and pressures of the foot in adult Native Americans with diabetes is presented. Skin hardness was measured at 10 sites (plantar side of the hallux, third and fifth toes, first, third, and fifth metatarsal heads, medial and lateral midfoot, heel, and the dorsal aspect between the hallux and second toe) with a durometer. The PressureStat yielded data about barefoot, static pressures. The durometer was shown to be reliable (r = .62 to .91) at all sites of the foot except at the third and fifth toe, the medial midsection of both feet, and at the third metatarsal head and between the hallux and second toe, the dorsal aspect of the left foot. With four raters, concordance was found to be acceptable at the hallux, the third toe, the first, third, and fifth metatarsal heads and the heel (W = .61 to .86) for the PressureStat. Since most diabetic foot ulcers occur at the hallux, first, third, and fifth metatarsal heads, both the PressureStat and durometer may be reliable screening tools to determine the degree of risk.

Weight-bearing activity and foot parameters in Native Americans with diabetes with and without foot sensation.

Amputations from diabetic foot ulcers account for substantial health care costs and pain. At the point of neuropathy, it has been recommended that weight-bearing activities (WBA) be restricted to reduce the risk of ulcers. While regular WBA has been shown to control glycemia, stress from this exercise may lead to ulcers by various processes. This investigation compared Native Americans with diabetes, with or without foot sensation and who reported regular or no leisure-time WBA, with variables of significance for risk of diabetic foot ulcers. Analysis revealed that there were no differences in barefoot standing plantar pressure or plantar skin hardness between the four groups. Further study is recommended with a larger sample and the use of instruments that are more valid and reliable.

Reported stressors and ways of coping utilized by intensive care unit nurses.

Registered nurses within the intensive care unit work within a fast-paced, highly technologic setting, caring for patients with complex needs. The purpose of this investigation was to identify stressors intensive care unit nurses perceived as most prevalent within their work setting, and the types of coping utilized by nurses in this setting. The research design was a descriptive method that utilized a survey among a convenience sample of nurses, employed within the intensive care unit setting at 7 acute care metropolitan hospitals. The quest is to foster effective coping mechanisms and reduce stress to increase staff retention, increasing job value, while increasing quality of patient care and safety.