MN504 Assignment 1 Discover Evidence-Based Data Used In Clinical Practice

MN504 Assignment 1 Discover Evidence-Based Data Used in Clinical Practice

Assignment 1

This competency assessment assesses the following Outcome:

MN504-1: Discover evidence based data used in clinical practice.

Assignment Details – Discover Evidence-Based Data Used in Clinical Practice

Purpose:
This assignment helps identify areas of clinical interest that you may have in integrating evidence into the population of interest. You will begin to find evidence as it relates to your practice of interest. (FNP)

An introduction, discussion, and conclusion are expected in the overview on this topic.

Directions:

Identify a clinical question of interest for you.
Provide an overview of databases that are available and relevant to your clinical question.
Write a 3- to 5-page paper that discusses your findings from the database, and the evidence determined.
Include a minimum of three mid- to high-level evidence-based references.

Minimum Submission Requirements

This Assessment should be a Microsoft Word document.
Respond to the questions in a thorough manner, providing specific examples of concepts, topics, definitions, and other elements asked for in the questions. Your paper should be highly organized, logical, and focused.
Your paper must be written in Standard English and demonstrate exceptional content, organization, style, and grammar and mechanics.
Your paper should provide a clearly established and sustained viewpoint and purpose.
Your writing should be well ordered, logical and unified, as well as original and insightful.
A separate page at the end of your research paper should contain a list of references, in APA format. Use your textbook, the Library, and the internet for research.
Be sure to cite both in-text and reference list citations were appropriate and reference all sources. Your sources and content should follow proper APA citation style. Review the APA formatting and citation style found in the Writing Center. (It should include a cover sheet, paper is double spaced, in Times New Roman 12-point font, correct citations, Standard English with no spelling or punctuation errors, and correct references at the bottom of the last page.)

If the work submitted for this competency assessment does not meet the minimum submission requirements, it will be returned for revision. If the work submitted does not meet the minimum submission requirements by the end of the term, you will receive a failing score.

MN504M1 Competency Assessment rubric

If work submitted for this Competency Assessment does not meet the minimum submission requirements, it will be returned without being scored.

CRITERIA	MET	NOT MET
Identified three evidence-based references to formulate a valid clinical question
[Clearly Identified three relevant evidence based references related to a clinical question]
Defined the clinical question.
[Succinctly defined the clinical question as it relates to the topic]
Summarized evidence for PICOT
[Clearly and precisely summarized the evidence for the PICOT]
Identified relevant databases
[Clearly identified databases relevant to the clinical question]
Overall # Bold Criteria Met/Not Met
[Overall # Mastery Criteria Met/Not Met]

The criterion statements in bold are the minimum requirement to show competent performance on the course outcome; all bold criteria must be met to pass this Course Outcome.

The criterion statements in [Brackets] represent mastery achievement. A predefined number of mastery criteria must be achieved to earn an A grade, indicating mastery of the Course Outcome.

CLA and Grade Criteria Chart

CRITERIA	CLA Score	Grade	Points
Meets all bold criteria and 50%-100% of mastery criteria	5	A	1,000
Meets all bold criteria and 0%-49% of mastery criteria	4	B	850
Meets 75%-99% of bold criteria	3	Not yet competent (F at term end)	0
Meets 50%-74% of bold criteria	2	Not yet competent (F at term end)	0
Meets 1%-49% of bold criteria	1	Not yet competent (F at term end)	0
Meets no bold criteria	0	Not yet competent (F at term end)	0
No submission	NA	Not yet competent (F at term end)	0

Discover Evidence-Based Data Used in Clinical Practice Example Solution Approach

Family Nurse Practitioners are important practitioners in primary care. Unlike other advanced practice nurses, they do not work with a specific population and thus function as general specialists in primary care. They identify gaps in care delivery for all populations across the lifespan. Their advanced knowledge and skills make it possible to provide advanced care to diverse populations. An FNP analyzes current problems and prepares well-structured and highly efficient care plans for the healthcare problems. Diabetes is a significant healthcare problem with high healthcare costs and mortality and morbidity rates. This essay analyzes a diabetes clinical question, reviews useful databases for research, and presents formidable data for the clinical question.

Clinical Question: Among elderly diabetic patients, does standardized patient education compared to traditional education improve self-management, adherence to interventions, and follow-up visits in six months?

Nursing research requires various considerations to ensure the data is reliable, relevant, and applicable. Thus, identifying the best and most relevant databases is vital in getting quality evidence. For diabetes care, there are several reliable and relevant databases. These databases include PubMed (NCBI), CINAHL Plus with Full Text (EBSCO), Academic Search Complete (EBSCO), and Cochrane Library (Wiley) (Welch Medical Library, 2021). PubMed (NCBI) is a database developed and managed by the national center for biotechnology information. The database is a free search engine containing medical-related articles, abstracts, and references. PubMed’s main aim is to improve health both globally and personally hence it has a collection of healthcare research articles that provide reliable evidence for application in managing healthcare problems. The database is reputable in providing all kinds of publications. However, the primary resources are rather wide-spreading, making accreditation and filtration of these resources difficult. Thus, the website may not be a reliable source of evidence.

CINAHL Plus with Full Text (EBSCO) database provides the top available nursing literature and other closely related health disciplines (Welch Medical Library, 2021). The database is vital because it allows for full-text nursing literature, not readily available in other databases. The researchers get all information without incurring costs or being limited by less available knowledge. The articles available are also peer-reviewed, making them reliable and applicable. Academic Search Complete (EBSCO) database is a leading source of scholarly literature. The database is designed for institutions, and thus the database is accessible through the institution library. It contains literature from all disciplines, including social sciences. The database has a higher preference for high-level evidence articles such as systematic reviews and randomized control trials. The articles in this database are also full text making it easy to read, understand, and apply evidence.

Cochrane Library (Wiley) is the database of choice for the Picot question. The database collects systematic reviews, which provide the highest level of evidence in research and evidence-based practices evaluation and implementation (Welch Medical Library, 2021). The systematic reviews identify an intervention for a healthcare condition or problem and analyze evidence to determine the effectiveness of the intervention. The database is free and open, with open access to majorly of the research articles. They are critically filtered and reviewed before being published, making the database a globally recognized and reputable database for systematic reviews in healthcare. These databases are vital for providing evidence for developing the PICOT question.

Diabetes is a severe clinical problem. It is the most expensive chronic illness and has a high mortality and morbidity rate; hence it is a disease of clinical significance (Riddle & Herman, 2018). Diabetes care is palliative and requires the collaboration of the patient, primary caregivers, and healthcare providers (Lee et al., 2019). Diabetes education is a vital aspect of diabetes care. Most interventions in diabetes management depend on the patient. The quality of patient education determines their self-efficacy, self-management, and overall success in diabetes care. The components of diabetes education are insulin injection and injection sites, medications and side effects, diet, exercise, disease complications (for early identification and management), and patient follow-up interventions and their importance (Ghisi et al., 2021).

Traditional patient education has no clear framework for delivering the education. Healthcare providers teach patients about diabetes care, but there is a high possibility of ignoring or forgetting components. Ignoring some aspects leads to patient knowledge deficits hence deficiencies in self-care and self-management. Structured patient education is a formidable tool in ensuring patients receive education in all diabetic care interventions (Chatterjee et al., 2018). In addition, it ensures that patients receive uniform and quality care, hence better patient outcomes. The primary aims of diabetes management are stabilizing blood sugars, achieving therapeutic targets (HbA1c tests), increasing self-efficacy and self-management, and minimizing complications (Zheng et al., 2019).

Education removes negligent excuses and promotes ethical responsibility. Diabetes follow-up visits are also vital in diabetes management. The components of follow-up visits include diabetic foot and diabetic eye examinations, HbA1c tests, treatment modality evaluation, and drug replenishment (Lee et al., 2019). Individuals rely heavily on merit systems to gauge interventions. Emphasizing the importance of follow-up visits is integral to ensuring individuals take the initiative, plan, and attend these follow-up visits without fail. These interventions are essential to providing high-quality disease management and early detection and treatment of complications. According to Rahaman et al. (2018), diabetes education on foot care decreases diabetes foot complications and increases diabetes foot examinations rates. Educating patients will improve their care-seeking behavior. Diabetes education reminds patients of the importance of these follow-up visits and the consequences of attending follow-up visits.

As mentioned earlier, standardized nursing technologies ensure patients receive uniform education (Chatterjee et al., 2018). Preparing the education checklist will require advanced knowledge and skills. As an FNP, I will utilize my advanced knowledge and skills, care collaboration, and leadership skills to gain buy-in from the healthcare leaders and develop a diabetes education checklist for the institution. The checklist will be uploaded in the electronic health system and signed when education is delivered. The checklist will be part of diabetes patient care and stored in the patient falls for record purposes and future references.

Conclusion

FNPs are advanced practice nurses with advanced knowledge which can be used to improve the health outcomes of populations across the lifespan. Formidable databases that provide articles for evidence-based practice include PubMed, Cochrane Library, Academic Search Complete (EBSCO), and CINAHL Plus with Full Text (EBSCO). They have extensive collections of articles for interventions in diabetes care. Structured diabetic patient education improves adherence to medications, increases patient follow-up visits, and improves self-management and self-efficacy. Structured patient education is thus more effective than traditional patient education. Hospitals should utilize structured patient education and diabetes education checklist to help improve diabetic patient outcomes.

References

Chatterjee, S., Davies, M. J., Heller, S., Speight, J., Snoek, F. J., & Khunti, K. (2018). Diabetes structured self-management education programs: a narrative review and current innovations. The Lancet Diabetes & Endocrinology, 6(2), 130-142. https://doi.org/10.1016/S2213-8587(17)30239-5

Ghisi, G. L. D. M., Seixas, M. B., Pereira, D. S., Cisneros, L. L., Ezequiel, D. G. A., Aultman, C., Sandison, N., Oh, P., & da Silva, L. P. (2021). Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health, 21(1), 1-16. https://doi.org/10.1186/s12889-021-11300-y

Lee, D., & Zonszein, J. (2022). Outpatient Management of Type 2 Diabetes Mellitus. In A Case-Based Guide to Clinical Endocrinology (pp. 369-385). Springer, Cham. https://doi.org/10.1007/978-3-030-84367-0_40

Rahaman, H. S., Jyotsna, V. P., Sreenivas, V., Krishnan, A., & Tandon, N. (2018). Effectiveness of a patient education module on diabetic foot care in outpatient setting: An open-label randomized controlled study. Indian Journal of Endocrinology and Metabolism, 22(1), 74. https://dx.doi.org/10.4103/ijem.IJEM_148_17

Riddle, M. C., & Herman, W. H. (2018). The cost of diabetes care—an elephant in the room. Diabetes Care, 41(5), 929-932. https://doi.org/10.2337/dci18-0012

Welch Medical Library (2021). Databases for Nursing Research. Nursing Resources. The John Hopkins University of Medicine. https://browse.welch.jhmi.edu/nursing_resources

Zheng, F., Liu, S., Liu, Y., & Deng, L. (2019). Effects of an outpatient diabetes self-management education on patients with type 2 diabetes in China: a randomized controlled trial. Journal of Diabetes Research, 2019. https://doi.org/10.1155/2019/1073131

MN504-2: Examine the Key Elements of Evidence Based Practice.

This competency assessment assesses the following Outcomes:

MN504-2: Examine the key elements of evidence based practice.

Assignment Details – Descriptive Statistics Overview

Purpose:

The purpose of this assignment is to review the statistics presented in the articles you reviewed in relation to your clinical topic. You will provide a brief overview of statistics in the studies.

Directions:

Define the clinical key question of interest.
Identify the studies of the database search that represent the highest levels of evidence found Identify the statistics discussed in the study as it relates to confidence intervals or statistical description.
Discuss the statistical results of the studies identified.
Write a 3- to 5-page paper reviewing the evidence as it relates to confidence.
Follow APA 7th edition format.

Minimum Submission Requirements

This Assessment should be a Microsoft Word document.
Respond to the questions in a thorough manner, providing specific examples of concepts, topics, definitions, and other elements asked for in the questions. Your paper should be highly organized, logical, and focused.
Your paper must be written in Standard English and demonstrate exceptional content, organization, style, and grammar and mechanics.
Your paper should provide a clearly established and sustained viewpoint and purpose.
Your writing should be well ordered, logical and unified, as well as original and insightful.
A separate page at the end of your research paper should contain a list of references, in APA format. Use your textbook, the Library, and the internet for research.
Be sure to cite both in-text and reference list citations were appropriate and reference all sources. Your sources and content should follow proper APA citation style. Review the APA formatting and citation style found in the Writing Center. To access the (It should include a cover sheet, paper is double spaced, in Times New Roman 12-point font, correct citations, Standard English with no spelling or punctuation errors, and correct references at the bottom of the last page.)

MN504M2 Reading List

Textbook Readings

Evidence-Based Practice in Nursing and Healthcare

“Finding Relevant Evidence to Answer Clinical Questions”
“Critically Appraising Quantitative Evidence for Clinical Decision Making”
“Clinically Appraising Knowledge for Clinical Decision Making”
“Clinically Appraising Quantitative Evidence for Clinical Decision Making”
“Clinically Appraising Qualitative Evidence for Clinical Decision Making”

Journal Readings

Please retrieve and read the following Journal articles from the Library. Articles can be located through a search in the CINAHL database, OVID database, Course Resources, or by using the link at the end of the reference if provided.

Jesson, J., & Lacey, L. (2006). How to do (or not to do) a critical literature review. Pharmacy Education, 6(2), 139–148.

Pierce, L. (2009). Twelve steps for success in the nursing research journey. Journal of Continuing Education in Nursing, 40(4), 154–164.

Salmond, S. W. (2007). Advancing evidence-based practice: A primer. Orthopedic Nursing, 26(2), 114–125.

Schardt, C., Adams, M. B., Owens, T., Keitz, S., & Fontelo, P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Medical Informatics & Decision Making, 7(1), 16–26

Web Resources

Review the following website, specifically the Continuing Education articles under Tools and Resources, and the About Us section.

Evidence-Based Practice Network. (2015). Retrieved from http://www.nursingcenter.com/evidencebasedpracticenetwork

Review the sites below that detail ongoing research efforts.

Agency for Healthcare Research and Quality. U.S. Department of Health and Human Services. (2015). Retrieved from http://www.ahrq.gov/
Institute for Healthcare Improvement. (2015). Retrieved from http://www.ihi.org/

Review the NCQA website, paying special attention to the clinician’s website, specifically the Patient Experience Reporting section.

It is expected that you spend approximately 1–2 hours reviewing this resource.

National Committee on Quality Assurance. 2015. CAHPS Patient Experience Reporting Distinction. Retrieved from https://www.ncqa.org/Portals/0/Patient%20Experience%20Web%2009%2030%2011.pdf?ver=2011-10-03-144056-000

Practice

Review Appendix C.
Use the table as a framework to appraise the studies you have found for your PICOT questions.
Implement this into your PICOT project.

MN504M2 Competency Assessment Rubric

If work submitted for this Competency Assessment does not meet the minimum submission requirements, it will be returned without being scored.

CRITERIA	MET	NOT MET
Defined key clinical question with reference to evidence-based databank (for example, Pubmed, Medline, CINAHL, etc).
[Clearly defined the key clinical question as it relates to the evidence]
Reviewed database results (based on key clinical question search)
[Succinctly reviewed database detailed results]
Referenced randomized control study research and systematic review of randomized control studies (Level 1 and 2 Evidence).
[Clearly referenced randomized control study research studies , representing Level 1 and 2 of evidence with clarity]
Provided an overview of the evidence using descriptive statistics, including the sample size, p-factor and strength of evidence.
Clearly provided and overview of the evidence with descriptive statistics used throughout to define the strength of the evidence and study.
Overall # Bold Criteria Met/Not Met
[Overall # Mastery Criteria Met/Not Met]

The criterion statements in bold are the minimum requirement to show competent performance on the course outcome; all bold criteria must be met to pass this Course Outcome.

The criterion statements in [Brackets] represent mastery achievement. A predefined number of mastery criteria must be achieved to earn an A grade, indicating mastery of the Course Outcome.

CLA and Grade Criteria Chart

CRITERIA	CLA Score	Grade	Points
Meets all bold criteria and 50%-100% of mastery criteria	5	A	1,000
Meets all bold criteria and 0%-49% of mastery criteria	4	B	850
Meets 75%-99% of bold criteria	3	Not yet competent (F at term end)	0
Meets 50%-74% of bold criteria	2	Not yet competent (F at term end)	0
Meets 1%-49% of bold criteria	1	Not yet competent (F at term end)	0
Meets no bold criteria	0	Not yet competent (F at term end)	0
No submission	NA	Not yet competent (F at term end)	0

MN504-3 Evidence-Based Clinical Question Search Assignment

MN504-3: Differentiate statistical output for data analysis.
Assignment Details
Evidence-Based Clinical Question Search Assignment
Purpose:
The purpose of this assignment is to give you a practical application to implement your compelling clinical question idea, supported by the evidence-based research you have obtained during your systematic review. You will apply evidence-based research findings discovered from your clinical question, and then integrate those to support your suggested change in nursing practice.

Directions:

Identify your refined clinical question.
Provide a summary of the database used.
Determine an evidence-based quantitative article from the search that contains an evidence-based randomized control trial.
Summarize the case study selected.
Describe the study approach, sample size, and population studied.
Apply the evidence from this review to your practice specifically in your overview.
Evaluate the outcomes, identifying the validity and reliability.
Discuss if the study contained any bias.
Determine the level of evidence identified in the review.
The length should be no less than 10 pages in APA 7th edition format.
Minimum Submission Requirements
• This Assessment should be a Microsoft Word document.
• Respond to the questions in a thorough manner, providing specific examples of concepts, topics, definitions, and other elements asked for in the questions. Your paper should be highly organized, logical, and focused.
• Your paper must be written in Standard English and demonstrate exceptional content, organization, style, and grammar and mechanics.
• Your paper should provide a clearly established and sustained viewpoint and purpose.
• Your writing should be well ordered, logical and unified, as well as original and insightful.
• A separate page at the end of your research paper should contain a list of references, in APA format. Use your textbook, the Library, and the internet for research.
• Be sure to cite both in-text and reference list citations were appropriate and reference all sources. Your sources and content should follow proper APA citation style. Review the APA formatting and citation style found in the Writing Center. It should include a cover sheet, paper is double spaced, in Times New Roman 12-point font, correct citations, Standard English with no spelling or punctuation errors, and correct references at the bottom of the last page.)

MN504M3 Competency Assessment rubric- updated Oct

If work submitted for this Competency Assessment does not meet the minimum submission requirements, it will be returned without being scored.

CRITERIA	MET	NOT MET
Describe systematic review and include an errors analysis.
[Clearly described the systematic review with errors analysis integrated]
Summarize the case study (RCT) selected including the study approach, sample size, and population studied.
[Clearly summarized the case study with a detailed overview of case details such as sample size, control group, and study approach]
Evaluate the study outcomes, identifying the validity, reliability, and bias.
[Provide a clear description of the study including any unique approach, reliability, validity, and bias noted]
Apply the evidence from this review to your practice specifically in your overview.
[Clearly applied the evidence from the review to practice including detailed descriptions of the study]
Overall # Bold Criteria Met/Not Met
[Overall # Mastery Criteria Met/Not Met]

The criterion statements in bold are the minimum requirement to show competent performance on the course outcome; all bold criteria must be met to pass this Course Outcome.

The criterion statements in [Brackets] represent mastery achievement. A predefined number of mastery criteria must be achieved to earn an A grade, indicating mastery of the Course Outcome.

CLA and Grade Criteria Chart

CRITERIA	CLA Score	Grade	Points
Meets all bold criteria and 50%-100% of mastery criteria	5	A	1,000
Meets all bold criteria and 0%-49% of mastery criteria	4	B	850
Meets 75%-99% of bold criteria	3	Not yet competent (F at term end)	0
Meets 50%-74% of bold criteria	2	Not yet competent (F at term end)	0
Meets 1%-49% of bold criteria	1	Not yet competent (F at term end)	0
Meets no bold criteria	0	Not yet competent (F at term end)	0
No submission	NA	Not yet competent (F at term end)	0

Evidence-Based Clinical Question Search Assignment Example Approach

Clinical questions help improve nursing practice, education, and research. They require extensive research to validate or refute claims and gain insight into the topic to ensure it is of high quality and efficacy. A proper analysis of randomized control trials provides high-level evidence, and their results are applicable in various ways in healthcare settings. The information can also be used in various ways to inform care interventions. Advanced practice nurses are majorly managers of the healing environment, and they utilize research to prepare and improve care interventions. They also utilize their knowledge, skills, and positions to improve healthcare institutions and care delivery. This essay evaluates a clinical question and supporting literature and utilizes the evidence to improve FNP practice.

Refined Clinical Question Review

Among elderly diabetic patients, does standardized patient education compared to traditional education improve self-management, adherence to treatment modalities, and follow-up visits in six months? This short review evaluates evidence that informed the clinical question and any modifications to ensure the change is impactful and relevant to the selected healthcare settings. The review also gives reasons and insights that led to the development of the question. Diabetes among elderly patients is a rummaging condition, affecting about 20-30% of adults above 65 years old (Sinclair et al., 2020). The condition is also very expensive due to the daily treatment modalities such as insulin. In addition, elderly patients have declining cognitive, physical, and physiologic functions primarily due to old age and associated conditions. Decreasing immunity, physiologic function, and activity are leading causes of poor prognosis in managing diabetes in the elderly. Thus, the group is exposed to higher mortalities and morbidities than other groups creating the need for vigorous management.

Standardized or structured patient education is education based on a checklist or education tailored to meet all patient needs and offer vital skills and knowledge. It focuses on the outlined components of health education that are carefully selected and appraised as vital to achieving the desired output (Chatterjee et al., 2018). For example, the care provider can teach patients specific exercises for older adults considering their physical and physiologic limitations instead of just telling them to exercise, as in traditional patient education. It is organized in chronological order of relevance and importance to promote patient understanding and minimize time wasted gathering education materials (Ernawati et al., 2021). The checklist also provides a vital follow-up tool that improves professionals’ responsibility and adherence to the interventions. Traditional education lacks order of education increases the chances of missing out on information or the education exercise because it provides no care provider follow-up intervention. Thus, structured education is integral for diabetic patients to promote better health outcomes.

The disease is preventable through education and collaborative intervention between healthcare providers and patients. Knowledge and skills to manage diabetes are vital. Educating patients to help ensure they adhere to routine medication administration, diet/ eating habits, and exercise/ physical activity. Individuals with skills have a likelihood of utilizing them (self-efficacy). Treatment adherence is also expected to increase when patients learn the importance of adhering to the modalities. Diabetes complications are notorious and take a long to manage, and thus, it is vital to prevent them (Ghisi et al., 2021). They are prevented through up and periodic visits to determine patterns leading to their development and thus preventing them from developing early in their development stages. Diabetes follow-up entails diabetic foot examination, eye examination, and HbA1c tests. Educating patients helps them understand the importance of adhering to these visits, thus increasing their adherence to follow-up care which helps prevent complications and promote effective glycemic control.

Diabetes management interventions take time to produce change. Individuals also take time to adapt to new interventions hence the need for six months. The change has been clearly and carefully crafted to produce an evidence-based change in diabetic patient outcomes.

Structured Diabetes patient Education Systematic Review

Traditional diabetes patient education does not provide clear instructions on content and chronology of implementations and leaves the liberty to choose to the healthcare institutions and healthcare providers. The education is ineffective, as evidenced by the rising rates of diabetes complications, mortalities, morbidity, healthcare costs, and poor quality of life. Diabetes self-management education is the recommended management intervention by institutions like the CDC, NDEP, ADA, and WHO. Ernawati et al. (2021) conducted a systematic review to help understand the effectiveness of DSME in diabetic patients. The review utilized fifteen articles from reputable databases. The DSME education, according to the review, increases an individual’s knowledge and adherence to various interventions such as diet, exercise, and follow-up. The lifestyle changes from the DSME were changes in exercises attitude and time allocation, changes in drinking and smoking habits, and increased fruits and vegetables diets. These changes were expected to increase various clinical outcomes of these patients.

A systematic review study showed a significant improvement in therapeutic tests such as cholesterol, FBS, and RBS tests results (Ernawati et al., 2021). HbA1c results are the best in evaluating glycemic controls over time. Cunningham et al. (2018), a study in the review, provides conflicting evidence and shows that DSME does not produce a significant change in HbA1c results. Other studies, such as Ghisi et al. (2021), showed a significant improvement in patient knowledge and possible behavior change. Knowledge greatly influences behaviors, and patients are highly likely to portray the right behaviors when they receive the right education. Adherence to treatment modalities, follow-up visits, and lifestyle changes in diet and exercise promotes better health outcomes.

DSME, according to the review, thus improves knowledge and the clinical health status of the patients. The study also identified the various barriers to implementing DSME, including scarce healthcare resources, cultural barriers, personal differences, and poor patient-clinic relationships. Poor professional commitment is another problem that negatively affects the education interventions, quantity instead of quality. Professionals want to manage more patients without paying attention to the quality of care (Ernawati et al., 2021; Chatterjee et al., 2018). The systematic review used a mixture of qualitative and quantitative studies. These studies present different levels of evidence hence presenting a huge problem in the reliability of the data produced. However, the review process was vigorous, thus leading to high-level evidence when informing the study.

Summary of The Database Used

Various databases provide reliable nursing studies and articles. These databases include PubMed (NCBI), CINAHL Plus with Full Text (EBSCO), Academic Search Complete (EBSCO), and Cochrane Library (Wiley) (Welch Medical Library, 2021). Cochrane Library is the best database for getting systematic reviews for broader insights into a topic. In addition, systematic reviews produce the highest level of evidence; hence the database is an important source of evidence-based practices. PubMed (NCBI) is a database developed and managed by the national center for biotechnology information. The database is a free search engine containing medical-related articles, abstracts, and references. PubMed aims to improve health both globally and personally hence it has a collection of healthcare research articles that provide reliable evidence for application in managing healthcare problems. The database is reputable in providing all kinds of publications. PubMed contains case studies, randomized controlled studies, quasi-experimental studies, and qualitative studies (Welch Medical Library, 2021). The focus on medical-related articles of all years makes the database reliable. The articles are also peer-reviewed, increasing the reliability of the database. The article used is also published in various journals, increasing the data’s reliability.

An evidence-based quantitative article containing an evidence-based randomized control trial

When exploring diabetes education programs studies, I came across many qualitative, quantitative studies, and systematic reviews during the search. Systematic reviews, majorly from the Cochrane library, showcased the importance of structured diabetes patient education. Randomized controlled studies are structured studies that use high-level data collection and analysis tools, and their results are useful in making clinical decisions. They use methods that filter out many biases, thus increasing the reliability of the results. The chosen study is an article by Rahaman et al. (2018) from the PubMed database. The study evaluated the effectiveness of a diabetic patient education module on foot care in an outpatient setting. The study is an open-label randomized controlled study. The education module was structured for diabetic patients in the outpatient department.

Case Study Summary

The study describes the care gap in care provision where patients are unaware of diabetic foot complications and only realize their existence when they develop the complications. According to the study, foot care is the least emphasized component of diabetes education despite the risk for further complications, high healthcare costs, and poor-quality lives. The deficient knowledge makes it difficult to manage these preventable diabetes complications. Diabetic foot is a major diabetes complication resulting from poor foot care leading to poorly healing wounds. Diabetic foot leads to high healthcare costs due to daily dressing and medications. When poorly managed, they lead to amputations, significantly affecting a patient’s quality of life. The researchers used a unique tool (patient education module) for patient education, which they developed for the study.

The intervention was an audio-visual display and a pamphlet on diabetes foot care, while the control group received traditional care at baseline, 1 and 3 months. The intervention was given to the intervention group, besides the routine diabetes education on dietary advice, exercise, medication, and follow-up given to the control group. The study recruited 127 diabetes patients attending an endocrinology outpatient department in AIIMS, New Delhi, and assigned them to control (n=64) and intervention groups (n=63) (Rahaman et al., 2018). At baseline, both groups filled a questionnaire testing their foot care knowledge. The patients then filled out a questionnaire at 1 and 3 months to test their knowledge of diabetes foot care. The results were analyzed for the three periods to determine their differences after introducing the intervention.

The Study Outcomes, Validity, Reliability, and Bias.

The study excluded patients with vision problems, hearing impairment, and present or past foot ulcer cases. These conditions in these patients would have negatively affected the reliability of the study’s results. The unique approach used by this study was the intervention prepared by the researchers. The intervention was structured to improve patient foot care and improve the patients’ knowledge and entailed an audio-visual on foot care and a pamphlet on foot care. The pamphlet covered all diabetic foot and diabetic care areas according to National Diabetes Education Program and American Diabetes Association recommendations. Only 51 patients from the intervention group and 50 patients in the control group completed the three visits; hence they are the only ones included in the results. The knowledge scores at baseline for the intervention and control groups were 9.8 ± 1.8 and 9.9 ± 1.7, at 1 month; 10.2 ± 1.6 and 9.8 ± 1.6, and 3 months, respectively.

As seen from the results, the intervention group showed statistically higher scores which rose steadily from the baseline test scores. The control group scores showed a drop in the first month and a slight rise in the third. The changes were not statistically significant in the control group. The results showed significant statistically significant differences at 1 and 3 months, which were not observed in the control group. In the beginning, the results from both groups were low and had very few differences in the control and intervention groups. Still, these differences were significantly different in the first and third months. The study shows significant improvement in patient knowledge and practices.

The study’s validity depends on the objectives, the study interventions, and the congruent evaluation methods. The intervention was education using the audio-visual display and a pamphlet on diabetic foot care. These interventions are geared towards increasing patients’ knowledge, and the evaluation methods used, a questionnaire, testing changes in the patient’s knowledge and practice hence the validity of the research. The study results were also analyzed using a students’ t-test, which determines changes in mean scores. The study creates the need for further research on the effectiveness of diabetes patient education on the behaviors associated with increased knowledge.

The data evaluation methods provided for the reliability of the data; questionnaires. Questionnaires are reliable because they provide reliable first-hand data from the study participants. The questionnaires were prepared from the diabetic foot care education components, which align with NDEP and ADA recommendations. The unique education tool was comprehensive and created by reputable healthcare professionals and recommendations from ADA and NDEP. However, the study does not mention how the tools were tested statistically for reliability. Reliability is integral in ensuring that the data is valid, and reliability must be present to ensure data validity.

Bias in research interferes with the study results and significantly affects their generalizability and implementation of the data produced. There are three types of bias: confounding, information, and selection biases. The study was a randomized control trial which removes selection bias leading to better representative results. During the study, confounding bias was present. There were no interventions to prevent patients from sharing the pamphlets or education in their social interactions, significantly affecting study results. There was no information bias noted in this study, thus making the results more reliable and the data generalizable.

Applying the Evidence from the Review to FNP.

Study results could be useless when not utilized in clinical practice. After evaluating and appraising evidence, advanced practice nurses use the knowledge in their practice areas to improve care quality and promote patient safety. FNPs utilize abstractions and evidence from studies to change practices. The randomized clinical trial shows the importance of testing the patients’ level of understanding, retention, and recall of information given during their care. APRNs in primary care (FNPs and other specialists) should also ensure they test if their patients understand what they were taught. The whole study is based on testing knowledge levels after the education intervention using questionnaires. During education programs, patients may fail to retain knowledge or become inattentive, and thus the education becomes less impactful. Testing their level of understanding helps understand the likelihood of improving their behavior (Rahman et al., 2018). Strategies such as the teach-back where patients are expected to recall information taught after patient education are integral in determining their level of understanding. Testing their knowledge also ensures they pay attention to educational interventions.

The primary takeaway is the emphasis on patient education for self-care in primary settings. The results showed that focused patient education is integral in improving patient knowledge and possibly changing health behavior (Rahaman et al., 2018). The study results are congruent with other studies on the importance of patient education (Wittink & Oosterhaven, 2018). Diabetic patient education from the randomized control study improved patients’ knowledge in the intervention group compared to the control group. FNPs should leverage the benefits of patient education to improve knowledge and care of other healthcare conditions. Increased patient knowledge also increases care collaboration and adherence to their responsibilities, thus increasing healthcare efficiency.

Another takeaway is the often-ignored importance of diabetic patient education materials such as pamphlets. These resources are common in chronic conditions management, and healthcare professionals and individuals should strive to ensure they are properly utilized in healthcare institutions (Wittink & Oosterhaven, 2018). FNPs in primary care should advocate for the materials to be availed to the populations in healthcare settings to help manage preventable conditions of public importance, such as diabetes, hypertension, and cancer.

The study utilized a unique intervention where they developed a diabetes foot care pamphlet and an audio-visual display to help educate the patients. The components are based on the recommendations by reputable international organizations such as ADA, increasing the relevance and validity of the data produced. APRNs can assist in developing healthcare tools and materials for patient education to fill the gaps in care provision in healthcare settings. Many healthcare conditions can be prevented, but there lacks practice-level interventions to help nurses and other healthcare providers prevent them. FNPs in primary care are responsible for improving the health of individuals and families and should this prepare tools and materials to improve practice at the department or institution levels. Thus, the study results are integral in improving FNPs’ practice in primary care settings.

Conclusion

Diabetes education is an important intervention, especially in older adults with many needs due to the conditions of old age. The review and systematic review provide significant insight into structured patient education and the importance of diabetic self-management education (DSME). The randomized clinical trial presented increased knowledge and practice among patients after audio-visual display and pamphlets on diabetes foot care. The basis of the education is that diabetes prevention and effective management depend on patient education because most of the care requires collaborative interventions between patient and caregiver. FNPs have several takeaways from the study they can utilize in primary care settings to promote better patient outcomes and improve their quality of life. FNP utilize patient education and education resources such as checklists and pamphlets to improve patients’ knowledge. FNPs should also collaborate with other care providers to develop modified care interventions where clear frameworks are unavailable. By doing so, they will help increase healthcare efficiency and health outcomes.

References

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of Public Health Research, 10(2). https://dx.doi.org/10.4081/jphr.2021.2240

Rahaman, H. S., Jyotsna, V. P., Sreenivas, V., Krishnan, A., & Tandon, N. (2018). Effectiveness of a patient education module on diabetic foot care in an outpatient setting: An open-label randomized controlled study. Indian Journal of Endocrinology and Metabolism, 22(1), 74. https://dx.doi.org/10.4103/ijem.IJEM_148_17

Sinclair, A., Saeedi, P., Kaundal, A., Karuranga, S., Malanda, B., & Williams, R. (2020). Diabetes and global aging among 65–99-year-old adults: Findings from the International Diabetes Federation Diabetes Atlas. Diabetes Research And Clinical Practice, 162, 108078. https://doi.org/10.1016/j.diabres.2020.108078

Welch Medical Library (2021). Databases for Nursing Research. Nursing Resources. The John Hopkins University of Medicine. https://browse.welch.jhmi.edu/nursing_resources

Wittink, H., & Oosterhaven, J. (2018). Patient education and health literacy. Musculoskeletal Science and Practice, 38, 120-127. https://doi.org/10.1016/j.msksp.2018.06.004

MN504-4: Evaluate Evidence Based Nursing Findings From Nursing Research.

This competency assessment assesses the following Outcomes:

MN504-4: Evaluate evidence based nursing findings from nursing research.

PC-1.3: Apply conflict management skills to resolve issues and/or build team alliances.

Purpose:

Explore conflict management principles and professional integrity through a review of healthcare personnel conflict management review.
This conflict management assignment allows you to review common conflict scenarios in clinical practice and reflect on appropriate resolution strategies. This gives you a review of an evidence-based approach to training conflict management in healthcare settings.
Critically access conflict management as it relates to team building in clinical practice.

Description:

You will reference the conflict case management study from the nursing literature. You will develop a summary and reflection consensus of strategies used to resolve the case review. Support your summary utilizing a minimum of three academically credible sources in addition to the source provided.

Please retrieve and read the following journal article from the Course Documents.

Sinskey, J. L., Chang, J. M., Shibata, G. S., Infosino, A. J., & Rouine-Rapp, K. (2019). Applying conflict management strategies to the pediatric operating room. Anesthesia & Analgesia, 129(4), 1109–1117. https://doi.org/10.1213/ANE.0000000000003991

Directions:

You are expected to create a 5-10 slide PowerPoint presentation, not including the title slide or reference slide addressing the following:

Create a brief and concise overview of the case study within the PowerPoint slides.
Reference a minimum of three academically credible sources in addition to the source provided.
Develop a PowerPoint, like an executive summary, critically assessing conflict management principles used in the case for clinical practice.
Submit the summary and poster slide to the Competency Assessment Dropbox.

Minimum Submission Requirements

This Assessment should be a Microsoft PowerPoint presentation.
Respond to the questions in a thorough manner, providing specific examples of concepts, topics, definitions, and other elements asked for in the questions. Your presentation should be highly organized, logical, and focused.
Your presentation must be written in Standard English and demonstrate exceptional content, organization, style, and grammar and mechanics.
Your presentation should provide a clearly established and sustained viewpoint and purpose.
Your writing should be well ordered, logical and unified, as well as original and insightful.
A separate slide at the end of your presentation should contain a list of references, in APA format. Use your course resources, the Library, and the internet for research.
Be sure to cite both in-text and reference list citations were appropriate and reference all sources. Your sources and content should follow proper APA citation style. Review the APA formatting and citation style found in the Writing Center. (It should include a cover sheet, paper is double spaced, in Times New Roman 12-point font, correct citations, Standard English with no spelling or punctuation errors, and correct references at the bottom of the last page.)

MN504M4 Competency Assessment rubric

If work submitted for this Competency Assessment does not meet the minimum submission requirements, it will be returned without being scored.

CRITERIA	MET	NOT MET
Provides a concise overview of the case study, identifying specific conflict resolution strategies applicable to case study reviewed.
[Explains in detail specific conflict resolution strategies applicable to case study reviewed]
Highlights how conflict resolution strategies were applied.
[Highlights how conflict resolution strategies were applied and references other supporting evidence]
Submitted a poster project in PowerPoint format (poster slide)
[Executive Summary included with presentation]
Overall # Bold Criteria Met/Not Met
[Overall # Mastery Criteria Met/Not Met]

The criterion statements in bold are the minimum requirement to show competent performance on the course outcome; all bold criteria must be met to pass this Course Outcome.

The criterion statements in [Brackets] represent mastery achievement. A predefined number of mastery criteria must be achieved to earn an A grade, indicating mastery of the Course Outcome.

CLA and Grade Criteria Chart

CRITERIA	CLA Score	Grade	Points
Meets all bold criteria and 50%-100% of mastery criteria	5	A	1,000
Meets all bold criteria and 0%-49% of mastery criteria	4	B	850
Meets 75%-99% of bold criteria	3	Not yet competent (F at term end)	0
Meets 50%-74% of bold criteria	2	Not yet competent (F at term end)	0
Meets 1%-49% of bold criteria	1	Not yet competent (F at term end)	0
Meets no bold criteria	0	Not yet competent (F at term end)	0
No submission	NA	Not yet competent (F at term end)	0

MN504-5: Evaluate Interdisciplinary Approaches To Organizational And System Change Through Evidence Based Practice.

MN504M5

MN504-5: Evaluate interdisciplinary approaches to organizational and system change through evidence based practice.

Assignment Details

Evaluating Clinical Question Publication

Description:

This assignment provides an opportunity to review the clinical question identified with a focus of research or publication opportunities on this question.

Directions:

Describe a clinical question as it relates to your practice setting.
Identify the growth of this clinical question in research possibilities.
Discuss journals that would be a potential publisher for your future authorship on the clinical question posed.
Review collaborative practice opportunities as it relates the evidence determined in the database searches.
Provide an overview of the guideline and the discussion in the paper.
Write a 3- to 5-page paper using APA format.

Minimum Submission Requirements

This Assessment should be a Microsoft Word document.
Respond to the questions in a thorough manner, providing specific examples of concepts, topics, definitions, and other elements asked for in the questions. Your paper should be highly organized, logical, and focused.
Your paper must be written in Standard English and demonstrate exceptional content, organization, style, and grammar and mechanics.
Your paper should provide a clearly established and sustained viewpoint and purpose.
Your writing should be well ordered, logical and unified, as well as original and insightful.
A separate page at the end of your research paper should contain a list of references, in APA format. Use your textbook, the Library, and the internet for research.
Be sure to cite both in-text and reference list citations were appropriate and reference all sources. Your sources and content should follow proper APA citation style. Review the APA formatting and citation style found in the Writing Center. (It should include a cover sheet, paper is double spaced, in Times New Roman 12-point font, correct citations, Standard English with no spelling or punctuation errors, and correct references at the bottom of the last page.)

MN504M5 Competency Assessment rubric

If work submitted for this Competency Assessment does not meet the minimum submission requirements, it will be returned without being scored.

CRITERIA	MET	NOT MET
Introduced an overview of a healthcare system practice guideline, preferably where you work or have worked.
[Clearly identified and introduced an overview of a healthcare system at work]
Discussed how different professionals in the healthcare system (Nurses, Pharmacists, Technicians, Nurse Educators, CFO, etc.) are held to this guideline.
[Cleary discussed how different professionals in healthcare use and hold to the guideline identified]
Determined the level of evidence for the guideline
[Succinctly determined the level of evidence for the guideline identified]
Addressed how the guideline is followed in the healthcare system
[Clearly delineated how the guideline is followed in the healthcare system addressed]
Overall # Bold Criteria Met/Not Met
[Overall # Mastery Criteria Met/Not Met]

The criterion statements in bold are the minimum requirement to show competent performance on the course outcome; all bold criteria must be met to pass this Course Outcome.

The criterion statements in [Brackets] represent mastery achievement. A predefined number of mastery criteria must be achieved to earn an A grade, indicating mastery of the Course Outcome.

CLA and Grade Criteria Chart

CRITERIA	CLA Score	Grade	Points
Meets all bold criteria and 50%-100% of mastery criteria	5	A	1,000
Meets all bold criteria and 0%-49% of mastery criteria	4	B	850
Meets 75%-99% of bold criteria	3	Not yet competent (F at term end)	0
Meets 50%-74% of bold criteria	2	Not yet competent (F at term end)	0
Meets 1%-49% of bold criteria	1	Not yet competent (F at term end)	0
Meets no bold criteria	0	Not yet competent (F at term end)	0
No submission	NA	Not yet competent (F at term end)	0

Evaluating Clinical Question Publication Example Solution

Nursing research, practice, and education are significant components of nursing. Nursing research is a vital pillar that supports nursing education and nursing practice. Nursing research produces studies that test to refute or affirm abstractions, create new knowledge, and determine causal-effect relationships, contributing to evidence-based practices. Nursing research is highly sensitive, and the information produced requires evaluation to ensure it meets the data standards for nursing research. Information from studies should be shared widely to improve nursing practice. The correct choice of journal for publications is also vital to ensure the data reaches a large population and is implemented. This essay analyzes an identified clinical question focusing on research and available publication opportunities for the clinical question.

Describe a Clinical Question

The clinical question is: Among elderly diabetic patients, does standardized patient education compared to traditional education improve self-management, adherence to interventions, and follow-up visits in six months? My area of clinical practice is primary care which is the focus of family nurse practitioners. Elderly patients present various knowledge gaps and complicated healthcare conditions. Diabetes is a disease of clinical significance to primary care. Epidemiological statistics show that diabetes is the 8^th leading cause of death globally and a leading cause of morbidities such as hearing and vision loss (Menneilly et al., 2018). Diabetes exacerbates underlying systemic conditions such as hypertension and renal failure. The disease has been identified as a comorbid condition associated with high mortalities in other diseases. Cancer, HIV, heart disease, COVID 19, and acute renal injury are conditions reported to have high mortality rates (Nowakowska et al., 2019). Diabetes is an expensive condition and accounts for over 25% of healthcare spending due to complications such as stroke and amputations (Riddle & Herman, 2018). Diabetes management is complex and requires collaboration between interprofessional, patient, and primary care providers. Unlike other conditions, most of the care interventions are carried out by the patient and the primary care provider hence the need for comprehensive patient assessment. Diabetes management also requires keen follow-up to detect and manage complications early.

Growth of the Question in Research Possibilities

The clinical question can grow in various ways in research. The growth will be determined by the multiple goals, objectives, and desired outcomes of the clinical question and its interventions. The first step is to identify the interaction between patient education and diabetes management and the studies that emphasize patient education in diabetes management (Ghisi et al., 2021). It is also vital to understand the traditional patient education methods and their success and flaws (Rahaman et al., 2018). The results will then inform the structured patient education to address these gaps. Evidence-based practices are vital in healthcare, and identifying studies that provide evidence on the effectiveness of structured diabetes education will further inform the research.

Another investigation identifies studies that explain how diabetes interacts with elderly patients compared to the rest of the population (Meneilly et al., 2018). These differences can further inform the chosen interventions to ensure effectiveness and relevance. The nurse practitioner, the researcher, identifies the effects of education on the identified population and determines the best interventions. Another direction is selecting healthcare technologies that can be integrated into the chosen intervention and the appropriacy in the population of interest (Rahaman et al., 2018). Contributions from different studies can also help the researcher determine the most appropriate topics in the education program. Choosing the current best practices such as recommended diets, medications, and follow-up visits is vital. The nurse practitioner will then use the information to prepare the diabetes education program and ensure quality outcomes for the patients.

Potential Publication

There are various opportunities for publishing information on structured diabetes education in future authorship. The journal of diabetes, journal of diabetes & metabolism, and journal of diabetes research are vital journals in diabetes research (Contreras & Vehi, 2018). A potential publisher is the journal of diabetes & metabolism. It is an open publications journal that features scientific work of great significance and impact from virtually all fields of diabetes. It ensures information is available online widely to improve article impact and promote the utilization of research information therein. The journal is specific to diabetes, and hence the editorial process is constructive, courteous, and effective. Articles are peer-reviewed by prominent scientists in the diabetology field. Thus, the journal is a reliable potential publisher.

The journal of diabetes is the second pliable publisher in diabetes-related research. The journal is an open-access journal from 2022, which increases the availability of the information and the possibility of its implementation. The journal does not have submission charges but only pocket-friendly costs, unlike other journals that charge high submission and publication fees. The journal of diabetes research provides open access and peer-reviewed articles that address etiology, management, pathogenesis, prevention, and complications. The journal has a serious editorial team that filters many flawed research articles, evidenced by the low acceptance rate. Hence, the journal is trusted by many individuals; articles published by the journal have a broad audience. Publishing with this journal will ensure the information is shared widely and accessible to many consumers of nursing research.

Collaborative Practice Opportunities

Interprofessional collaboration in diabetes management is vital. Interprofessional team collaboration is critical in the project’s preparation, implementation, and evaluation. In structured diabetes education, there are various opportunities for interprofessional collaboration. One opportunity is in preparing a structured diabetes education. The interprofessional team, through shared decision-making, will provide their varied perspectives to the education plan to ensure it meets the patients’ holistic needs (Nowakowska et al., 2019). Another opportunity is the implementation of structured patient education. Areas of education such as nutrition, pharmacologic management, and psychological welfare require professionals to ensure they are comprehensively addressed. Nutritionists, pharmacists, and psychologists can be assigned roles of teaching patients these interventions

Overview of Guideline and Discussion

LeRoith et al. (2019) is a clinical practice guideline that addresses diabetes management in older adults. The guideline provides a list of recommendations on diabetes management from diagnosis, management, and follow-up interventions. The guideline recommends fasting blood glucose and HbA1c tests for diagnosis and suggests a complete health history, personal values, nutritional status, and cognitive health during diagnosis.

These recommendations will be incorporated into the clinical question research to ensure holistic, individualized patient care. It also recommends lifestyle modification as the first-line management of hypoglycemia, metformin as the first-line antidiabetic medication, and insulin as the second-line intervention. These interventions will be integral in determining the best treatment regime and planning health education components (such as medications and side effects and injection sites) for the clinical question. The guideline also recommends an annual lipid profile, eye exam, foot exam, and HbA1c tests (LeRoith et al., 2019). These recommendations are most relevant, in addition to other interventions. The clinical question will address these recommendations and incorporate them to ensure high-quality outcomes.

Conclusion

Nursing research is an essential facet of professional practice and education. Diabetes management can benefit greatly from extensive research and evidence-based practices from existing research. Patient education is vital in diabetes management because most interventions are patient and primary care provider-based. There are various available opportunities for publishing diabetes research, and they include the journal of diabetes, the journal of diabetes research, and the journal of diabetes & metabolism. These journals focus on diabetes, making them the best publishing options. Incorporating interprofessional perspectives, collaboration, and clinical practice guidelines in diabetes management is also integral for practical, holistic, and individualized care.

References

Contreras, I., & Vehi, J. (2018). Artificial intelligence for diabetes management and decision support: a literature review. Journal of medical Internet Research, 20(5), e10775. https://doi.org/10.2196/10775

LeRoith, D., Biessels, G. J., Braithwaite, S. S., Casanueva, F. F., Draznin, B., Halter, J. B., Hirsch, I. B., McDonnell, M. E., Molitch, M. E., Murad, M. H., & Sinclair, A. J. (2019). Treatment of diabetes in older adults: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1520-1574.https://doi.org/10.1210/jc.2019-00198

Meneilly, G. S., Knip, A., Miller, D. B., Sherifali, D., Tessier, D., & Zahedi, A. (2018). Diabetes in older people. Canadian Journal of Diabetes, 42, S283-S295. https://doi.org/10.1016/j.jcjd.2017.10.021

Nowakowska, M., Zghebi, S. S., Ashcroft, D. M., Buchan, I., Chew-Graham, C., Holt, T., Mallen, C., Marwijk, H., Peek, N., Perera-Salazar, R., Reeves, D., Rutter, M. K., Weng, S. F., Qureshi, N., Mamas, A. M., & Kontopantelis, E. (2019). The comorbidity burden of type 2 diabetes mellitus: patterns, clusters, and predictions from a large English primary care cohort. BMC Medicine, 17(1), 1-10. https://doi.org/10.1186/s12916-019-1373-y

Riddle, M. C., & Herman, W. H. (2018). The cost of diabetes care—an elephant in the room. Diabetes Care, 41(5), 929-932. https://doi.org/10.2337/dci18-0012