Evaluating the Literature Gathered for DPI Project
PLEASE READ THE INSTRUCTIONS CAREFULY WITH THIS ASSIGMENT.
THE WRITER THAT WILL WRITE THIS ASSIGMENT WILL COMPLETE THIS ASSIGMENT IN WEEK 4
Pleas it has be the same writer
The purpose of this two-part assignment is to identify a minimum of 15 empirical research articles that support the intervention for your proposed DPI Project. In this topic, you will complete Part I by identifying eight of the 15 articles.
In Topic 4, you will complete Part II, make any necessary changes based on instructor feedback, and then identify an additional seven articles.
General Requirements
• Use the attached "Literature Evaluation Table – DPI Intervention" to complete this assignment.
• Refer to the "Levels of Evidence in Research" resource, located in the Class Resources.
• While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Directions
Using the "Levels of Evidence in Research" document, located in the Class Resources, identify eight empirical research articles to support the proposed intervention for your DPI Project. Complete the following steps using the attached "Literature Evaluation Table – DPI Intervention" document:
1. Present your PICOT-D question.
2. Table 1: Identify five primary quantitative research articles that support your intervention. Two of the articles must come from the United States or Canada. Three additional articles may come from any of the following countries: United Kingdom, Denmark, India, New Zealand, Germany, or Australia.
3. Table 2: Identify three primary or secondary quantitative research studies that provide additional support for your intervention or some aspect of your intervention. These four articles may come from any of the 133 countries listed on the "International Compilation of Human Research Standards," located in the Class Resources.
4. Table 3: Present the nursing and change theory that align to the DPI Project (from DNP-815A).
5. Table 4: Present the clinical guidelines that align to the DPI Project, if applicable. If you choose to implement a clinical practice guideline, include the primary research for the clinical practice guideline as part the primary quantitative research that supports your intervention (Table 1).
Learner Name:
Instructions: Use this table to evaluate and record the literature gathered for your DPI Project. Refer to the assignment instructions for guidance on completing the various sections. Empirical research articles must be published within 5 years of your anticipated graduation date. Add or delete rows as needed.
PICOT-D Question:: In adult patients with type 1 diabetes mellitus (T1DM), what is the impact of continuous glucose monitoring (CGM), in comparison to standard self-monitoring of blood glucose (SMBG) levels in reducing hypoglycemic events, enhancing glycemic control, minimizing avoidable hospital readmissions or admissions, and supporting value/cost-effectiveness?
Table 1: Primary Quantitative Research – Intervention (5 Articles)
APA Reference
(Include the GCU permalink or working link used to access the article.)
Research Questions/ Hypothesis, and Purpose/Aim of Study
Type of Primary Research Design
Research Methodology
* Setting/Sample (Type, country, number of participants in study)
* Methods (instruments used; state if instruments can be used in the DPI project)
* How was the data collected?
Interpretation of Data
(State p-value: acceptable range is p= 0.000 – p= 0.05)
Outcomes/
Key Findings
(Succinctly states all study results applicable to the DPI Project.)
Limitations of Study and Biases
Recommendations for Future Research
Explanation of How the Article Supports Your Proposed Intervention
Polonsky, W. H., Hessler, D., Ruedy, K. J., & Beck, R. W. (2017). The impact of continuous glucose monitoring on markers of quality of life in adults with type 1 diabetes: further findings from the DIAMOND randomized clinical trial. Diabetes Care, 40(6), 736-741. Retrieved from https://care.diabetesjournals.org/content/40/6/736.abstract
Assess CGM versus SMBG and its impact on the quality of life.
RCT level 1
DIAMOND (Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes). An RCT from the USA with a sample of 158 adults. Participants filled quality of life measures that assessed different variables like hypoglycemic fear, diabetes distress (DDS), health status (EQ-5D-%L), and overall well-being(WHO-5). Linear regression was used to compare changes over time. The instruments can be used in the DPI project.
hypoglycemic confidence (P < 0.001)
diabetes distress (P < 0.001)
well-being (P = 0.01)
hypoglycemic fear (P = 0.02)
CGM leads to improvement in quality of life measures like hypoglycemic confidence and diabetes distress. However, it does not improve measures linked to health status and well-being. It is linked with the most quality of life outcomes and not the glycemic outcomes.
Only focuses on adults who rely on multiple daily injections of insulin.
The study participants are also racially homogeneous, e.g., mostly educated whites.
A short trial period of 24 weeks
Include a diverse sample, e.g., teens
It offers insights about CGM and how it improves glycemic control, demonstrates cost-effectiveness, and prevents hospital admission/readmission.
Feig, D. S., Donovan, L. E., Corcoy, R., Murphy, K. E., Amiel, S. A., Hunt, K. F., ... & Pragnell, M. (2017). Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPT): a multicentre international randomised controlled trial. The Lancet, 390(10110), 2347-2359. Retrieved from /science/article/pii/S0140673617324005
Determine the effectiveness of CGM on obstetric, maternal glucose control, and health outcomes of the unborn baby.
RCT level 1
The quantitative RCT study relies on a sample of 325 women aged between 18-40 years with type 1 diabetes. The article is from the USA. The data was obtained via CGM. The instrument involves the control and experimental group. ANOVA statistical analysis was used to compare the different therapies. The same instruments might not apply to the DPI project since it will not rely on an experiment.
p=0·0171
CGM is beneficial during pregnancy since it is linked to better neonatal outcomes, which can be due to lower levels of exposure to maternal hyperglycemia. CGM is most applicable among women who are undergoing intensive insulin therapy, and self-monitoring is hard.
The study uses HbA1c as the primary outcome even though the levels can be impacted by gestational changes in anemia, red cell deviations, and using iron supplements. Other issues include withdrawals, lost or missing samples, delivery before full-term or pregnancy losses, making it harder to determine the magnitude of the differences.
Focus on data about the frequency of CGM and its link to glucose control.
Proves that CGM improves glycemic control, minimizes instances of hypoglycemic events, and reduces rates of hospital readmissions.
DeSalvo, D. J., Miller, K. M., Hermann, J. M., Maahs, D. M., Hofer, S. E., Clements, M. A., ... & T1D Exchange and DPV Registries. (2018). Continuous glucose monitoring and glycemic control among youth with type 1 diabetes: International comparison from the T1D Exchange and DPV Initiative. Pediatric Diabetes, 19(7), 1271-1275. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/pedi.12711
To evaluate the change in the rate of intermittent scanning CGM or pediatric real-time use over five years by comparing the German and US diabetes exchange registry.
Level 2 Cohort studies
Data from a registry consisting of participants who are less than 18 years. The article is from Germany. The sample comprised 29007 participants in 2011 and 29150 participants in 2016. Linear and logistic regression modeling was used. The instrument can be used in the DPI project since it relies on data from registry participants.
P < 0.001
CGM is linked to lower mean HbA1c irrespective of the insulin delivery mode (injection only or pump only)
Data regarding the brand of CGM and consistency of use among participants were not available.
There is a need to consider clinical protocols and costs of CGM that can be a barrier to use.
The article shows that CGM benefits pediatric patients since self-monitoring cannot be helpful, especially if parents are expected to conduct the procedure.
Kristensen, K., Ögge, L. E., Sengpiel, V., Kjölhede, K., Dotevall, A., Elfvin, A., ... & Berntorp, K. (2019). Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies. Diabetologia, 62(7), 1143-1153. Retrieved from https://link.springer.com/article/10.1007/s00125-019-4850-0
Analyze patterns of CGM and how it impacts adverse composite outcomes among pregnant women with type I diabetes
Level 2 Cohort studies
An observational cohort study involving 186 women from Sweden.
Instrument – different in means using differences in medians using U test and unpaired t-test. The instrument can be used in the DPI project.
Data was obtained using glucose readings from CGM devices.
p values <0.05
High glucose levels lead to a higher risk of adverse neonatal outcomes and large for gestational age (LGA)
Since it is observational, it is not possible to make causal inferences.
The women...
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