2.17 Working Draft NRS 490 RS LiteratureEvaluationTable 1

Literature Evaluation Table
Student Name: Harkirat Kaur
Change Topic (2-3 sentences): Diabetes Type 2, Telehealth
© 2015. Grand Canyon University. All Rights Reserved.

2
Criteria Article 1
Author, Journal (Peer-
Reviewed), and
Permalink or Working
Link to Access Article
Article Title and Year

Published
Research Questions
(Qualitative)/Hypothesis
(Quantitative), and
Purposes/Aim of Study
Design (Type of
Quantitative, or Type of
Qualitative)
Setting/Sample
Methods:
Intervention/Instrument
s
Analysis
Key Findings
Recommendations

3
Explanation of How the

Article Supports
EBP/Capstone Project
Criteria Article 2

Reviewed), and

Published
Research Questions
(Quantitative), and
Design (Type of
Qualitative)
Setting/Sample
Methods:
s
Analysis
Key Findings

4
Recommendations

Article Supports
Criteria Article 3

Reviewed), and

Published
Research Questions
(Quantitative), and
Design (Type of
Qualitative)
Setting/Sample
Methods:
s
Analysis

5
Key Findings
Recommendations

Article Supports
Criteria Article 4

Reviewed), and

Published
Research Questions
(Quantitative), and
Design (Type of
Qualitative)
Setting/Sample
Methods:
s

6
Analysis
Key Findings
Recommendations

Article Supports
Criteria Article 5

Reviewed), and

Published
Research Questions
(Quantitative), and
Design (Type of
Qualitative)
Setting/Sample
Methods:

7
s
Analysis
Key Findings
Recommendations

Article Supports
Criteria Article 6
Author, Journal (Peer- American Diabetes Association

Reviewed), and
Article Title and Year Economic Costs of Diabetes in the U.S. in 2012, 2015
Published
Research Questions
(Quantitative), and
Design (Type of
Qualitative)
Setting/Sample

8
Methods:
s
Analysis
Key Findings
Recommendations

Article Supports
Criteria

Reviewed), and

Published
Research Questions
(Quantitative), and
Design (Type of
Qualitative)

9
Setting/Sample
Methods:
s
Analysis
Key Findings
Recommendations

Article Supports
Criteria

Reviewed), and

Published
Research Questions
(Quantitative), and
Design (Type of

10
Qualitative)
Setting/Sample
Methods:
s
Analysis
Key Findings
Recommendations

Article Supports
Criteria Article 8

Reviewed), and

Published
Research Questions
(Quantitative), and

11
Design (Type of
Qualitative)
Setting/Sample
Methods:
s
Analysis
Key Findings
Recommendations

Article Supports
Article 9
Criteria
Reviewed), and Berkowitz, JAMA International Medicine

12
Article Title and Year Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the
Published Measuring Economic Insecurity in Diabetes study 2015
Research Questions
(Quantitative), and
Design (Type of Study

Qualitative)
Setting/Sample
Methods:
s
Analysis
Key Findings
Recommendations

Article Supports
EBP/Capstone

13
Notes:
1. Delivering diabetes care to people in hard-to-reach groups.
Full Text Available
Academic Journal
(includes abstract) Bellary, Srikanth; Diabetes & Primary Care, 2011; 13(6): 358-366. 9p. (Journal Article - case study, CEU, exam
questions, tables/charts) ISSN: 1466-8955, Database: CINAHL Complete
Subjects: Diabetes Mellitus, Type 2 Therapy; Psychiatric Patients; Ethnic Groups; Homeless Persons; Prisoners; Health Care
Delivery; Adolescence; Diabetes Mellitus, Type 1 Therapy; Health Services Accessibility; Adolescent: 13-18 years; Middle Aged: 45-
64 years; Aged: 65+ years; Male
https://eds-a-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=3&sid=a039d7a2-5f3e-4882-9f81-
dbb51136f442%40sessionmgr4009
2. The Association Between Food Prices and the Blood Glucose Level of US Adults With Type 2 Diabetes.
Full Text Available
Academic Journal
(includes abstract) Anekwe, Tobenna D.; Rahkovsky, Ilya; American Journal of Public Health, 2018 Supplement 6; 108 S475-S482.
8p. (Article) ISSN: 0090-0036, Database: CINAHL Complete
Subjects: Food and Beverages Economics; Blood Glucose In Adulthood; Diabetes Mellitus, Type 2 In Adulthood; Adult: 19-44 years
3. What's New in the Evolving Management of Type 2 Diabetes: Individualizing Therapy with Novel Treatment Options.

14
Full Text Available
Academic Journal
Wysham, Carol H.; Journal of Managed Care Medicine, 2018; 21(4): 47-52. 6p. (Article) ISSN: 1094-1525, Database: CINAHL
Complete
Subjects: Diabetes Mellitus, Type 2 Therapy; Disease Management; Individualized Medicine
4. Margaret A. Powers, P. R., Joan Bardsley, M. R., Marjorie Cypress, P. R., Paulina Duker, M. R., Martha M. Funnell, M. R.,
Amy Hess Fischl, M. R., . . . Eva Vivian, P. D. (2015, June 5). Diabetes self-management education and support in type 2 diabetes A
Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of
Nutrition and Dietetics . The Diabetes Educator, 41(4), 417-430.
5. Feng, X., & Astell-Burt, T. (2017). Impact of a type 2 diabetes diagnosis on mental health, quality of life, and social contacts: a
longitudinal study. BMJ Open Diabetes Research and Care . doi:10.1136/bmjdrc-2016-000198
6. American Diabetes Association. (2013, April ). Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care, 36(4), 1033-
46.
7. Richard M. Davis, M. A., Zimmer-Galler, I. E., & Mayer-Davis, E. J. (2010, August ). TeleHealth Improves Diabetes Self-
Management in an Underserved Community. Diabetes Care, 33(8), 1712-1717. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909047/
8. Seth A. Berkowitz, M. M., James B. Meigs, M. M., Darren DeWalt, M. M., & Hilary K. Seligman, M. M. (2015, February ).
Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the Measuring Economic Insecurity
in Diabetes study. JAMA Internal Medicine, 175(2), 257-265. doi:10.1001/jamainternmed.2014.6888
9. Dunkley, A. J. (2014, April 1). Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for
the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations . Diabetes Care, 37, 922-933. doi:
10.2337/dc13-219

15
Max Points: 5.0
Submit a summary of six of your articles on the discussion board. Discuss one strength and one weakness to each of these six articles on why
the article may or may not provide sufficient evidence for your practice change.
Submit a summary of six of your articles on the discussion board. Discuss one strength and one weakness to each of these six articles on why
the article may or may not provide sufficient evidence for your practice change.
Diabetes
My research started with one list of sources and I had to change my direction about prevention and intervention for a community of homeless
people that live in the hospital area that I serve as a med-surg nurse in Oroville, California. In my work I have observed a problem with patients
that are homeless and are returning to the hospital on a regular basis due to complications such as surgery for amputations.
I am concerned and as a nurse and as a health care provider in a community that I care about. Most of these people do not have any
preventative medical access, and there are not predictable along with many other issues.
My goal is to create a community program to invest in the education of these people as well as a means of access to glucose monitoring and
nutritional support. This is a meaningful investment to avoid the continuing problems associated with this issue for all stakeholders.
Article 1
https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302330
Diabetes and Hypertension Prevalence in Homeless Adults in the United States: A Systematic
Review and Meta-Analysis
Rebecca S. Bernstein MD, MS, Linda N. Meurer MD, MPH, Ellen J. Plumb MD, and Jeffrey L. Jackson

16
Accepted: September 14, 2014
Published Online: December 18, 2014
We estimated hypertension and diabetes prevalence among US homeless adults compared with the general population, and investigated
prevalence trends. We systematically searched 5 databases for published studies (1980–2014) that included hypertension or diabetes
prevalence for US homeless adults.
We included data from 97 366 homeless adults. The pooled prevalence of self-reported hypertension was 27.0% (95% confidence interval =
23.8%, 29.9%; n = 43 studies) and of diabetes was 8.0% (95% confidence interval = 6.8%, 9.2%; n = 39 studies). We found no difference in
hypertension or diabetes prevalence between the homeless and general population.
Additional health care and housing resources are needed to meet the significant, growing burden of chronic disease in the homeless population
This article was insufficient in sample size in my opinion.
Article 2
What are the early signs of type 2 diabetes?
Last reviewed Wed 26 September 2018
By Nicole Galan
This article was helpful in helping to gather information that is easy to read and to disseminate to those that recognize early symptoms and the
importance of diagnosis and treatment.
Type 2 diabetes is a common condition. A 2017 report from the Centers for Disease Control and Prevention (CDC) found that 30.3 million
adults in the United States have diabetes. The report also estimated that another 84.1 million U.S. adults have prediabetes.
People with prediabetes have higher-than-normal blood sugar levels, but doctors do not consider them to have diabetes yet. According to
the CDC, people with prediabetes often develop type 2 diabetes within 5 years if they do not get treatment.

17
The onset of type 2 diabetes can be gradual, and symptoms can be mild during the early stages. As a result, many people may not realize that
they have this condition.
In this article, we look at the early signs and symptoms of type 2 diabetes and the importance of early diagnosis. We also discuss the risk
factors for developing this condition.
Article 3
The relationship between diabetes mellitus and 30-day readmission rates
Stephanie Ostling,et al.
Clinical Diabetes and Endocrinology20173:3
https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-016-0040-x
It is estimated that 9.3% of the population in the United States have diabetes mellitus (DM), 28% of which are undiagnosed. The high
prevalence of DM makes it a common comorbid condition in hospitalized patients. In recent years, government agencies and healthcare
systems have increasingly focused on 30-day readmission rates to determine the complexity of their patient populations and to improve
quality. Thirty-day readmission rates for hospitalized patients with DM are reported to be between 14.4 and 22.7%, much higher than the rate
for all hospitalized patients (8.5–13.5%). The objectives of this study were to (1) determine the incidence and causes of 30-day readmission
rates for patients with diabetes listed as either the primary reason for the index admission or with diabetes listed as a secondary diagnosis
compared to those without DM and (2) evaluate the impact on readmission of two specialized inpatient DM services: the Hyperglycemic
Intensive Insulin Program (HIIP) and Endocrine Consults (ENDO).
Methods
For this study, DM was defined as any ICD-9 discharge diagnosis (principal or secondary) of 250.xx. Readmissions were defined as any
unscheduled inpatient admission, emergency department (ED) visit, or observation unit stay. We analyzed two separate sets of patient data.
The first pilot study was a retrospective chart review of all patients with a principle or secondary admission diagnosis of diabetes admitted to
any adult service within the University of Michigan Health System (UMHS) between October 1, 2013 and December 31, 2013. We then did
further uncontrolled analysis of the patients with a principal admitting diagnosis of diabetes. The second larger retrospective study included all
adults discharged from UMHS between October 1, 2013 and September 30, 2014 with principal or secondary discharge diagnosis of DM (ICD-9-
CM: 250.xx).

18
Results
In the pilot study of 7763 admissions, the readmission rate was 26% for patients with DM
Conclusions
Patients with both a primary or secondary diagnosis of DM have higher readmission rates. The reasons for readmission vary; patients with a
principal diagnosis of DM have more DM related readmissions and those with secondary diagnosis having more infection-related readmissions.
DM services were used in a small proportion of patients and may have contributed to lower DM related ED revisits. Further prospective studies
evaluating the role of these services in terms of glucose management, patient education and outpatient follow up on readmission are needed
to identify interventions important to reducing readmission rates.
Article 4
https://www.dhcs.ca.gov/services/medi-cal/Pages/Diabetes-Prevention-Program.aspx
This was a good article to model a program after even though it only targeted the Medi-Cal and Medicaid population.
California state law requires the Department of Health Care Services (DHCS) to establish the Diabetes Prevention Program (DPP) as a Medi-Cal
covered benefit. Medi-Cal's DPP benefit will be consistent with the federal Centers for Disease Control and Prevention's (CDC's) guidelines and
will also incorporate many components of the Centers for Medicare & Medicaid Services' (CMS') DPP in Medicare.
The DPP is an evidence-based, lifestyle change program designed to assist Medi-Cal beneficiaries diagnosed with prediabetes in preventing or
delaying the onset of type 2 diabetes. Medi-Cal providers choosing to offer DPP services must comply with CDC guidance and obtain CDC
recognition in connection with the National Diabetes Prevention Recognition Program (DPRP). DPP services will be provided through trained
peer coaches who use a CDC-approved curriculum.
Medi-Cal's DPP will include a core benefit consisting of at least 22 peer-coaching sessions over 12 months, which will be provided regardless of
weight loss. In addition, beneficiaries who achieve and maintain a required minimum weight loss of 5 percent from the first core session will
also be eligible to receive ongoing maintenance sessions, after the 12-month core services period, to help them continue healthy lifestyle
behaviors. The CDC's DPP curriculum promotes realistic lifestyle changes, emphasizing weight loss through exercise, healthy eating and
behavior

19
One of the most impressionable articles that I have read makes it clear while the homeless don’t have access, nor can they navigate the
bureaucracy of healthcare management.
Article 5
https://www.cdc.gov/diabetes/prevention/pdf/prediabetestest.pdf
This was an interesting article that indicated many of the prediabetic warning signs that might alert an at risk population from creating a
personal and even wider burden on society.
Article 6
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001488.pub4/abstract
Main results
Of the 12 RCTs included, the effect of patient education on primary end points was reported in only five. Pooling of outcome data was
precluded by marked, mainly clinical, heterogeneity. One of the RCTs showed reduced incidence of foot ulceration (risk ratio (RR) 0.31, 95%
confidence interval (CI) 0.14 to 0.66) and amputation (RR 0.33, 95% CI 0.15 to 0.76) during one‐year follow‐up of diabetes patients at high risk
of foot ulceration after a one‐hour group education session. However, one similar study, wloss oith lower risk of bias, did not confirm this
finding (RR amputation 0.98, 95% CI 0.41 to 2.34; RR ulceration 1.00, 95% CI 0.70 to 1.44). Three other studies, also did not demonstrate any
effect of education on the primary end points, but were most likely underpowered. Patients' foot care knowledge was improved in the short
term in five of eight RCTs in which this outcome was assessed, as was patients' self‐reported self‐care behaviour in the short term in seven of
nine RCTs. Callus, nail problems and fungal infections improved in only one of five RCTs. Only one of the included RCTs was at low risk of bias.
Authors' conclusions
In some trials, foot care knowledge and self reported patient behaviour seem to be positively influenced by education in the short term. Yet,
based on the only two sufficiently powered studies reporting the effect of patient education on primary end points, we conclude that there is
insufficient robust evidence that limited patient education alone is effective in achieving clinically relevant reductions in ulcer and amputation
incidence.
Education about loss of limbs gets attention from the public.

20

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Literature Evaluation Table

Student Name: Harkirat Kaur

Change Topic (2-3 sentences): Diabetes Type 2, Telehealth

© 2015. Grand Canyon University. All Rights Reserved.

Article Title and Year

© 2017. Grand Canyon University. All Rights Reserved.

Explanation of How the

Author, Journal (Peer-

Article Title and Year

© 2017. Grand Canyon University. All Rights Reserved.

Explanation of How the

Author, Journal (Peer-

Article Title and Year

© 2017. Grand Canyon University. All Rights Reserved.

Explanation of How the

Author, Journal (Peer-

Article Title and Year

© 2017. Grand Canyon University. All Rights Reserved.

Explanation of How the

Author, Journal (Peer-

Article Title and Year

© 2017. Grand Canyon University. All Rights Reserved.

Explanation of How the

Author, Journal (Peer- American Diabetes Association

© 2017. Grand Canyon University. All Rights Reserved.

Explanation of How the

Author, Journal (Peer-

Article Title and Year

© 2017. Grand Canyon University. All Rights Reserved.

Explanation of How the

Author, Journal (Peer-

Article Title and Year

© 2017. Grand Canyon University. All Rights Reserved.

Explanation of How the

Author, Journal (Peer-

Article Title and Year

© 2017. Grand Canyon University. All Rights Reserved.

Explanation of How the

© 2017. Grand Canyon University. All Rights Reserved.

Design (Type of Study

Explanation of How the

© 2017. Grand Canyon University. All Rights Reserved.

1. Delivering diabetes care to people in hard-to-reach groups.

Full Text Available

Full Text Available

© 2017. Grand Canyon University. All Rights Reserved.

Full Text Available

Subjects: Diabetes Mellitus, Type 2 Therapy; Disease Management; Individualized Medicine

© 2017. Grand Canyon University. All Rights Reserved.

Max Points: 5.0

Rebecca S. Bernstein MD, MS, Linda N. Meurer MD, MPH, Ellen J. Plumb MD, and Jeffrey L. Jackson

© 2017. Grand Canyon University. All Rights Reserved.

Accepted: September 14, 2014

Published Online: December 18, 2014

This article was insufficient in sample size in my opinion.

What are the early signs of type 2 diabetes?

Last reviewed Wed 26 September 2018

© 2017. Grand Canyon University. All Rights Reserved.

The relationship between diabetes mellitus and 30-day readmission rates

Clinical Diabetes and Endocrinology20173:3

© 2017. Grand Canyon University. All Rights Reserved.

© 2017. Grand Canyon University. All Rights Reserved.

Education about loss of limbs gets attention from the public.

© 2017. Grand Canyon University. All Rights Reserved.