Posted: December 4th, 2022
NRS-493 Literature Evaluation Table
NRS-493 Literature Evaluation Table
Literature Evaluation Table
Student Name:
Change Topic (2-3 sentences): Diabetes management is the topic of interest. This capstone project aims to identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among socially disadvantaged populations especially but not exclusive in-home health setting NRS-493 Literature Evaluation Table.
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| Criteria | Article 1 | Article 2 | Article 3 | Article 4 |
| Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
|
Dehnabi, A., Navipour, H., Radsepehr, H., & Al- Reza Tadayonfar, M. https://doi.org/10.32598/jccnc.3.4.251 |
White, R et al.
https://doi.org/10.1007/s11606-019-05617-z) |
Azami, G et al. https://doi.org/10.1155/2018/4930157 | Hildebrand et al. https://doi.org/10.1016/j.pec.2019.09.009 |
| Article Title and Year Published
|
2017 – Effect of discharge planning on metabolic factors in type 2 diabetic patients | 2019 – The partnership to improve diabetes education trial: A cluster randomized trial addressing health
communication in diabetes care |
2017-Effect of a nurse-led diabetes self-management education program and glycosylated hemoglobin among adults with type 2 diabetes | 2020- Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis |
| Research Questions (Qualitative)/Hypothesis (Quantitative)
|
What is the effect of discharge planning program on metabolic factors in type 2 diabetic patient?
Discharge planning is an important principle in patients’ need analysis during hospitalization in order to determine the continuity of care after discharge
|
No defined research question but comparison/evaluation of two distinct approaches to improve care for vulnerable patients. | Nurse-led diabetes self-management education intervention compared with usual care would result in improvement in hemoglobin A1C
The nurse lit diabetes self-management education intervention will improve lipid profile blood pressure, body weight, self-management behavior self-efficiency quality of life, depression, and social support |
In Latino adults with T2DM, does DSME improve glycemic control? |
| Purposes/Aim of Study | Evaluating the effect of a nursing process based proposed discharge program on controlling the metabolic factors of patients with type 2 diabetes | Translating prior health communication research to the community level and inform models of care targeting glycemic control in vulnerable populations |
To investigate the effectiveness of a nurse-led diabetes self-management education on glycosylated hemoglobin | A systematic review and meta-analysis to evaluate the evidence of the effectiveness of DSME interventions on glycemic control and research gaps in the adult Latino population with T2DM across all settings
An appraisal of systematic reviews and meta-analyses literature to assess the effects of DSME in adults with T2DM |
| Design (Type of Quantitative, or Type of Qualitative)
|
Quasi- experimental research | Cluster randomized controlled trial NRS-493 Literature Evaluation Table | Randomized controlled trial | Randomized controlled trial and Quasi- experimental research |
| Setting/Sample
|
70 participants with diabetes type II, ages 40-60 years, both male and female who were patients at Vasei Hospital, Sabzevar-Iran | 410 enrolled type II diabetic patients, 364 included in analysis across 10 unblinded, randomly assigned safety net clinics in Middle TN. Median age was 51 | Randomized 142 type II diabetic patients in hospital-based clinic located within a teaching hospital in Ilam city, Iran | 23 studies used |
| Methods: Intervention/Instruments
|
Check list, training/education sessions, medical measurement devices, sphygmomanometer, and blood test to |
A literacy-sensitive, provider-focused,
health communication intervention (PRIDE; 5 clinics)
Standard diabetes education (5 clinics)
Diabetes Numeracy Test, Short Test of Functional Health Literacy in Adults, Summary of Diabetes Self-Care Activities, Personal Diabetes Questionnaire, Adherence to Refills and Medication Scale, Diabetes Treatment Satisfaction Questionnaire, Perceived Diabetes Self- Management Scale
Clinical measures such as A1c, blood pressure, and BMI |
Booklet consisting of education on diet, physical activity, medication, monitoring of blood glucose, foot care, healthy living with diabetes, weekly group based educational session, follow up telephone call, viewing four 10-minute movie clips, questionnaire
Blood samples for fasting hemoglobin A1C, total triglyceride, total cholesterol, high density lipoprotein, low density lipoprotein, blood pressure, quality of life, depression social support |
A systematic search was conducted of Medline, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Library and Web of Science
Cochrane risk of bias tool was utilized to assess the methodological quality of studies |
| Analysis
|
Data was analyzed by pair t test, independent t-test, and chi-square using SPSS-PC (V.20) NRS-493 Literature Evaluation Table |
Adjusted mixed effects regression models were used to examine the comparative effectiveness of each approach to care
Linear mixed models for the continuous outcome measures Categorical variables with frequencies and proportions are used for summaries
χ2 tests for unadjusted comparison
All analyses were conducted with R software version 3.3.0
|
All data were analyzed using SPSS Software
Statistical significance was reported at the 0.05 alpha level, with two-tailed P values. Values are expressed as mean ± SD or n (%). Comparisons of baseline data between two experimental groups were made using Student’s t-test or Mann–Whitney
U test for continuous variables based on their normality, and the Chi-square or Fisher exact test for categorical variables
Main analyses were made on an intention to treat basis using repeated measures ANOVA. |
Data were analyzed using the Comprehensive Meta-Analysis, version 3.1 software
Sandard deviations were calculated for studies where a change in A1C was presented with confidence intervals or standard errors
Random-effects model was utilized to estimate the effect size of DSME on A1C due to the moderate heterogeneity between the studies |
| Key Findings
|
Statistically significant difference in the mean systolic blood pressure, glycosylated hemoglobin and triglyceride between the intervention and control groups.Reduction of hemoglobin glycosylated levels in type II diabetic patients.
No difference in Mean diastolic blood pressure or waist size |
Adequate health literacy was seen in 83% but numeracy deficits were common
The PRIDE trial failed to demonstrate superiority at lowering A1C relative to a rigorously delivered standard national diabetes-based education
Both programs had significant impact on glycemic control and behavioral outcomes
The PRIDE intervention
|
Participants in the intervention group showed
significant improvements in glycemic control, blood pressure, body weight, efficacy expectation, outcome expectation, self-management behaviors, and social support compared with patients in the control group
These improvements were sustained over a 24-week follow-up period.
There were no significant differences between groups in their lipid profiles |
Culturally tailored DSME programs reduce A1C levels in adult Latinos
On average, people assigned to DSME experienced 0.24 standard deviations lower in A1C value compared to those in usual care
Duration of DSME intervention was evaluated by the length of time; studies that were less than six months demonstrated the most improvement
Integrating ongoing support to the educational format may boost and maintain self-management behaviors that improve glycemic control
Integration of culturally tailored interventions for Latinos must be considered cautiously given the variation in tradition in each subculture |
| Recommendations
|
There is positive impact of discharge planning on the outcomes of post- discharge illness and the need to apply it in practice
Further studies are recommended according to the limitations |
Continued translational work to improve care delivery is needed | Implementation of a program that emphasizes collaborative learning
Further research, with extended contact time and longer follow-up, to show if our intervention has long-term effects |
Further studies to identify Latino subcultures to determine unique intervention that positively effect glycemic control across diverse population |
| Explanation of How the Article Supports EBP/Capstone Project
|
This article presents healthcare intervention inform of discharge planning to improve diabetic care | This article presents evidenced based method of community health intervention program that could be at improving glycemic control and behavioral outcome in diabetic patient | This article presents evidence that nurse lead diabetic education is effective which is one of the goals for this capstone project | This articles present evidence that culturally tailored diabetes self-management education program is also necessary for this project |
| Criteria | Article 5 | Article 6 | Article 7 | Article 8 |
| Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
|
Whitehouse et al. 10.3928/19404921-20180223-02 | McElfish et al.
doi: 10.2337/dc18-1985 |
Chakraborty et al.
https://doi.org/10.1016/j.diabres.2020.108363 |
Robbins, T et al.
https://doi.org/10.1016/j.jdiacomp.2019.01.004 |
| Article Title and Year Published
|
2018- Supporting transitions in care for older adults with type 2 diabetes mellitus and obesity | 2019 – Comparative effectiveness and maintenance of diabetes self-management education intervention for Marshallese patients with type 2 diabetes: Arandomized controlled trial | 2021 – The effectiveness of in-hospital interventions on reducing hospital length of stay and readmission of patients with Type 2 Diabetes Mellitus: A systematic review | 2019 – Risk factors for readmission of inpatients with diabetes: A systematic review |
| Research Questions (Qualitative)/Hypothesis (Quantitative)
|
Does inpatient diabetes education and homecare helps improve rates of rehospitalization and hemoglobin A1C during care transitions from hospital to home | Adapted DSME intervention would result in greater reductions of HbA1c than would the standard DSME intervention. | Is hospital-based multidisciplinary interventions for managing patients diagnosed with type 2 diabetes mellitus effective? | What are the currently understood risk factors for readmission of people with diabetes? |
| Purposes/Aim of Study | The aim of the study was to compare the effects of inpatient diabetes self-management education (DSME) plus home care, inpatient DSM only, usual care on hospital, readmission rates and glycemic control for hospitalized older adults with type 2 diabetes mellitus and obesity | The aim of the study was to assess the effectiveness of a culturally adapted family-model DSME intervention (adapted DSME) compared with that of a standard DSME intervention among Marshallese with type 2 diabetes in Arkansas NRS-493 Literature Evaluation Table | NRS-493 Literature Evaluation TableThis aimed to assess the effectiveness of multifaceted in-hospital interventions for patients with type 2 diabetes mellitus on hospital readmission, hospital length of stay (LOS), and glycated hemoglobin (HbA1c) | The aim is to identify, systematically, known risk factors for readmission to hospital, amongst people with diabetes. The intention of the study is to cast a ‘broad net’, ascertaining all known risk factors, irrespective of whether identified for a specific subset of patients (such as emergency admissions only) or generalized populations of all inpatients with diabetes |
| Design (Type of Quantitative, or Type of Qualitative)
|
Longitudinal study | Randomized controlled trial | Randomized controlled trial, non-randomized quasi-experimental studies
in a systematic review |
Prospective pilot studies; Prospective cohort studies;
Case control study; Qualitative study; Systematic review; Narrative review |
| Setting/Sample
|
A total of 180 individuals 60 or older were evaluated and enrolled based on convenience sampling n 3 different groups; on medical unit or emergency department unit, inpatient education alone, inpatient+ home care education, and usual patient without diabetic education. Patient were recruited during any medical admission to urban academic medical center in the mid-Atlantic U. S | Randomized 240 participant with type 2 diabetes status in Washington County and Benton County in northwest Arkansas
Adapted DSME delivered in participants homes Standard DSME delivered at a community center near Marshallese community |
Nine studies. Most studies comprised of a wide range of intervention components and outcome measure
Diabetic patient 18 years or older admitted to hospital Studies were mostly Asia, America, and Europe |
83 studies were selected for inclusion, predominantly from the United States
This research topic was identified as an area of priority for people with diabetes. This was both through the Diabetes Voices Programme, operated by Diabetes UK
|
| Methods: Intervention/Instruments
|
Two APRNs who were also certified diabetes educators provided patient-centered, individualized inpatient diabetes education
follow-up phone call within 24 to 48 hours of hospital discharge and again at 30 days following hospital discharge by a project manager baseline enrollment questions |
Standard DSME included 10 h of content delivered over a 6-week period and covered eight core elements: healthy eating, being active, glucose monitoring, understanding blood glucose and taking medications, problem solving, reducing risks and healthy coping, mitigating complications of diabetes, and goal setting
Adapted DSME included 10 h of content delivered over an 8-week period and covered the same eight core elements of DSME. NRS-493 Literature Evaluation Table |
Use of MEDLINE, EMBASE, Emcare, Web of Science, PsycINFO and Google Scholar search database from 2007 to current date and restricted to English
Use of PICOS (Population, Intervention, Comparison, Outcome, and Study design) framework
JBI Critical Appraisal Instruments relevant to RCTs, and quasi-experimental studies |
Systematic review was conducted according to the PRISMA standards
Literature search was performed using PubMed, EMBASE & SCOPUS databases
Quality assessment for each of the selected papers was performed against pre-determined standards
|
| Analysis
|
Statistical analyses were performed using SPSS version 23 | Power calculations accounted for model covariates by specifying the assumed R2 between the main independent variable and preplanned adjustment variables. Power was calculated by using PASS 15
0.5% (5.5 mmol/mol) change in HbA1c is considered to be a clinically important difference |
Findings are reported in narrative form, supported by figures and tables. Raw data as reported in the studies and contextual information are included | A narrative summary of risk factors identified was extracted, with subsequent thematic grouping of the risk factors
|
| Key Findings
|
Content of DSME programs needs to be adapted to older adults with different degrees of independence and comorbidity
It is important for health care providers to ensure that their patients understand key points for diabetes care during their hospital admission regardless of the length of time from diagnosis with diabetes provide support for the development of recommendations for the type and site of effective educational interventions for older adults with T2DM and obesity The overall benefits of patient education are clear |
Participants receiving the adapted DSME showed significantly greater reductions in mean HbA1c than did those receiving the standard DSME immediately after and 12 months after the intervention
finding supports the hypothesis that adapted DSME would produce greater reductions in mean HbA1c than occur with standard DSME
This study points to the potential effectiveness of mobilizing family members and cultural context in education about chronic disease self-management. |
An in-hospital intervention for patients diagnosed with type 2 diabetes can contribute to improvements in hospital LOS and HbA1c concentration
The reduction in hospital LOS ranged from half a day (0.5) to 0.8 of a day. Improvements in HbA1c concentration levels across studies were clinically significant, ranging from a mean reduction of −1.1 (±2.2) mmol/L to −2.8 (±2.7) mmol/L
here was no overt benefit for hospital readmission and no evidence of the impact of HbA1c on hospital LOS and readmission
Common strategies towards the success of multidisciplinary interventions in reducing hospital LOS and HbA1c were a dedicated care team, hospital wide approach, quality improvement focus, insulin therapy, early short-term intensive program, transition to primary care physicians, and on-going outpatient follow-up for at least 6–12 months. |
48 studies identified statistically significant risk factors for readmission
20 studies identified risk factors in generalized populations of patients with diabetes
28 studies identified risk factors for specific sub-populations of patients with diabetes
Most commonly identified risk factors being co-morbidities, age, race, insurance type, sex.
A requirement for insulin was a widely reported risk factor either before admission, during admission or subsequent to discharge
This study identifies a number of key research priorities to better sup-port patients at discharge from hospital with diabetes
This is a valuable resource to patients, clinicians and academics looking to improve the process of inpatient discharge from hospital |
| Recommendations
|
Determined type of education and setting that is most beneficial for hospitalized older adults with T2DM and obesity and if improvements in patient-centered outcomes can be measured over time. | Further study to examine contributions of culturally adapted educational curriculum | Enrollment of First Nations and ethnically diverse populations in these types of studies and addressing the social determinants of health | Further work that will lead to introducing targeted personalized interventions, in order to improve the quality of care for provided for people with diabetes |
| Explanation of How the Article Supports EBP/Capstone
|
This article highlights the need to incorporate age-appropriate educational material within this project NRS-493 Literature Evaluation Table |
The article emphasized the importance of diabetic education in the home and supporting the primary setting this capstone |
This article is a level 1 research that presents intervention to reduce readmission and hospital LOS among DMT2 patients which a question posed to be addressed in in this project | It is critical to identify risk factors that increases DMT2 morbidity/mortality in order to execute a secondary or tertiary intervention for these individuals and prevent readmission to the hospital |
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