Visit the website for the Agency for Healthcare Research and Quality (AHRQ)
at http://www.ahrq.gov/clinic/epcix.htm.
1. Locate 1 area of interest for Evidence-Based Practice in the EPC Reports section (found
under the Research tab) on the website. What does it focus on?
2. In the EBP section within the Evidence Report, what are the primary
recommendations?
Select at least 2 peers’ posts to read, and provide a thoughtful response to them. In
your replies, state whether or not you were aware of this evidence and if it is currently
being followed in your area of practice (if applicable). Feel free to post additional
resources or statements either in support of or against the evidence stated.
Your thread is due by 11:59 p.m. (ET) on Thursday of Module/Week 1, and your replies
are due by 11:59 p.m. (ET) on Sunday of the same module/week.
Discussion 1:
The Agency for Healthcare Research and Quality (AHRQ) (2020), created the Evidence-based Practice
Centers (EPCs) in 1997 to conduct evidence reports for the Effective Health Care (EHC) Program. The
EPCs are housed at universities, medical centers, and research institutions in the United States. The EPCs
produce evidence reports on medications, devices, and other health care services for the EHC Program
with the goal of helping consumers, health care professionals, and policymakers make informed and
evidence-based health care decisions. Each EPC is made up of medical researchers from a broad range of
clinical health and scientific backgrounds. The people who conduct research at the EPCs are medical
doctors, pharmacy doctors, psychologists, physical therapists, and other medical specialists. In addition,
they are also trained in different types of health research such as epidemiology, health services research,
and organizational change research (Agency for Healthcare Research and Quality, 2020).
For the subject of this topic I chose to review the AHRQ’s EPC on Methods for Insulin Delivery and
Glucose Monitoring. The primary focus of this EPC was to address the question of whether the mode of
intensive insulin therapy; multiple daily injections (MDI) or external continuous subcutaneous insulin
infusion (CSII) results in better glycemic control (Golden et at., 2012).
Key questions of the EPC ranged from:
“In patient’s receiving intensive insulin therapy, does mode of delivery (CSII vs. MDI) have a
differential effect on process measures, intermediate outcomes, and clinical outcomes in patients with
diabetes mellitus? Do these effects differ by: Type 1 or Type 2 status? Does the type of glucose
monitoring have an effect on clinical outcomes?” (Golden et al., 2012)
It was found that insulin therapy delivered by either CSII or MDI were equally effective in the reduction
of HgbA1C in both adolescents and pregnant women with type 1 diabetes. CSII had increased results on
decreasing HgbA1c in the traditional adult patient with type 1 diabetes. They studied different age
classes and also pregnant women. The article did not delve in to if there were key outcomes related to
the different type of glucose monitoring (Golden et al., 3012).
I choose to review this EPC on the subject matter of hoping to learn more on the type of glucose
monitoring having an effect on clinical outcomes. In my critical care practice, we are being made to get
new glucose monitoring devices because the FDA has stated that only certain glucose machines can be
used in the critical settings. Glucose meters are common throughout hospitals and are used for a variety
of reasons, from quick checks of glucose levels to hourly glucose level monitoring as part of intensive
insulin protocols. The FDA is seeing a difference in reading based up patients who are doing self-
management and those who are sick and critically ill. Hospitalized patients present with extremes of
hematocrit, pH, and perfusion that challenge glucose meter performance. They also often are on
intravenous drug and oxygen therapies that pose potential for interferences not found in patient self-
management. Recent incidents with maltose interference and a specific glucose meter methodology led
to death in several hospitalized patients (Klonoff et al., 2018).
A lot of hospitals are also going to software called Endo Tool to capture exact insulin dosing’s on critically
ill patients. The use of this software reduces the high possibility of patients experiencing long
hyperglycemia experiences. Those of which cause increase days in the critical care setting, increased
days on ventilators, increased risk of infections and increased mortality rates (John et al., 2018).
I found this article to be interesting, but thought it would have different outcomes and go in to more
detail on the meter usage. Although maybe that is just what I was hoping it would do since that is what I
am experiencing in this certain timeframe. Never the less, it was very educational to read up on how
MDI and CSII only has a main effect on patient’s with type 1 diabetes.
References
Agency for Healthcare Research and Quality. (2020). Evidence-based practice centers. Effective Health
Care Program. https://effectivehealthcare.ahrq.gov/about/epc
Golden, S. H., Brown, T., Yeh, H. C., Maruthur, N., Ranasinghe, P., Berger, Z., Suh, Y., Wilson, L. M., Haberl,
E. B., & Bass, E. B. (2012). Methods for Insulin Delivery and Glucose Monitoring: Comparative
Effectiveness. Agency for Healthcare Research and Quality (US).
John, S.M., Waters, K.L., & Jivani, K. (2018). Evaluating the implementation of the Endo Tool glycemic
control software system. Diabetes Spectrum, 31(1), 26-30. Doi:10.2337/ds16-0061
Klonoff, D. C., Umpierrez, G. E., & Rice, M. J. (2018). A milestone in point of care capillary blood glucose
monitoring of critically ill hospitalized patients. Journal of Diabetes Science and
Technology, 12(6), 1095-1100. doi:10.1177/1932296818801607
Response to: Jessica Bunn
Jessica- I enjoyed reading your discussion post on clinical Alzheimer’s- Type Dementia (CATD). I agree
that evidence based practice (EBP) is the foundation for excellent nursing care. The facility I work for
strives to make changes based up EBP. It provides that best and safe practice for our patients based
upon research and clinical practice. Each EBP are made up of medical researchers from a broad range of
clinical health and scientific backgrounds. (Agency for Healthcare Research and Quality, 2020).
Alzheimer’s is a very tough disease to deal with as a healthcare working and as a family member. As a
healthcare worker you never know what person you are going to get or who they are going to remember.
It is tough comforting them when they are in an unfamiliar place. It is also tough on the family members
when they aren’t remember. That can take an emotional toll on families. It makes them have hate, even
anger towards their loved one and the disease itself. We must remember what James 1:19-20 says.
“Everyone should be quick to listen, slow to speak and slot to become angry, because human anger does
not produce the righteousness that God desires.”
When reviewing the article you choose, I also found it discouraging in the fact that the research showed
that medications and supplements didn’t often help with the disease itself. We often think and want
medications and supplements to cure those who are taking them, when most generally they are taken to
decrease the progression and decrease symptoms. As in many circumstances, research is still needed to
help the actual cure of this disease.
References:
Agency for Healthcare Research and Quality. (2020). Evidence-based practice centers. Effective Health
Care Program. https://effectivehealthcare.ahrq.gov/about/epc
The Holy Bible: New international version. (2011). Grand Rapids, MI: Zondervan.
Response to Amanda Sampson:
Amanda- great review of the article on Attention Deficit Hyperactivity Disorder (ADHD). I think you had
some very valid points in your description of the article and the limitations that it found. ADHD is more
common in boys than girls and is characterized by developmentally inappropriate and impairing
inattention, motor hyperactivity, and impulsivity, with difficulties often continuing into adulthood. The
diagnosis of ADHD or hyperkinetic disorder also requires the presence of symptoms across more than
one setting (ex. home and school) and requires that the symptoms needed for diagnosis result in
impairment, for example in academic, social, or occupational functioning (Thapar & Cooper, 2016).
I liked how the article focused on the effectiveness of ADHD treatment, the long-term effectiveness of
ADHD treatment in all ages and the variability in ADHD prevalence, diagnosis and treatments, and
addresses important gaps in knowledge related to the diagnosis and labeling of ADHD (Kemper et al.,
2018). I think there is a fine line that must occur when diagnosing children. Labeling them can cause
issues with possible bulling from other children or them to retreat and defy their parents even further. I
also feel that once labeled they are at times pushed aside. They have their diagnosis now so they can
get better magically. I know from personal experience that most children don’t think to take medication
and it often gets much worst when the parent has to force them to take something for a diagnosis that
they don’t want as a child. Parents of children with ADHD must stay on top of their symptoms and
continue to manage and get new treatment plans as they age. “Direct your children onto the right path,
and when they are older, they will not leave it” (Proverbs 22:6).
References:
Kemper, A. R., Maslow, G. R., Hill, S., Namdari, B., Allen LaPointe, N. M., Goode, A. P., Coeytaux, R. R.,
Befus, D., Kosinski, A. S., Bowen, S. E., McBroom, A. J., Lallinger, K. R., & Sanders, G. D. (2018). Attention
deficit hyperactivity disorder: Diagnosis and treatment in children and adolescents. AHRQ (18).
Https://doi.org/10/23970/AHRQEPCCER203
Thapar, A., & Cooper, M. (2016). Attention deficit hyperactivity disorder. The Lancet, 387(10024).
http://dx.doi.org.ezproxy.liberty.edu/10.1016/S0140-6736(15)00238-X
The Holy Bible: New international version. (2011). Grand Rapids, MI: Zondervan.
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