N-5370 PICOT Question Evidence Table Template Paper

N-5370 PICOT Question Evidence Table Template Paper

N-5370 PICOT Question Evidence Table Template Paper

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School of Nursing

N-5370

PICOT Question Evidence Table Template

Student:

 

Date:
Statement of Question:

Type 1 diabetes in younger children can be extremely challenging for various reasons. One is the fact that they are still learning how to communicate, sharing symptoms and abnormal physiological and psychosocial functions are not quite there yet to share and tell the symptoms they are experiencing. It is obvious that parents do struggle to maintain and manage the sugars to avoid hyper or hypoglycemic levels unless there is a constant sugar monitoring, and having uncontrolled glucose levels can lead to DKA and hospitalizations. It seems like a transdermal glucose monitor can be an easier, less painful, and more effective way to maintain and help monitor the management of diabetes type 1 in younger children. One of reasons can be that it tracks daily glucose levels and reports hyper or hypoglycemia episodes. Which implies this method is a better way to treat the disease and give insulin treatments. In my opinion, it seems like transdermal glucose monitoring can be validated to decrease DKA hospitalizations.

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Identification of PICOT elements (separate the elements of your question into the appropriate box)
Population

 

Children aged 3-12 with type 1 diabetes hospitalized with diabetes ketoacidosis

 

 

Intervention

 

Transdermal glucose monitoring

Comparison

 

Finger stick glucose monitoring

Outcome

 

Decreases DKA hospitalizations

Time Frame

 

Six months

Article/Citation/Year Type of Article or Study / Level of Evidence Sample Size Article or Study Results Strengths and Weaknesses Implications Your conclusions regarding the value to your Research interest
Janapala, R. N., Jayaraj, J. S., Fathima, N., Kashif, T., Usman, N., Dasari, A., Jahan, N., & Sachmechi, I. (2019). Continuous Glucose Monitoring Versus Self-monitoring of Blood Glucose in Type 2 Diabetes Mellitus: A Systematic Review with Meta-analysis. Cureus, 11(9), e5634. https://doi.org/10.7759/cureus.5634

 

 

Systematic Review with Meta-analysis

Level- I

5 RCTs The article found a varying level of evidence supporting that employing a Continuous glucose monitors (CGM) can reduce glycated hemoglobin (HbA1c), hypoglycemic events, and increase patient satisfaction. Strengths- The study conducted literature search of RCTs.

Weaknesses- The literature search was conducted only in one electronic database, Medline (PubMed) database.

The metrics of CGM have to be standardized so that they can be widely adopted into clinical practice. The article is valuable to PICOT since it shows that the use of CGM in patients with diabetes mellitus is beneficial, as it markedly reduces HbA1c compared to the usual method of self-monitoring of blood glucose (SMBG).
Boscari, F., Vettoretti, M., Cavallin, F., Amato, A. M. L., Uliana, A., Vallone, V., … & Bruttomesso, D. (2022). Implantable and transcutaneous continuous glucose monitoring system: a randomized cross over trial comparing accuracy, efficacy and acceptance. Journal of Endocrinological Investigation, 45(1), 115-124.

https://doi.org/10.1007/s40618-021-01624-2

Randomized crossover trial 

Level I

16 subjects ·                     While using Eversense implantable sensor (EVS) time spent in range increased and time spent in hyperglycemia decreased.

·                     Dexcom G5 transcutaneous sensor (DG5)  was used more than EVS

·         The researchers employed a randomized crossover trial which minimized the risk of confounding since both interventions were measured on the same participants.

·         Weaknesses- The study was powered to compare the accuracy between the devices (as primary outcome), while the comparison of secondary outcomes may be hindered by the limited sample size.

The study reveals how different CGM systems affect, under real-life conditions, glycemic control, sensor use and acceptance by patients. The article is valuable to my PICOT question since it gives insights that

Continuous glucose monitoring characteristics need to considered when prescribing Transdermal glucose monitoring devices.

 

Langford, S. N., Lane, M., & Karounos, D. (2021). Continuous Blood Glucose Monitoring Outcomes in Veterans With Type 2 Diabetes. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 38(Suppl 4), S14–S17. https://doi.org/10.12788/fp.0189

 

Retrospective Review

Level- III

Total population-175

Adherent group- 40

Both the total population and the adherent subgroup had an improved HbA1c, weight, and systolic BP.

There was also a decrease in the total encounters for DM complications.

Adherent patients had more reduction in weight and hospital or clinic visits with Continuous glucose monitoring (CGM).

Strengths- Strengths of this study include specificity to the veteran population using VA resources, and including non-diabetes outcomes.

Weaknesses- Applying a retrospective design, a small sample size, and solely focusing on Type 2 diabetes.

The study establishes that CGM may offer improved disease management. The study applies to my research since it establishes that CGM is linked with reduction in weight and hospital or clinic visits.

Thus, applying GM with a transdermal device can lower DKA hospitalizations in children.  

 

Hilliard, M. E., Levy, W., Anderson, B. J., Whitehouse, A. L., Commissariat, P. V., Harrington, K. R., Laffel, L. M., Miller, K. M., Van Name, M., Tamborlane, W. V., DeSalvo, D. J., & DiMeglio, L. A. (2019). Benefits and Barriers of Continuous Glucose Monitoring in Young Children with Type 1 Diabetes. Diabetes technology & therapeutics, 21(9), 493–498. https://doi.org/10.1089/dia.2019.0142

 

Qualitative study

Level III

79 parents The parents described  the benefits of CGM as:

      i.        Decreased worry about glucose excursions

     ii.        Improved sleep.

    iii.         Increased sense of safety with children who cannot recognize or express symptoms of hypo- or hyperglycemia.

   iv.        Greater comfort with other caregivers, especially using remote monitoring functionality when away from children.

Strength- The study careful assessed parent perceptions of CGM that allowed them to share both positive and negative experiences.

Weaknesses- The study sample was restricted to parents of children with HbA1c <10.5% and who had been diagnosed with T1D for at least 6 months.

The study highlights the importance of understanding the range of family experiences with respect to how individuals and families use diabetes technology.  

The study  is valuable to my research since it shows that CGM can address the unique challenges of Type 1 diabetes in young children and increase parental comfort with diabetes management

References

Boscari, F., Vettoretti, M., Cavallin, F., Amato, A. M. L., Uliana, A., Vallone, V., … & Bruttomesso, D. (2022). Implantable and transcutaneous continuous glucose monitoring system: a randomized cross over trial comparing accuracy, efficacy and acceptance. Journal of Endocrinological Investigation, 45(1), 115-124. https://doi.org/10.1007/s40618-021-01624-2

Hilliard, M. E., Levy, W., Anderson, B. J., Whitehouse, A. L., Commissariat, P. V., Harrington, K. R., Laffel, L. M., Miller, K. M., Van Name, M., Tamborlane, W. V., DeSalvo, D. J., & DiMeglio, L. A. (2019). Benefits and Barriers of Continuous Glucose Monitoring in Young Children with Type 1 Diabetes. Diabetes technology & therapeutics, 21(9), 493–498. https://doi.org/10.1089/dia.2019.0142

Janapala, R. N., Jayaraj, J. S., Fathima, N., Kashif, T., Usman, N., Dasari, A., … & Sachmechi, I. (2019). Continuous glucose monitoring versus self-monitoring of blood glucose in type 2 diabetes mellitus: a systematic review with meta-analysis. Cureus, 11(9). https://doi.org/10.7759/cureus.5634

Langford, S. N., Lane, M., & Karounos, D. (2021). Continuous Blood Glucose Monitoring Outcomes in Veterans With Type 2 Diabetes. Federal Practitioner, 38(Suppl 4), S14. https://doi.org/10.12788/fp.0189

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Use 7th ed. APA (title page, body of the paper – maximum 2 pages of narrative body, citation formatting, and reference page).

submit a refined background of the nursing practice problem. Max 2-3 paragraphs. Provide citations.

Identy a theory, theoretical framework, or conceptual model that may help explain your findings and provide rationale. Learners should refer to retreived articles or your theory textbook. Maximum 1 paragraph.

Report your final PICO(T) question.

Explain how your PICO(T) question evolved and the reason for the change OR substantiate why there was no need to change the developed PICO(T) question. Maximum 1 paragraph.

Attach your beginning evidence table with articles supporting the problem.

PICOT QUESTION TO BE USED

For children with ages of 3-12 who are diagnosed with type 1 diabetes and hospitalized with Diabetes Ketoacidosis, monitoring can prevent these hospitalizations, finger sticks glucose monitors or transdermal glucose monitor

P = children age of 3-12 with type 1 diabetes hospitalized with diabetes ketoacidosis

I = transdermal glucose monitor

C = finger stick glucose monitor

O = Decreases DKA hospitalizations

ATTACHED EVIDENCE TABLE TO BE FILLED OUT AND PLEASE PROVIDE WITH ARTICLES USED

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