pdfsecond post picot questionin hospitalized patients W r i t i n g

I HAVE TO REPLY TO 3 POST

1ST POST

PICOT question

In adults with type 2 diabetes mellitus in the outpatient setting, how does implementing weekly tele-monitoring of glucose levels compared to routine 3-month follow up visits affect glycemic control over the course of 12 months?

Level of Evidence

Upon reviewing the seven different levels of evidence in the textbook, it is clear that systematic reviews and meta-analyses possess the greatest value as the strongest level of evidence (Melnyk & Fineout-Overhoult, 2019); it would be advisable to utilize these types of articles when attempting to support the implementation of new practice measures. Caldwell and Bennett (2020) state that systematic reviews decrease bias by assessing a number of different articles on a particular topic in an attempt to eliminate bias and provide quality data. Meta-analyses are similar in that they summarize quantitative data found in the articles of interest, making it easier to determine the legitimacy or efficacy of a certain intervention on a much grander scale (Caldwell & Bennett, 2020).

In conducting the literature search, there were a number of articles that stood out. One in particular, The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic and meta-analysis of systematic reviews of randomized controlled trials, seemed promising. Not only would it be classified as level I on the levels of evidence, but it contained most of the key words of the PICOT question. The article attempts to verify the efficacy of telehealth and remote monitoring on improving glycemic control by conducting a systematic review of systematic reviews they found regarding this topic. They concluded that remote monitoring and telehealth did result in improvements in HbA1c levels; the article also alludes to future areas of inquiry, as there was no consistency on remote monitoring/telehealth delivery methods, duration of follow up periods, sample size or baseline HbA1c levels (Lee et al., 2018). This provides more than enough evidence that although this topic has been explored and studies generally support the efficacy of telehealth in improving glycemic control in diabetic patients, more research must be done in order to figure out what best practice is regarding delivery of tele-monitoring.

References

Caldwell, P. H. Y., Bennett, T. (2020, June). Easy guide to conducting a systematic review. Journal of Paediatrics & Child Health, 56(6), 852-856. https://doi.org/10.1111/jpc.14853 (Links to an external site.)

Lee, P. A., Greenfield, G., Pappas, Y. (2018, June). The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: A systematic and meta-analysis of systematic reviews of randomized controlled trials. BMC Health Services Research, 18(1), 1-10. https://doi.org/10.1186/s12913-018-3274-8 (Links to an external site.)

Melnyk, B. M., Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare (4th ed.). Wolters Kluwer.

The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes- a systematic review and meta-analysis of systematic reviews of randomised controlled trials.pdf

SECOND POST

PICOT Question

In hospitalized patients with central access devices (P), how does the use of daily chlorohexidine baths (I) compared with daily baths of soap and water, impact the incidence of CLABSI (O) within a hospital stay (T)?

Level of Evidence

When searching for the best possible evidence, the elements of the PICOT question need to be considered. Using keywords from the PICOT question, it has been found to best answer an intervention question with a meta-analysis or systemic review. These two types are considered to be the strongest level of evidence to base those treatment decisions (Melnyk & Fineout-Overhoult, 2019). The peer reviewed journal article I chose is considered to be classified as a Level 1 on the rating system of the hierarchy of evidence for intervention questions. The article uses a meta-analysis method. A meta-analysis is at the highest part due to it using pooled analysis of several randomized controlled studies to form its review. However, there are sources that place a systemic review over a meta-analysis and vice versa. A meta-analysis is different from a systemic review in that the results are from two or more individual quantitative studies and are summarized by using the measure of effect that allows the statistics to be compared and combined (Ingham-Broomfield,2016).

The article I chose to support my PICOT question “The effects of chlorhexidine gluconate bathing on health care-associated infection in intensive care units: A meta-analysis”, did just that. The meta-analysis used studies from Pubmed, Embase and Cochran databases. Cochran Collaboration was used to evaluate all the publications for the study. A total of eighteen studies were included. The finding indicated that daily CHG baths decreased the acquisition of CLABSI (Kim et al., 2016).

References

Ingham-Broomfield, R. (2016). A nurses’ guide to the hierarchy of research designs and evidence. Australian Journal of Advanced Nursing, 33(3), 38-43. Retrieved January 11, 2021, from http://search.proquest.com.ezproxylocal.library.no…

Kim, H. Y., Lee, W. K., Na, S., Roh, Y. H., Shin, C. S., & Kim, J. (2016). The effects of chlorhexidine gluconate bathing on health care–associated infection in intensive care units: A meta-analysis. Journal of Critical Care, 32, 126-137. doi:10.1016/j.jcrc.2015.11.011

Melnyk, B. M., Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare (4th ed.). Wolters Kluwer.

The_effects_of_chlorhexidine_g.pdf

THIRD POST

PICOT Question

(P) In young adult female patients with exercise-induced asthma, (I) does using a rescue inhaler regularly increase the probability that (C) one then becomes dependent on inhalers, compared to similar (O) patients who do (P) In young adult female patients with exercise-induced asthma, (I) does using a rescue inhaler regularly increase the probability that (C) one then becomes dependent on inhalers, compared to similar (O) patients who do not use inhalers?

Level of Evidence

The scholarly article selected to support the above picot question supports intervention in the formulated PICOT question titled, “A modified breathing exercise program for asthma is easy to perform and effective.” Some asthmatic patients use breathing exercises, but they are also difficult to execute and time-consuming. A simple, updated breathing exercise program was evaluated in this research in terms of ease of performance and efficacy as an adjunctive therapy. In this study, a total of 74 subjects were enrolled. Nonetheless, for 52.9 percent of the participants, the intervention improved breathing, while 67.6 percent thought that their everyday life was enhanced, and 66.1 percent noted that the exercises required reduced use of a rescue inhaler (Karam et al., 2016). It was noticed that a simple breathing exercise program was reliable and could be completed in less than 10 minutes per day. There was, besides, a statistically important increase in post-exercise ACT ratings. The best way to avoid exercise-induced asthma is to effectively control the symptoms of asthma. If necessary, it also recommends taking additional medication before exercising. Well-controlled asthma leads to fewer symptoms and almost normal lung function (Karam et al., 2016). Despite these growing consequences, asthma adherence is still a poorly understood issue that results in inadequate control of asthma.

A well-built PICOT question increases the probability that the best evidence will be quickly and efficiently identified to guide practice. The strongest level of evidence is given by a level 1 rating which includes systematic and meta-analyses reviews with the highest level of evidence (Melnyk & Fineout-Overholt, 2019). Hence, after reviewing the seven levels of the evidence hierarchy, the chosen article is classified as level 1 because it is based on evidence-based systematic and meta-analyses reviews of randomized controlled trials. It is important for nurses to know and appreciate the hierarchy of evidence so that they can recognize the reliability of research papers and apply them to practice.

References

Karam, M., Kaur, B. P., & Baptist, A. P. (2016). A modified breathing exercise program for asthma is easy to perform and effective. Journal of Asthma, 54(2), 217–222. https://doi.org/10.1080/02770903.2016.1196368 (Links to an external site.)

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer Health.

A modified breathing exercise program for asthma is easy to perform and effective.pdf