Scientific research methods\Critical appraisals (Essay Sample)

The Effectiveness of a Structured Transition Programmein Improving Glycaemic Control in Type 1 Diabetes Mellitus Name Institution The research (PICO) question is: In adolescents and young adults with Type 1 Diabetes, does a structured transition programme result in improved glycaemic control and reduced hospital admissions? 1.Introduction The application of evidence-based practice in the healthcare sector requires an adequate and critical appraisal of studies to ensure only the best interventions or therapies are accepted into practice. Critical appraisal involves a systematic process to recognize strengths and shortcomings of a research article to evaluate the value and validity of its findings. The role of a research consumer entails the critical appraisal of studies (Polit& Beck, 2010). The appraisal process helps determine the implication of a research findings, the merits of the design, and the correctness of implementing the recommendations or findings in nursing practice (Straus, Sackett,& Haynes, 2005). Elliot, Schneider, and Geri (2002) noted that critical appraisal of research articles forms the foundation of quality research because it ensures old quality work are incorporated into the nursing practice.Crombie (2000) noted the research studies should be evaluated in the context of their methodology including the study design and analysis strategies. Additionally, the statistical procedure should be appropriate for the collected data and the appropriate test carried out (Greenhalgh, 2006) The following section evaluates evidence that supports or refutes the efficacy of a structured transition programme in improving glycaemic control in Type 1 Diabetes Mellitus.The appraisal seeks to identify current practice in the application of structured transition programmes and how such practices can be employed to improve the transition between paediatric diabetes services to adult diabetes services. 1 Characteristics of the Research Studies 1 Description of the Studies The evaluation involves six studies which diverse in place where they were conducted and methodologies. Two of the studies were carried out in USA (Los Angeles and Winthrop University), two in Australia (Sydney andWestmead) with the remaining two being conducted in Spain and Italy each. Only one of the studies used randomized control trial (Steinbeck et al, 2014) while the other used non-randomized designs including prospective, nonrandomized trial (Sequeira et al., 2015), mixed method (Egan, Corrigan,&Shurping, 2015), and retrospective examination. Steinbeck at al. (2015) recruited 26 participants who received standardized communication assistance at week 1, and three, six and 12 months after discharge from paediatric care. The intervention group was compared with standard clinical practices in which the participants were briefly contacted biannually to confirm their status. 2 Description of theInterventions The studies explored various transition interventions and programmes ranging from structured transition, comprehensive transition programme, and therapeutic education programme and structured education programmes.Steinbeck et al. (2015) evaluated the effectiveness of a comprehensive transition programme (CTP) with standard clinical practices. The CTP constituted of comprehensive communication with the patient and unbroken support from a health practitioners. Sequeiraet al. (2014)evaluated the effectiveness of a structured transition programme that incorporated specifically tailored diabetes instruction, case management, group meetings and admission to young ADS and diabetes education. Egan, Corrigan and Shurpin (2015) explored the structured transition process comprised of a transition coordinator who reminded the participants of their appointment and made the necessary changes when the participants were unavailable for the appointment. Cadario et al. (2009) integrated two groups, one that followed a structured shiftwhilst the other followed an unstructured transition process. The structured transition involved a transition plan designed by an endocrinologist at the start of the start of adult diabetes services. Attention was given to foresee or hold-up the transfer to particular conditions such as acute hypegylcaemia. Paediatrics and adult diabetes service coordinators worked together with the parents to ensure the transition was smooth as possible. A similar transition programme was investigated by Holmes-Walker, Llewellyn and Farrell (2006).Holmes-Walker, Llewellyn and Farrell (2006) investigated a transition programme that was tailored to allocate young diabetics as they transferred from PDS to ADS, to adhere to the designed programme including visiting a diabetes specialist, a primary care clinician and a diabetes instructor. Vidal et al (2004) investigated a specifically designed programme that integrated a therapeutic education programme. The constituent element of the therapeutic education programme included a coordinated transfer visits and a baseline evaluation of the patient. The programme sought to help patients improve their self-management, glycemic management and adherence to physicians’ visits. 3 Characteristics of the Structured Programme The summary of the studies and interventions is shown in the table below. Author Date Design Sample Transition Intervention Study Duration Results Outcome Measures Steinbeck et al. 2014 Randomized controlled trials 26 Comprehensive transition programme (CTP) compared with Standard clinical practice (SCP) 12 months Most Comprehensive Therapeutic Programme participants (11/14) and all SCP (2/12) completed the programme Primary outcome measures- commitment and retention in the ADS. Secondary- hemoglobin A1c, diabetes-connected hospital visits, micro-vascular complication and global self-worth. Participants (p=0.1) transferred to ADS (median transfer time = 14-15 week), both groups showed sup-optimal frequency of visits to diabetes services despite the high retention rate. The study reported significant variation in HBA1c between the CTP group and SCP group. A linear progression model reported that the follow-up HbAc1; p = improved by 1.2% for every increase in initialHemoglobin (at 95% CI,0.4, 1.9; p=0.01). Sequeira et al. 2014 Prospective, nonrandomized trial 81 Structured transition programme constituting diabetes education, case management, group meetings, and access to a novice ADS and website. 12 months Primary outcomes- routine clinic visits. Secondary outcomes- gycemic control, hypoglycemia, healh-care use, and psychosocial well-being. Intervention group had improved glycemic management (-0.4% vs. 0.4% p =0.01) in comparison to the control group, episodes of acutehypoglycemia (0%vs 0.16%, p =0.02), andpatient’s well-being (p=0.02) at 12 months. Egan, Corrigan, &Shurping 2015 Mixed method (prospective longitudinal study) 29 Structured transition with joint appointments and transition coordinators 6 months Primary outcome- devotionto follow-up. Derivate outcome- diabetes-related suffering, professed health care provider independence support, quality of life, and AIC. There was a momentous correlation between the value of life and diabetes-related distress and correlation between diabetes-related distress and AIC during the pre-transition phase. Paired t-test reported a statistically significant decrease in diabetes pain and an increase in the quality of life. Vidal et al. 2004 80 Specifically designed transition therapeutic education programme (TEP). TEP constituted coordinated transfer visits and preliminary evaluation by the ADS professional 12 months Primary outcomes- glycemicmanagement, self-management and quality of life. Secondary outcomes-metabolic control, hypoglycemic episodes, and total daily insulin dose. TEP enhanced metabolic management (HbA 8.5 vs 7.4, p<0.001) and decreased the number of severe hypoglycemic episodes (0.39 vs 0.14). Cadario et al. 2009 Retrospective examination 162 Structured transition 10 years Duration of transfer, HbA1c, and clinical attendance The transfer duration was longer in unstructured transition coupled with a lack of medical help. Structured transition significantly improved HbA1c (p < 0.01) and improved clinical attendance. Holmes-Walker, Llewellyn,&Farell 2006 191 Transition support programme 12 months Clinical attendance, HbA1c, number of admissions and readmissions with DKA, and hospital of stay. The transition support improved HbA1c (8.8+-1.9%, p < 0.001) after five visits. Diabetes Ketoacidosis admissions reduced by 30% (p=0.05) and extent of stay following readmissions 2.4 Main Clinical Findings Steinbeck et al. (2015) conducted a randomized controlled trial of after discharge programme to helppaediatricswith type 1 diabetes transition from PDS to ADS. Using appointment and retention in the adult services as the primary outcome, and haemoglobin A1c, diabetes-related hospitalization and, global self-worth as the derivative outcome, Steinbeck et al. (2014) reported that CTP impact positively haemoglobin A1c. However, the study reported no noteworthy difference in the retention of patients in adult services. Additionally, the small sample did not allow for the stratification of the randomization by HbA1c. As such, the failure to record any significant difference between CTP and SCP can be attributed to the slow recruitment process that led to a small sample size and skewed representativeness of the target group. Although the study conducted in Australia provided fundamental feas...