Research Critiques and PICOT Statement Final Draft

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RunningHead: PICOT Question 1

RunningHead: PICOT Question 7

PICOT Question

Avery Bryan

NRS-433V

Professor Christine Vannelli

May 19, 2019

Clinical Problem

A report from the Center for Disease Control and Prevention in 2015 revealed that (9.4%) 30.3 million Americans are diabetic and 84.1 million have prediabetes. This is a total population of over 100 million is at risk of developing type 2 diabetes which is a growing health problem being the seventh leading cause of death in the U.S. An estimated 1.5 million new cases were among 18-year old bracket and the rates of diagnosed diabetes increased proportionally to age. Below 44 years accounted for 4%, below 64 years at 17 % and 25% for those above 65 years across both genders. One-third of adults in America has prediabetes but sadly, they are unaware despite reports released by The National Diabetes Statistics Report every year. These reports elaborate on prevalence and incidence, prediabetes, long-term complications, risk factors, mortality, and cost. Diabetes poses the risk of serious complications like death, blindness, stroke, kidney disorders, cardiac diseases and health problems that lead to amputation of legs. However, the risks can be mitigated through physical body activities, proper dieting and prescribed use of insulin and other related measures to control the blood sugar levels. Diabetes Prevention Program was funded by NIH to research a yearly evidence-based program to improve healthy weight loss through diet and physical activities. There also efforts to determine the effectiveness of public service campaigns in improving the real-life experience in the diagnosis and treatment of diabetes.

PICOT Question.

The population affected by diabetes cuts across all ages, gender, race, and ethnicity. The prevalence is significantly high from 18 years and it increases with age to about 25% above 65 years. In terms of gender, men are at higher risk accounting for 37% while women are at 30% across races and educational levels. On races, the rates were higher among Indians/Alaska natives at 15%, non-Hispanic blacks at 12.7% and Hispanics at 12%. Among Asians, the rates were lower at 8% and 7.4% for non-Hispanic whites.

Intervention indicator for diabetes shows that individuals who do not observe a healthy diet are more exposed to the disease. Some risk behaviors include lack of exercise and excessive intake of junk foods that lead to obesity and increased blood sugar levels. Diabetes prevalence varied according to education levels were those with less than high school education at 12.6% and 7.2% for those higher than high school education.

Comparison and use of a control group from the popularity of Complementary and Alternative Medicine and Traditional Chinese Medicine showed distinct knowledge of diabetes, blood sugar control, and self-care. The experimental group received education through interactive multimedia for three months while the control group received a routine patient education for 3 months.

The outcome of diabetes includes risk factors and accuracy of diagnosis. Obesity, impaired glucose tolerance, insulin resistance, ethnic background, age, and sedentary lifestyle are the leading factors. Diagnosis is usually accurate by determining the blood sugar levels and analyzing genetic combinations to establish the possibility of prediabetes condition. Adverse effects of diabetes like blindness and amputations occur to patients who have delayed in seeking medication but early treatment can prevent such cases.

The Time it takes for interventions to be effective can be two years just as The National Diabetes Statistics Report is released. The report provides relevant information on prevalence, risks, and complications, mortality, and costs in America. Such information can be used to determine how effective the interventions are in controlling diabetes.

Literature Evaluation Table

Qualitative

Criteria	Article 1	Article 2	Article 3
Author, Journal (peer-reviewed) working link to access the article	Campbell, R., Pound, P., Pope, C., Britten, N., Pill, R., Morgan, M., & Donovan, J https://www.sciencedirect.com/science/article/abs/pii/S0277953602000643	Greenhalgh, T. https://europepmc.org/abstract/med/12227121	Jansink, R., Braspenning, J., van der Weijden, T., Elwyn, G., & Grol, R https://bmcfampract.biomedcentral.com/articles/10.1186/1471-2296-11-41
Article Title and year Published	Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social science & medicine, 56(4), 671-684 (2003)	Integrating qualitative research into evidence-based practice. Endocrinology and metabolism clinics of North America, 31(3), 583-601. (2002)	Primary care nurses struggle with lifestyle counseling in diabetes care: a qualitative analysis. BMC family practice, 11(1), 41. (2010)
Research Question (Qualitative/ Quantitative) Purpose of the study	To purposely evaluate adult patients’ perspective of diabetes	Provide a rigorous study in diagnosis, prognosis, prevalence, and therapy to clinical decision-making in endocrinology	To develop an implementation strategy to improve lifestyle behavior change in diabetes patients
Design, (Type of Qualitative or Quantitative) research	A quasi-experimental design was used	Exploratory qualitative analysis of data	The retrospective cohort analysis study
Setting/ Sample	Diabetes patients and prediabetes and their caregivers were involved in answering questions about the disease.	The study involved medical practitioners and patients of diabetes.	The research was conducted with nurses in Dutch general practices to give a view of the challenges they face in advising patients.
Methods; Interventions/ Instruments	A short self-administered questionnaire was used.	Face to face interviews and collection of written data	Data were obtained from Dutch general practice from nurses and other professionals.
Analysis	Descriptive statistical analysis using percentages, averages and standard deviations	The confirmatory data analysis method	Bivariate analysis was used to evaluate the responses
Key Findings from the Research	Caregivers were personally concerned with the patients’ conditions Diabetes is preventable and if patients and those at risk make efforts to control it	It is possible to make positive changes in the endocrinology field like diabetes using comprehensive research	Nurses lack the skills for counseling the patients and they use the traditional approach to train patients
Recommendations for the study	There should be consistent screening and provision of proper guidelines to patients by medical officers and caregivers	The public should be provided with sufficient information concerning the importance of physical exercises	Nurses should be trained on how to impact motivation in patients towards changing lifestyle in regards to controlling diabetes.
Explanation of how Article supports the Capstone	The article is connected to the topic by providing suggestions to control diabetes The articles also give an insight into the role of caregivers and medical practitioners	The article is important to the project because physical exercise is one of the important measures in regulating blood sugar levels	This article is important because it shows how motivating patients to change lifestyle can impact the fight against diabetes. It also shows that nurses play an important role in changing lifestyles.

Quantitative

Criteria	Article 1	Article 2	Article 3
Author, Journal (peer-reviewed) working link to access the article	Lanza, I. R., Zhang, S., Ward, L. E., Karakelides, H., Raftery, D., & Nair, K. S https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0010538	Singh, G. M., Danaei, G., Farzadfar, F., Stevens, G. A., Woodward, M., Wormser, D., ... & Di Angelantonio, E https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0065174	https://europepmc.org/abstract/med/3073901
Article Title and year Published	Quantitative metabolomics by 1H-NMR and LC-MS/MS confirms altered metabolic pathways in diabetes. PloS one, 5(5), e10538. (2010)	The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PloS one, 8(7), e65174 (2013)
Research Question (Qualitative/ Quantitative) Purpose of the study	Analyze pathways known to be affected by insulin deficiency in the body of diabetes patients	Establish the risk of cardiovascular disease in epidemiological studies with estimates using effect sizes of age and sex where possible	Perform an analysis of endocrine and exocrine pancreas in relation to diabetes
Design, (Type of Qualitative or Quantitative) research	The quasi-experimental method was followed	A cohort pooling study	A case-control study
Setting/ Sample	The study was carried out on patients concerning levels of insulin and hormones with profound effects on carbohydrates, fats and protein metabolism.	The study was conducted on the basis of age especially the elderly who are at higher risk of suffering from diabetes	It was done on immunoperoxidase stained post-mortem tissues of 15 type-2 diabetes
Methods; Interventions/ Instruments	Basic analysis on urine cotinine, heart rate variability, and psychiatric scale.	Average of 123 cohorts provided about 1.4 million individuals and 52000 CVD cases. The data was obtained through interview and lab tests.	Data came from 15 type-2 diabetes patients with 10 matched age control sets
Analysis	Confirmatory data analysis was used for the data.	SPSS 22 version was used	Descriptive statistical analysis was used
Key Findings from the Research	This study showed that the metabolism concept applied to the clinical situation of acute insulin deprivation as associated with insulin deficiency.	Each metabolic risk factor was robustly related to Cardiovascular disorder.	Impaired insulin secretion in type 2 diabetes may be due to a decrease in B-cells and disruption on the islet structure.
Recommendations for the study	Insulin deficiency is linked to insulin deprivation which affects metabolism and causes abnormalities.	Due to the increased risk factor of diabetes with age, the elderly should receive special care to minimize the prevalence.	There should be measures to reduce the increase in A-cells in order to prevent hyperglucagonemia and diabetic subjects.
Explanation of how Article supports the Capstone	The article is important to the capstone because it relates to insulin and the role of hormones in dealing with diabetes.	The study provided robust, comparable and clear estimates of how the risk factors related to CVD and diabetes.	This is important in relating the effect of A-cells and B-cells in diabetes patients.