What Does the Review Ask? Main Issue Being Researched
The presented review was aimed at understanding the existing “cardiovascular autonomic neuropathy (CAN) guidelines about epidemiology, clinical impact, diagnosis, the usefulness of CAN testing, and management” (Spallone et al., 2011, p. 639). The other objective was to update the CAN guidelines and present new ideas that can meet the health needs of many patients with diabetes. The research issue was the identification of new criteria for diagnosis and assessment of CAN in diabetes. After conducting the study, the CAN Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy concluded that an abnormal cardiovagal test indicates the possibility of CAN. Two abnormal tests should be used to confirm the presence of CAN (Spallone et al., 2011). The sign of advanced CAN is the presence of an abnormal heart rate and orthostatic hypotension.
Applying the Idea to My Practice
Several elements are outlined in this review. These elements include epidemiology, clinical impact, assessment, staging and diagnosis, clinical implication, and management of CAN. The committee observed that the epidemiology or prevalence of CAN was hampered by insufficient criteria for diagnosis. The identified risk factors for the condition include glycaemic control in diabetes type 1 and obesity, hypotension, and dyslipidemia in type 2 diabetes (Spallone et al., 2011). The presence of orthostatic hypotension was described as a clear suggestion of CAN. The researchers indicated that the CAN condition should be documented using several CARTs (cardiovascular autonomic reflex tests). The main CARTs for clinical autonomic testing include “Valsalva maneuver, blood pressure to standing, and heart rate response to deep breathing” (Spallone et al., 2011, p. 647). After confirming the nature of the situation, physicians can use various therapies and strategies to help patients with type 1 and type 2 diabetes.
The members of the CAN Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy used a powerful methodology to gather accurate and evidence-based information. The committee obtained valid results that can be used by healthcare practitioners to address the changing health needs of patients with diabetes. The systematic review focused on the existing evidence regarding the diagnosis and assessment of CAN in patients with diabetes. The gathered information made it easier for them to come up with new guidelines for assessing, diagnosing, and managing CAN (Spallone et al., 2011). The systematic review also evaluated the usefulness of continuous autonomic testing in patients with diabetes. The main focus was on the impact of CAN on health outcomes and cost-effectiveness (Spallone et al., 2011). This discussion shows conclusively that the results of the systematic review were valid.
The committee was able to present the final results that can support the health needs of many patients with diabetes. According to the results of the systematic review, two or more abnormal results for the cardiovagal test are needed to confirm the presence of CAN. Heart rate abnormalities and orthostatic hypotension are also vital signs for severe CAN. When CAN is diagnosed properly, healthcare providers “can use therapeutic interventions and foster adherence in patients with diabetes” (Martin & Lipman, 2013, p. 439). Therapy can slow down the development of this condition in type 1 diabetes. The use of insensitive multi-factorial cardiovascular risk intervention prevents CAN in patients with type 2 diabetes (Spallone et al., 2011).
The results presented in this systematic review can make a significant difference in nursing. Advanced practice nurses (APNs) are expected to provide appropriate incentives and support to their patients. As caregivers, they should be able to assess and monitor the conditions affecting their clients. The findings of the committee can, therefore, be used to identify more patients at risk of CAN. Nurses can use various CARTs to achieve this objective. The information can be used by APNs to monitor abnormal heartbeat rates and orthostatic hypotension. APNs can conduct cardiovagal tests to confirm the presence of CAN in a patient. The successful assessment of CAN in diabetic patients can help nurses design appropriate healthcare delivery models. The practitioners will use the information to manage the health condition. The article encourages healthcare workers to implement lifestyle changes or interventions as preventive measures for CAN (Spallone et al., 2011).
Funding and Objective
The systematic review was funded by the Toronto Consensus Panel on Diabetic Neuropathy. The main objective was to come up with new guidelines that can direct healthcare providers to provide evidence-based support to more patients with type 1 and type 2 diabetes. The selected committee was able to conduct an extensive literature search in an attempt to obtain positive results (Spallone et al., 2011). The final results of the study show conclusively that the intended objective was accomplished.
Strengths and Limitations of the Review
The completed study reveals several strengths that make the review applicable in different healthcare settings. To begin with, the reviewers used a powerful methodology focusing on past clinical trials and researches. The authors contrasted the existing guidelines with their new ones. This approach made it easier for them to present evidence-based ideas that can be used to diagnose, assess, and manage CAN in patients with diabetes (Johnson & Melton, 2016). The sections of the article have been presented professionally.
The information contained in the document is referenced properly. The authors also offer new issues that can be considered by future researchers (Spallone et al., 2011). For instance, future scholars can evaluate the role of lifestyle and pharmacological interventions in managing CAN (Martin & Lipman, 2013). The only weakness is that the study was limited. This gap explains why the scholars were unable to identify appropriate therapeutic approaches for dealing with CAN.
Critical Analysis of the Review: Implementing it into My APRN Practice
I strongly believe that the authors used a powerful approach to complete the study. They focused on the existing guidelines and presented amendments that can revolutionize the nature of healthcare delivery for patients with diabetes (Vahidi, Shahmirzadi, Shojaeizadeh, Haghani, & Nikpour, 2015). The proposed topics for future studies can present new ideas that have the potential to make a difference in nursing. The information can be used to monitor abnormal heartbeat rates and orthostatic hypotension. Advanced Practice Registered Nurses (APRNs) can conduct cardiovagal tests to confirm the presence of CAN in a patient.
The successful assessment of CAN is capable of guiding nurses to offer appropriate medical care to diabetic patients. Nurse practitioners will use the information to manage the condition and meet the needs of patients with CAN. Drugs capable of reducing HRV should never be administered whenever providing nursing care to clients with CAN (Spallone et al., 2011). APRNs can also use CARTs as endpoints in clinical trials or prospective observations. In conclusion, the results presented in the article apply to my advanced practice nursing.
References
Johnson, N., & Melton, S. (2016). Perceived benefits and barriers to the diabetes prevention program. The Plaid Journal, 2(1), 16-24.
Martin, A., & Lipman, R. (2013). The future of diabetes education: Expanded opportunities and roles for diabetes educators. The Diabetes Educator, 39(1), 436-446.
Spallone, V., Ziegler, D., Freeman, R., Bernardi, L., Frontoni, S., Pop-Busui, R.,…Valensi, P. (2011). Cardiovascular autonomic neuropathy in diabetes: Clinical impact, assessment, diagnosis, and management. Diabetes/Metabolism Research and Reviews, 27(1), 639-653.
Vahidi, S., Shahmirzadi, S., Shojaeizadeh, D., Haghani, H., & Nikpour, S. (2015). The effect of an educational program based on the health belief model on self-efficacy among patients with type 2 diabetes referred to the Iranian Diabetes Association in 2014. Journal of Diabetes Mellitus, 5(1), 181-189.