NSG 6999 PICOT question

NSG 6999 PICOT question
Starting this week we will be working on an Evaluation Table in Week 6.
With a minimum of 5 articles you must review the literature to find appropriate articles to support your evidence-based project.
Each article will be go through the critical appraisal process.
Complete Evidence Table as described in the Evidence Table Worksheet. Include Week 4 worksheet with completed Evidence Table.(SEE BELOW TABLES).
These are the formats & my PICOT QUESTIONS BELOW.
1: PICOT QUESTION:
In geriatric patients with Type II diabetes(P), does having a diabetic nurse educator (I) compared to not having a diabetic nurse educator (C) decrease hypoglycemic episodes of self-management (O) during a six-month time frame. (T)
Will you have a comparison group or will subjects be their own controls? Comparison
Is a ‘time’ appropriate with your question—why or why not?
11: Evidence Synthesis:
Database
Study #1 Study #2 Study #3 Study #4 Study #5 Synthesis
Population(P)
Intervention(I)
Comparison ©
Outcome (O)
Time (T)
III. Evaluation Table
Citation
Design Sample size: Adequate? Major Variables:
Independent
Dependent
Study findings: Strength and weaknesses Level of Evidence Evidence synthesis
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Complete Evidence Table as described in the Evidence Table Worksheet. Include Week 4 worksheet with completed Evidence Table.(SEE ABOVE TABLE).
NSG 6999
PICOT QUESTION:
In geriatric patients with Type II diabetes (P), does having a diabetic nurse educator (I) compared to not having a diabetic nurse educator (C) decrease hypoglycemic episodes of self-management (O) during a six-month time frame (T)?
Will you have a comparison group or will subjects be their own controls?
The research will use a comparison group to assess hypoglycemic episodes between geriatric diabetic patients who have a diabetic nurse educator and those not having an educator. The comparison will analyze outcomes to guide decision on the implementation of self-management to improve quality outcomes to the elderly patients diagnosed with diabetes.
Is a ‘time’ appropriate with your question – why or why not?
Yes. It is important to have a time limit in the clinical question considering that aspects of self-management need to be assessed in relation to confounding variables of hypoglycemic frequencies. In essence, time limit enhances a cohesive tracking of self-management practices to make a logical conclusion about the benefit of the intervention to the target population. Time in the clinical question helps to maximize the internal reliability of the given research to improve its applicability in patient care.
Evidence Synthesis:
Database: ex. Cochrane Study #1
Bhutani et al., (2015).
Study #2
Gagliardino et al., (2019).
Study #3
Hope et al., (2018).
Study #4
Sinclair et al., (2019).
Study #5
Yong et al., (2015).
Population (P) 137 diabetic elderly patients attending out-door facility of the hospital. 1316 adult participants with diabetes mellitus enrolled into the International Diabetes Management Practice Study (IDMPS) 335 Diabetic patients aged >65 years 10 study articles evaluated aspects of diabetes care for older adults (60-90 years) 20 men aged between 35 to 75 years and diagnosed with type 2 diabetes.
Intervention (I) Patients treated with oral hypoglycemic drugs; health education on hypoglycemia Participants enrolled in a diabetes education program From the total study populations, 79 patients were treated with insulin, 85 on sulphonylureas while 121 received metformin only and 50 participants had no diabetes. Data was searched from CINHAL, MEDLINE, Embase and Google Scholar to retrieve relevant review articles on the management of type 2 diabetes for older people. Participants received intensive individualized diabetes education program to influence prevention of hypoglycemic events.
Comparison (C) Diabetes care education on hypoglycemic control compared with actual practice among the population Self-management care was compared between diabetes-educated group and non-educated groups. Insulin treated patients were compared with sulphonylurea-treated patients and metformin-only treated patients together with patients without diabetes to assess the episodes of documented hypoglycemia. Up-to-date summaries of articles on glycemic control and outcome in older people with type diabetes were compared by analyzing glucose-lowering interventions with other care outcomes. This aimed to provide evidence-based individualized diabetes care. Differences in hemoglobin A1c values were identified between the control group (CG=22) and intervention group (IT=24) attending follow-up visits at 2,8,12 and 24 weeks.
Outcome (O) Improvements in knowledge, attitude and practice (KAP) of diabetic patients towards hypoglycemia. Participants who received diabetes education were more likely to practice self-management than those who had not Hypoglycemia consultation were most common for insulin-treated patients followed by the sulphonylurea-treated patients and finally metformin only-treated patients. Non-diabetic patients recorded the least documentation on the episodes of hypoglycemia. This is attributed to unrecognized hypoglycemia. Comorbid burdens among the elderly diabetic patients reduces the benefits of improved glycemic control. The intervention group demonstrated better practices in avoidance of hypoglycemia when compared to the control group. This include adherence to frequencies of physical exercise, improved dietary habits and self-monitoring of blood glucose.
Time (T) 1 month 22 months 1 year Articles published within the past five years 24 weeks
Evaluation Table:
Citation Design Sample size: Adequate? Major Variables: Independent Dependent Study findings: Strength and Weaknesses Level of Evidence
Bhutani et al., (2015). Longitudinal study design Sample size used was adequate. Actual study used 109 patients (male=63, female=46) Independent: Diabetes care education
Dependent: Improvements in KAP of diabetic patients towards hypoglycemia
Proper diabetic education improves knowledge, attitude of patients towards practice aimed at decreasing hypoglycemic episodes in diabetics.
Strength: The study compared hypoglycemic symptom score with the Stanford reference score to assess influence of diabetic education on the patients. Ensured reliability of study outcomes.
Weakness: study used a limited duration (1-month) not adequate for monitoring behavior change. Symptoms as judged by Stanford score were not backed with biochemical confirmation to affirm glycemic changes.
I
Gagliardino et al., (2019). Cross-sectional study design The study population was adequate to assess behavior change Independent: Self-management education (self-monitoring of blood glucose, self-adjustment of insulin dose)
Dependent: Attainment and maintenance of glycemic targets
Diabetes education provides knowledge and skills to improve self-management thereby favoring HbA1c target attainment.
Strengths: Use of large sample size and a standardized method of data collection ensured that outcomes provide objective outcomes for decision makers and health authorities on the importance of diabetes education and self-management to improve treatment outcomes.
Weakness: The research implemented observational study among participants across different cultures in Middle East and this was not an effective design to assess outcomes about knowledge and skills on self-management due to a lack of active participation among the study population.
I
Hope et al., (2018). Cross-sectional survey Sample size adequate and appropriate for the study. Independent: Primary care practice on patients
Dependent: Numbers of hypoglycemia consultations by both diabetic and non-diabetic patients.
Non-specific symptoms of hypoglycemia are a common presentation to primary care especially in people above 65 years with or without diabetes. Insulin-treated patients above 65 years have a higher episode of recognized hypoglycemia as compared non-diabetic patients who represent unrecognized hypoglycemia.
Strengths: Use of primary care consultation records guaranteed consistency and reliance of the outcomes.
Weakness: Inaccuracy of the outcomes especially due to the use a single primary care record which implies that outcomes on the episodes of hypoglycemia consultation could have been artificially elevated.
I
Sinclair et al., (2019). Randomized Control Trials Study articles used were adequate to predict the patterns of glycemic control among the elderly patients with type diabetes. Independent: Non-pharmacologic diabetes interventions
Dependent: Improved glycemic control.
From the studies, intensive glycemic control is important for older people with diabetes. These include the use of pharmacologic or non-pharmacologic interventions.
Strength: The studies selected contributed strongest evidence on the aspect of glycemic control for elder patients with type 2 diabetes.
Weakness: Some articles used weak study designs and this contributed to a high attrition rates in the overall outcome.
V
Yong et al., (2015). Randomized control trials The study population was 55 and this is not adequate to formulate an evidence-based practice for implementation in clinical setting. A population more than 100 would provide a bundle of evidence to evaluate outcome as it affects a larger intervention group. Independent: Intensive individualized diabetes education
Dependent: Baseline HbA1c based on the episodes of hypoglycemia reported by the target population.
Intensive individualized education on hypoglycemia provided additional benefits as it helped the intervention group to manage blood sugar control. The intervention reinforced the need for healthy life style behavior related to dietary practices and physical exercise pattern to manage blood sugar.
Strength: Reinforcement education on diabetes management followed a standard protocol as defined in the education curriculum for self-care. This ensured that intervention of practice was guided by evidence.
Weakness: The study included a small number of participants and this is not substantial to draw evidence on practice. The research was based on a limited duration (6-months) to monitor change in behavior. A QOL assessment on hypoglycemia management was not conducted in the research meaning that outcomes of the results could be affected by patient factors such as anxiety, fear or non-adherence to the education program.
I
References
Bhutani, G., Kalra, S., Lamba, S., Verma, P. K., Saini, R., & Grewal, M. (2015). Effect of diabetic education on the knowledge, attitude and practices of diabetic patients towards prevention of hypoglycemia. Indian journal of endocrinology and metabolism, 19(3), 383. DOI: 10.4103/2230-8210.152781.
Gagliardino, J. J., Chantelot, J. M., Domenger, C., Ramachandran, A., Kaddaha, G., Mbanya, J. C., … & IDMPS Steering Committee. (2019). Impact of diabetes education and self-management on the quality of care for people with type 1 diabetes mellitus in the Middle East (the International Diabetes Mellitus Practices Study, IDMPS). Diabetes research and clinical practice, 147, 29-36. DOI: 10.1016/j.diabres.2018.09.008.
Hope, S. V., Taylor, P. J., Shields, B. M., Hattersley, A. T., & Hamilton, W. (2018). Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia. Primary care diabetes, 12(2), 139-146. DOI: 10.1016/jpcd.2017.08.004.
Sinclair, A. J., Abdelhafiz, A. H., Forbes, A., & Munshi, M. (2019). Evidence?based diabetes care for older people with Type 2 diabetes: a critical review. Diabetic Medicine, 36(4), 399-413. DOI: 10.1111/dme.13859.
Yong, Y. M., Shin, K. M., Lee, K. M., Cho, J. Y., Ko, S. H., Yoon, M. H., … & Ahn, Y. B. (2015). Intensive individualized reinforcement education is important for the prevention of hypoglycemia in patients with type 2 diabetes. Diabetes & metabolism journal, 39(2), 154-163. DOI: 10.4093/dmj.2015.39.2.154.