Research Paper on Currency of Science

Introduction

Several approaches have been pursued to address deficiency reviewing diabetic patient labs. Review of the tests results and comparison with other methods have been the most effective methods. According to Sherwani et al (2016), a systematic investigation of the efficiency and efficacy of diabetic patient labs has been the most common method to determine the most validity and reliability of the reviews. The National Academy of Clinical Biochemistry reviewed the guidelines which were later reviewed by the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry. The long-standing criteria have been to measure the plasma glucose followed by multiple reviews. However, the diagnosis of diabetes based on the blood hemoglobin A1c (HbA1c) concentrations has been the most effective alternatives to plasma glucose (Sherwani et al., 2016).

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Self-monitoring of the plasma or the blood glucose has been the preferred method for monitoring glycemic control. The by the Professional Practice Committee reviewed the guidelines for reviewing the diabetic patient labs. The reviewers of the guidelines found that the limitation, inconsistency, indirectness and imprecision in the guidelines were moderate. The guidelines and recommendation for laboratory analysis in the diagnosis and management of the diabetes mellitus were only done in 2002 and since then the guidelines and recommendations have not been reviewed and updated in an evidence-based approach especially in those key areas where new pieces of evidence have emerged since the last publication in 2002. The systems to grade the quantity of the evidence and the strength of the recommendation proves that the science is moderate because further research is likely to have an important impact on the researcher's confidence in estimating the effect and may change the estimate as well as the recommendations. The strength of the evaded is quite limited in terms of number, quality, and consistency of the studies reviewed. Additionally, the results are limited in term of generalizability to routine practices. The evidence is also indirect in nature.

Difference in Outcomes

There is adequate evidence that the review of the diabetic patient labs is still based on the guidelines proposed and reviewed jointly by the National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry (Sacks et al., 2011). The guidelines were then revised by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. The differences in the outcomes can be attributed to the inconsistencies and bias in the review and evolution process. Not review the limitation of the guidelines based on the systematic review protocol such as PRISMA-P (Preferred Reporting Items for Systematic review) and Meta-Analysis but have in the recent past which requires immediate attention. the currency of the science underlying the practices used to address Deficiency reviewing Diabetic patient's labs is therefore questionable as the quality of evidence is moderate while the potential for bias is high and the inconstancy and imprecision is moderate (Sacks et al., 2011). Most of the labs are based on the noninvasive glucose monitoring processes, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, and C-peptide which means that potentials for bias can only be reduced in the sample selection process

Effect of Issue on Practice

The effect of deficiency reviewing diabetic patient labs includes poor patient outcomes. because the misinterpreted lab tests lead medication errors. In case the review of the deities patient labs was deficient, adverse medical outcomes or death is likely to occur as the medication are wrongly administered. Additionally, deficiency in reviewing the patient labs might result in delays in medication because the physicians might request additional dieted labs test to be conducted to confirm the diabetic condition and inform clinical decision. Such delays in a clinical setting especially during critical moments in the ICU can result in death. Clinicians cannot initiate medication without accurate information on the illness and the health status of the patient.

Research Evidence on New Practices

PICOT

Currently, there is research evidence that proves that deficiency in reviewing diabetic patient labs can lead to adverse patient outcomes. Grading Assessment, Development, and Evaluation (GRADE) framework proposed the formation of multiple PICOT questions to be answered (Guyatt et al., 2011). For example, using glucose to establish the diagnosis of diabetes requires that the test should be measured in the venous plasma. Reviewing such a result requires that the source of the glucose should be understood because the measurement of the venous and capillary glucose varies. Researchers have also proven that screening of high-risk individual using glucose should be measured in the venous plasma. Good Practice Point is that plasma glucose should be measured only in the accredited laboratories whenever glucose is to be used for diagnosis or screening for diabetes (Sacks et al., 2011). Meta-analyses have proven that intensive glycemic control can reduce cardiovascular disease in those people with type 2 diabetes, but further/ multiple clinical trials should be conducted they have failed to consistently demonstrate the reduction in the myocardial infarction or stroke. The follow-up by the United Kingdom Prospective Diabetes Study (UKPDS) population found that the analysis of the outcomes is linked to the HbA1c. This was the same findings of Diabetes Control and Complications Trial (DCCT) study as the review was based on the valuation of the glycemic control and not the glucose consecration. The deficiency therefore as a result of the protocol proposed by the organization such as the American Diabetes Association (ADA) that defined the target HbA1c concentration to be the only goal for optimal glycemic control (Sacks et al., 2011).

PICOT Questions

Among the female type 2 diabetes patient in ambulatory settings in Chicago Illinois, should capillary glucose measurement proposed by ADA or the venous plasma glucose measurement be used to measure the glucose level s measured one-year post implementation of the blood glucose management strategies

Evidence-Based Practice Model

There are several models that can be used to systematically integrate new approaches to practice to address the issue but this study will focus on only the reviewed PARIHS Framework (i-PARIHS). The Promoting Action on Research Implementation in Health Services (PARIHS) Framework has been reviewed and revised to into an integrated i-PARIHS framework. Schaffer, Sandau, &, Diedrick (2012) supported the model because "the model based on the understanding that the type of evidence available, the context of the healthcare setting as well as the facilitation process involved determines the core element of successful EBP innovation implementation" (pp.1197-1209). The strength of this model is that suggestion of all the change recipients are taken into consideration. The model is chosen because it outlines and promotes the drivers for a systematic approach to evidence-based change. The model support EBP sustainability through a series of activities including organizational culture change, stakeholder engagement as well as critical review and approval or literature. Schaffer, Sandau, and Diedrick (2012) also stated that "the model support the identification of barriers to change implementation and evaluation of the potential impacts of such evidence-based changes as opposed to the blind express implementation of the change" (p. 1200). Therefore, the chosen model will help in recognizing the problem, addressing the problem and improving the solution as well as how the solution can be transferred, generalized and shared across settings.

References

Guyatt, G., Oxman, A., Akl, E., Kunz, R., Vist, G., & Brozek, J. et al. (2011). GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal Of Clinical Epidemiology, 64(4), 383-394. doi: 10.1016/j.jclinepi.2010.04.026

Sacks, D., Arnold, M., Bakris, G., Bruns, D., Horvath, A., & Kirkman, M. et al. (2011). Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care, 34(6), e61-e99. doi: 10.2337/dc11-9998

Schaffer, M., Sandau, K., & Diedrick, L. (2012). Evidence-based practice models for organizational change: overview and practical applications. Journal Of Advanced Nursing, 69(5), 1197-1209. doi: 10.1111/j.1365-2648.2012.06122.x

Sherwani, S., Khan, H., Ekhzaimy, A., Masood, A., & Sakharkar, M. (2016). The significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomarker Insights, 11, BMI.S38440. doi: 10.4137/bmi.s38440

Sherwani, S., Khan, H., Ekhzaimy, A., Masood, A., & Sakharkar, M. (2016). The significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomarker Insights, 11, BMI.S38440. doi: 10.4137/bmi.s38440