Evidence-Based Practice

Healy, S. J., Osei, K., & Gaillard, T. (2014). Comparative study of glucose homeostasis, lipids and lipoproteins, HDL functionality, and cardiometabolic parameters in modestly severely obese African Americans and white Americans with prediabetes: implications for the metabolic paradoxes. Diabetes care, DC_141803.

A2 Quantitative Article 
Background or IntroductionThe author provides detailed information on the high prevalence of diabetes and cardiovascular-related diseases. The author discusses the prevalence of diabetes and cardiovascular-related diseases in African American population in respect to metabolism of, Low-Density Lipoproteins (LDL), insulin resistance, and High-Density lipoproteins (HDL). The researchers state that there are an existing literature gap and aim of the study to provide data on the gap.
Review of LiteratureThe literature review provided summarizes research studies that have focused on explaining the association between diabetes mellitus, cardiac-related conditions, HDL and LDL.
MethodologyThe methodology gives the sample size (145 patients) and demographic data collected, that is age, race, and gender. The methodology discusses the parameters measured in the study including insulin, blood glucose, LDL, HDL, Body Mass Index (BMI) and glycosylated hemoglobin levels. The methodology also specifies the patient populations excluded from the study, based on the legibility criteria.
Data AnalysisData analysis details include the expressions used for the parameters, for instance, Standard deviation, the formats used for calculations, for example, Friedwald equation for calculating HDL and LDL.The article describes computer application software such as Bergman MINMOD Millennium version 6.1 software programs used to analyze data.
Researcher’s ConclusionModestly severe diabetes mellitus plays a similar and slightly different role in the pathological development of glucose hemostasis imbalance across black and white patients who are obese.

(Healy, Osei, & Gaillard, 2014).

A2. Critique of Evidence

The authors conclude that pathological mechanisms underlying cardiac-related conditions such as atherosclerosis, coronary artery disease (CAD) are equally affected by the HDL and LDL functionality mechanisms.  However, data in the introduction states that the prevalence of cardiac-related conditions and diabetes mellitus are generally more prevalent among African Americans than any other race. 

The literature review presents evidence that only explains the lack of cardio-protective properties of HDL and is an anti-oxidative role in the prevention of cardiovascular conditions in diabetes mellitus. However, the evidence does not show the existence of defective cardioprotective properties of HDL in DM. This article discusses deficiency of cardioprotective properties of HDL. 

The results of the study indicate the presence of high levels of HDL and low LDL among diabetic African Americans despite the high prevalence of cardiovascular conditions. On the other hand, White Americans had high levels of LDL, and low HDL, accounting for cardiovascular conditions in pre-diabetic status (Healy, Osei, & Gaillard, 2014).

A3. Protection of Human Subjects and Cultural Consideration

The patient completed consent forms before enrolment into the study. Generally, informed consent in research informs participants on the purpose of research, benefits and potential risks.

The patients diagnosed with certain conditions such severe functional conditions of liver and kidneys and receiving specific treatments were excluded from the study.

The consent form was reviewed by the Ohio State University Biomedical Research Committee Institutional Review Board (Healy, Osei, & Gaillard, 2014).

A3.Strengths and limitations of the Study

Strengths. The study participants were drawn from two different races. Further, the sample size number was large enough for measurement of the study variables.

Weaknesses. The study was cross-sectional, and therefore cause-effect relations between variables could not be established. Additionally, the imbalance between the genders of participants could have impacted the results of the study (Healy, Osei, & Gaillard, 2014).

A5.Evidence and Nursing Practice

The application of weight management approaches in obese patients diagnosed with diabetes should be put into consideration variation in the role of lipoproteins in the pathology of cardiovascular-related diseases.  The role of race in cardiovascular disease occurrence in diabetes is a primary etiological consideration while managing diabetic and obese patients. Additionally, assessment of cardiovascular disease in obese diabetic patient needs to pay attention to the relationship between BMI, race, and lipid profile indicators (Healy, Osei, & Gaillard, 2014).

Tol, A., Sharifirad, G., Shojaezadeh, D., Tavasoli, E., & Azadbakht, L. (2013). Socio-economic factors and diabetes consequences among patients with type 2 diabetes. Journal of education and health promotion2.

B1.Qualitative Article
Background or IntroductionThe article provides information on global, regional and national diabetes statistics.The introductory part gives data on the outcomes of diabetes inform of lifestyle impacts and complications on other body organs and systems.The background information describes the economic burden of diabetes.
Review of literatureThe literature review provides data on discrepancies that are evident in the management and utilization of diabetes management healthcare services.Review of literature compares the health quality outcomes across populations from several ethnic groups.
MethodologyThe research design described is a cross-sectional study design.The sample size as is provided (304 participants).The parameters and variables measured are listed as occupational background, health behavior pattern and occurrence of a complication
Data AnalysisThe data were analyzed through SPSS and Fisher’s formula
Researcher’s ConclusionThe researcher concludes that resources allocation, empowering populations and elevation of populations’ social status improves diabetes clinical outcomes.

(Tol, Sharifirad, Shojaezadeh, Tavasoli, & Azadbakht, 2013).

B2.Critique of evidence

The evidence provided in the background information supports the author’s conclusion. In the introduction part, the evidence provided indicates that discrepancies are presented in the form of compilations, occupational and social functioning effects of diabetes across socio-economic groups. The author’s conclusion states that differences occur in the type and amount of the outcomes in the management of diabetes across socio-economic backgrounds. The literature review informs on the increased utilization of resources supports the author’s conclusion that social-economic factors impact on the outcomes of diabetes (Tol et al., 201). 

B3.Protection of Human and Cultural Consideration

The study’s proposal, ethical consideration, and methodology were presented to the Institutional Review Board for consideration. The study subjects signed informed consent forms. The signed consent form was an indication of the study participant’s agreement to participate in the study. The information in the form listed the risk and the benefits of the study. Additionally, the consent forms contained the terms of participating in the study (Tol et al., 201).

B4.Strengths and Limitations

Strengths. The research’s parameters relevant in diabetes include; weight, blood pressure, and calculated Body Mass Index. The study was conducted in a clinical setting where parameters and vital signs associated with diabetes were measured (Tol et al., 201).

Weaknesses. The study’s inclusion criteria did not put into consideration the demographic variations in the participants, including, age, race, and gender of the respondents. Additionally, the study did not involve community-based data collection to inform on the community-based outcomes in diabetes (Tol et al., 201).

B5.Evidence and Nursing practice

Nursing relies on socio-economic data in the assessment phase of the nursing process. Socioeconomic data an implies the nursing diagnosis, planning, and implementation of nursing interventions. The variation of outcomes of diabetes with changes in socio-economic class informs nursing practice on the need for detailed patient history when assessing diabetes patients. The evidence from the study described in the article is useful in predicting the outcomes of various diabetes management approaches. Additionally, diabetes management policies and approaches need to be based on the information that the outcomes of the condition vary between individuals from different socioeconomic classes and groups (Tol et al., 201).

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