1 REFERENCE PER RESPONSE
1.) My original research question was: In diabetic patients, how does maintaining contact through telehealth compared to physical in-person visits affect glycemic control over a six-month period? I think the question should be revised slightly to address the consistent gap of the insufficient sample size. In adult diabetic patients aged 18-80, how does implementing regular telehealth consultations compared to physical in-person visits impact glycemic control (measured by HbA1c levels) over a six-month period in a primary care setting? I feel adding specific measurements of age groups and setting directly in question may help identify a clear, targeted audience for research to close the gap on limited sample size. I also added the HbA1c levels because most of my studies measured their outcome by HbA1c.
Pick an article that is included in your submitted W4 Evidence Table & Literature Search Worksheet to discuss the reliability and validity of the tool. Based on your chosen article, interpret the results or findings of the article and its generalizability and evaluate the outcomes of the study and implications to practice.
I picked the article ‘Comprehensive Telehealth Model to Support Diabetes Self-management.’ The chosen article used hemoglobin A1c as one of the tools for measurement. The reliability and validity of the measurement tool are important to analyze. In this case, hemoglobin A1c is a standard biomarker utilized in diabetic management to determine long-term glucose control. Reliability is the extent to which scores are free from measurement error (Polit & Beck, 2021). Ultimately, reliability refers to the consistency and reproducibility of measurements. When considering hemoglobin A1c measurement, it would ensure repeated measurements from the same individual or different labs produce consistent results. In the study, they utilized a capillary blood collection kit which used a fingerstick to collect blood samples, then returned to the Advanced Research and Diagnostic Lab, where they used a Tosch Automated Glycohemoglobin Analyzer HCL-723G8 producing accuracy comparable to a venous blood hemoglobin A1c measurement (Aleppo et al., 2023). Assessing glycemic control with hemoglobin A1c measurement is a validated method for diabetic management. Another measurement used was continuous glucose monitoring (CGM). CGM measurements are another reliable and valid tool, as they are another way to assess glucose control for diabetic management. The large sample size and use of statistical analysis to assess for change also enhance the reliability of the findings in the study. The study’s results indicated significant improvement in glucose control and hemoglobin A1c levels over a six-month period. Specifically, hemoglobin A1c decreased from 7.8% at baseline to 7.1% at 6 months, with a corresponding increase in time in range (TIR) for type 1 diabetes (Aleppo et al., 2023, p. 1). For type 2 diabetic patients, the study produced similar results. Type 2 participants went from a hemoglobin A1c at baseline of 8.1% to 7.1% at 6 months (Aleppo et al., 2023, p. 1). Overall, the study’s generalizability is important. The study included participants who were type 1 and type 2 diabetics, representing both types of individuals with diabetes. Due to the generalizability, it suggests that utilizing the comprehensive care model may be applicable and beneficial to a wide range of patients. The outcomes and implications are important as well. The study demonstrated clinical benefits associated with the implementation and model of care, which have the potential to reach a large portion of patients, facilitate diabetes technology adoption, and improve glucose control. (Aleppo et al., 2023). The implications noted from the study would allow healthcare providers to feel confident in optimizing diabetic management to improve outcomes by implementing similar models. -meg
2.) Based on the identified gaps in the literature, the following refined PICOT question is proposed:
In adult patients (P) presenting to the emergency department with suspected sepsis, what is the impact of implementing a sepsis screening and treatment protocol (I) that incorporates pre-hospital assessment and diverse symptom profiles, compared to current practice (C) on time to initiation of appropriate antimicrobial therapy and fluid resuscitation, as well as mortality rates (O), over six months (T)?
It would respond to the need for a comprehensive sepsis protocol that considers pre-hospital screening, heterogeneous presentations, and diverse symptom profiles; it then evaluates its impact on critical outcomes, such as timely treatment initiation and mortality rates.
Q2
Various tools and scoring systems for sepsis screening and risk stratification have been assessed in several studies across the literature. For example, Elbaih et al. (2019) evaluated the performance of SPEED, PIRO, and MEDS scores for predicting 28-day mortality in ED sepsis patients. They found no significant difference in discriminatory ability among the scores. On the other hand, Brink et al. (2019) noted that, unlike the qSOFA and SIRS scores, the NEWS score had great discriminatory power concerning mortality among patients suspected of sepsis in an ED setting. The researchers indicate that a complementary or different screening tool is required since it has very low sensitivity apart from the 2-point qSOFA score cutoff. The studies underscored the need to validate and assess the reliability of sepsis screening and risk stratification tools and the possible need to incorporate other factors or combine multiple tools for the best possible accuracy and clinical utility.
Several literature gaps were identified concerning sepsis screening and treatment protocols in the ED. The identified gaps include a comprehensive evaluation of the specific screening tools, further exploration of the heterogeneous presentations of sepsis, and more evidence on the impact of pre-hospital sepsis assessment and treatment. A few of the studies that can be conducted to address these gaps include:
Evaluation of the performance of sepsis screening tools in the ED setting by factoring different symptom profiles and pre-hospital assessments.
Developing educational programs or clinical decision support tools to help in the early recognition of sepsis based on heterogeneous symptom presentations.
Studies should be conducted to assess the effectiveness of pre-hospital sepsis protocols and their impact on patient outcomes to identify best practices for EMS personnel in facilitating care transitions to the ED.
By addressing these gaps, researchers and healthcare professionals can contribute to the development of more effective sepsis screening and treatment protocols, ultimately improving patient outcomes and reducing mortality rates associated with this life-threatening condition. -Paul
