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Exploring Evidence to Improve Typical Healthcare Practices of Diabetes Mellitus

Task:

Write the following question:

1. What databases did you look at and why?

2. What date parameters did you use and why?

3. The key terms used and why?

4. What was the number of articles you retrived for the literature review?

5. What inclusion and exclusion criteria did you use to reduce the number of papers and why?

6. What was your final number of papers?

Answer

Summary


The proposal is based on the development of the treatment among the people who are suffering from the diabetes. There are almost 8.5% of the total population of the worlds is suffering from the diabetes. In order to provide the people with the uniform method of the treatment, the research has been conducted. There are different type of the diabetic patients’ such as the type 1 or the juvenile diabetes, the type 2 and the gestational diabetes. The patients can be lead to the death if they are left without treatment. In order to save the people from the disease, the research needs to be converted. In order to conduct the research, the three patients who are suffering from the type 1or type 2 juvenile diabetes have been selected as the first cohort of the respondents whereas the rest of the cohorts is composed of two physicians from the New medical centre of UAE. The respondents of the cohorts has been nominated accordingly in order to obtain their apprehensions backed by their experiences while having an encounter with Type 1 or Juvenile type 2 diabetes. The required data has been collected from these samples and the research is based on the analysis of these data and also the secondary sources of the data. 


Introduction                                                                                                                                       

Diabetic mellitus is known as the diabetes and  is becoming a major health issue worldwide. For example 8.5% people of the total population of the world, that is more than 415 million people are suffering from this disease (American Diabetes Association, 2014).The diabetes mellitus is the result of  reduced secretion of the insulin from the pancreases.There are the two types of diabetes are prevalent among the sufferers of the disease. They are known as the type 1 and type 2 diabetes. The type 1 is common among the juvenile and the young people and the type 2 is common among the elderly people. There is also the gestational diabetes which is common among the pregnant women

In a little elaborative tone, Diabetes Mellitus is supposed to cripple the processing and synthesizing of energy that are typically derived from food for a perpetual tenure. From the perspective of physiology, a normal body requires insulin to process the requisite energy from the carbohydrate that we actually have from our staple diet. A body afflicted with Diabetes Mellitus is unable to produce the insulin though in some cases it appear that the body appear incapable of processing the produced insulin which inherently disables the glucose to stimulate the cells as usual. Afterwards, if the body became unable to use the produced glucose the left over is became prone to sediment in the blood and initiates to damage the tiny blood cells of kidney, heart , eyes and the central nervous system.

Figure: Types of Diabetes Mellitus

Source:


On the other hand, Older people are thought to be the patients of the diabetes, yet the recent trend identify younger people have the s disease. Juvenile diabetes is one of the fast growing diseases of the contemporary world. The diabetic mellitus can be described as the metabolic disorder, which results in a high blood sugar level. The juvenile diabetes mellitus is also known as Type 1 Diabetes Mellitus, which is due to its excessive insulin dependence. As its designation suggest, the children are prone to be afflicted by this malady. The symptoms of the diabetes are frequent urination, extreme level of hunger and thirst. If left untreated the complications of the disease, incurs  more complications which may even lead to death.

. The diagnostic procedure and the management and the care of the diabetic patients are the integral part treatment.

 

Figure: Phases of Type 1 DM

Source:

The diabetes mellitus is the result of  reduced secretion of the insulin from the pancreases.. 

 In order to treat diabetes the medical and healthcare professionals need to have training


So we have something about diabetes, but form this it is not clear exactly what you want to do.  


Search strategy

The primary concern of the research is to explore and provide the fields to improve the practice of the healthcare professionals of the diabetic patients. In order to find the places where the improvements can be done, the medical journals and books have been used. Furthermore, in this section we are supposed to explore the prior causes of the several sorts of Diabetes Mellitus from multiple perspectives in order to discern the potential loopholes that the pertinent literature occupies which will be further served as the significance of the corresponding research suite.


Use the following heading to structure writing up your literature review.  Once you have written it up you can delete the headings.

What databases did you look at and why?  Don’t forget the grey literature and hand searches. 

What date parameters did you use and why?

The key terms used – and why?

What was the number of articles you retrieved for the literature review? 

What inclusion and exclusion criteria did you use to reduce the number of papers and why?


What was your final number of papers?


Complete the table:

Key   terms 
Cinahl   articles 
BNI   articles
Medline   articles
Total   articles

Retrieved =
Included =
Not relevant =
Retrieved = Included =
Not relevant =
Retrieved = 
Included = 
Not relevant =


If you have sorted your papers into themes note what the themes are: 


Literature review

Research studies reveal various instances where the evidence-based practice has led to better quality care of the diabetic patients. It has also been seen that evidence-based practice can be very beneficial in various ways such as the outcome for the diabetic patients can be improved, costs can be reduced and there would also be greater satisfaction on the part of the doctors than the traditional approaches (Hoffmann and Del Mar, 2012). EBP has been considered very significant for cultivating a spirit of enquiry and the problem solving approach of EBP towards treatment of Diabetes Mellitus helps to integrate best evidences gathered from best conducted studies (Melnyk, Fineout-Overholt, Stillwell and Williamson, 2010). In this regard, it can be mentioned thatEBP is the acronym of Evidence Based Practice in which the quality of the health treatment has been optimized through the seamless integration of prospective perspectives of the clients or the caregivers along with the prevalent scientific evidences and the expert opinion who are supposed to transmit the clinical expertise.Furthermore, the quality of the given care has been optimized simply by reflecting the core interests and proclivities of the individuals that the framework is supposed to serve while incorporating the individual values, needs and immediate choices of the respective patient. EBP has been found to be very productive in delivering outcomes for treatment of diabetic ailment because patient care information data can be combined with the complexities of the patients and the expertise of the nurses. It has been opined?? by Melnyk, Fineout-Overholt, Stillwell and Williamson (2010) that EBP progresses in seven steps and one step alone would not be sufficient to influence a change in the clinical practices. All the papers you are using need summarizing.


Figure: Overview of EBP

Source: 


It has been found that all over the world, the staff and doctors in the healthcare centers are facing increasing challenges due to the rising complexities in the treatment of diabetes and due to the presence of default diversity in age demography. It has been seen that the knowledge and techniques that are required for improving the skills of the nurses and doctors is also developing very rapidly considering the increasing complexities in the treatment of Diabetes Mellitus (World Health Organization, 2014). Thus there is an increasing pressure to continually evolve with the technological developments as well as to manage with the limited resources and knowledge. Thus there is need for developing strategies that would help the healthcare personnel involved in the treatment of diabetes Type 2 treatment to improve the quality of care and treatment given to the patients. It has been analysed that the recent medical trends needs to be monitored so that the diabetes personnel and doctors can be better informed about the treatment they are providing to the patients (Bonds, Camacho, Bell, Duren-Winfield, Anderson, and Goff, 2014). The strategies for improvement of the quality of diabetic care would focus on the Type 2 diabetes patients care along with the need for training of nurses, doctors and staff while some meant to be used by the authority at the local and state level for adopting new measures for the detection and treatment of Type 2 diabetes.

It has been observed that there is a growing need for having regular scrutiny and monitoring of people so that diabetes can be detected in the right time and thus there has been felt the need for inclusion of audit and feedback in the diabetes treatment system (Flottorp, Jamtvedt, Gibis and McKee, 2010). The need for audit and feedback has been felt necessary as it has been found that people are mostly not aware that they are affected by diabetes and thus fail to take necessary precautions. In practical terms, audit and feedback can be defined as statement of the clinical performance in the healthcare, as monitored over a specified period of time (Flottorp, Jamtvedt, Gibis and McKee, 2010). The intention is to give information to the patients and doctors on the regular monitoring and their feedback that they have been detected with diabetes or that the diabetes is affecting them in other ways. 

As per the studies of Geonnotti, Taylor, Peikes, Schottenfeld, Burak, McNellis and Genevro (2015), healthcare reports on the current and future demands in the healthcare system has ascertained that there are various challenges that had emerged to be prominent in the coverage area of diabetes mellitus treatment. It has also been suggested that the delivery of health care system needs to be redefined so that the role of the pharmacists can be given the due importance in the detection of treatment and the medication provided. There is a need for including the pharmacists in the primary health team so that the patients can be given proper medication in the first hand (Geonnotti, Taylor, Peikes, Schottenfeld, Burak, McNellis and Genevro, 2015). Thus it has been opined that there is a need for innovative practice models in Diabetes Mellitus so that the pharmacists can be involved as health care providers. Thus there is need for greater pharmacological interventions in the diabetic treatment reforms for providing direct as well as indirect care (Geonnotti, Taylor, Peikes, Schottenfeld, Burak, McNellis and Genevro, 2015). The aim is to expand the scope and role of the pharmacists in the clinical services and medications in treatment of diabetes.

Clinical medications in diabetes treatment cannot be defined in alienation from the discussion on the importance of nurses. While discussion can be undertaken on improving the quality in diabetic healthcare practices, the need for improving the skills of the nurses giving insulin injections and medicines cannot be ignored (Hughes, 2011). In the traditional practices, the responsibility of the nursing has been perceived in very narrow respects in relation to patient care (Hughes, 2011). The depth and breadth of the nursing capabilities have been limited in medication and clinical care. To improve the overall quality in diabetic healthcare settings, the role and responsibility of the nursing and supportive staff needs to be given more weight in the quality forum.

Diabetes is such a disease that the person suffering from this chronic disease would have to undertake various self management decisions (Bonds et al. 2014). Self management education in diabetes (DSME) is thus required so that the affected people can be helped to navigate their decisions for better health outcomes (World Health Organization, 2014). Diabetes self-management support (DSMS) can be termed as the support that would be required for sustaining skills and desired behaviors in individuals affected with diabetes for managing diabetes on their own with continual help for the medical practitioner (World Health Organization, 2014). The healthcare centers should have provisions so that they can provide referral process for providing both SMS and DSME. These supports are necessary to address the issues that the diabetic patients would be facing in their daily round of activities so that they can meet such challenges of diabetes aliments through self management (Powers et al. 2017)

This is an overview and there is no real focus to it .  

Gap analysis

In the above study, a lot has been discussed about the steps that can be taken to control diabetes and to takes necessary steps so that if necessary, insulin medications can also be provided. However, what has been missed in the analysis, as pointed in Sensory Nerve Conduction Studies In Non-Insulin Dependent Diabetes Mellitus (NIDDM) Patients Without Symptoms Of Peripheral Neuropathy And Healthy Volunteers: A Comparative Study , is that how non insulin dependent diabetes mellitus (NIDDM) can be managed. Here there has been discussion on the correct diagnosis for NIDDM and the diagnostic criteria. It has been opined that such treatments does not only include lowering blood glucose level but also correcting associated CVD risks. In the words of Verma, Mahajan and Khadayate (2015), management of NIDDM would require an effective team work where the doctors and the other members of the health team would collectively monitor NIDDM. This would require close monitoring, record keeping and good control.

      The focus of this study has been on improving the diabetic care including the improvement of the quality and control care however, the need for multi-component diabetes management intervention has not been mentioned by the researcher. The aim of multi component intervention in the improvement of the quality in diabetes treatment is that the treatment of diabetes should be done at various levels to determine what areas of the body have been affected by diabetes. Thus as stated in A systematic review of pharmacological and non-pharmacological interventions for improving diabetes outcomes in people with severe mental illness, the multi component intervention would include urine protection testing, foot examinations, examination of dilated eye. This needs to be followed by proper assessment of the tests to determine the set of medications needs to be provided by the healthcare personnel and whether the patient would need insulin treatment or NIDDM. In the opinion of Siddiqi et al. (2016), such tests would also provide new evidences so that the course of treatment of the diabetic patient can be ascertained by the healthcare experts. Such interventions are necessary to trace any new development in the body of the patients so that such developments can also be treated by the doctors and practitioners. 


There is no analysis of the studies you have taken them at face value 

Chapter summary

The detailed review of the literature sources have provided significant insights into the manner in which health care system can be improved and better measures can be taken so that better care can be provided to those patients affected with diabetes can be given proper care and in the right time. The quality control and performance management initiatives depend on various factors, not only on the health care personnel but also on the external support system for improving the treatment of diabetes. More focus should be given to the training of the nurses and provisions of DSMS and DSME should be given more importance in improving the quality of care for diabetes. Self management of diabetes is one of the most effective steps that are necessary for diabetic control and management. 

Aims and purpose of the study and the research question

  • The aim of the study is to find the evidences that have portrayed the scopes to improve the study of the diabetic patients and the management of their care. It has been evident that the diabetic patients are needed to provide the utmost care and management.
  •  In order to make the better treatment of the diabetic patients, the services of the healthcare industry has been developed. 
  • There are multiple divisions in the diabetic patients such as the type 1 or the juvenile diabetic patients, the type 2 patients and the gestational diabetic patients on whom the improvement is needed (Liberman et al. 2015). In order to identify the type of the developments that are needed to be done, the research has been conducted (Anderson, et al. 2014).
  •  On the other hand, the medical science and the medical practices have been developed along with the time. With the time, the changes have been occurred in the every field of the medical practices. 

It is has been evident that clinical and the theoretical changes are there in the medical practices. Along with the time, the improvements has been developed all the fields of the medical professions (Seuring, Archangelidi and Suhrcke, 2015).

In order to make the development of the diabetic treatment and provide the diabetic patients better treatment, the healthcare professionals are needed to be updated with the contemporary clinical researches that are being used for the treatment of the diabetic patients. It is necessary that the patients are treated with care and positive chances to cure the problem. In order to provide the patients with the proper care, it is the responsibility of the medical practitioners to improve the practices of the diabetic care (Arredondo, 2014). On the other hand, as the diabetes is one of the most emerging diseases among the population of the worlds, the clinical researcher and the other people who are associated with the patients of diabetes such as clinical laboratory, the diagnostic center, the management of the healthcare in the nursing homes and the hospitals are required to focus on the better treatment of the diabetic patients (Arditi, 2017). 

The objectives of the study are to determine how the patients can be treated better and provided with the better opportunities. In order to identify the areas where the development can be done, the objectives of the proposal can help the healthcare professionals. They are as follows: 

  • To specify the people who are the easy target of the diabetic mellitus  
  • To identify the way to provide the better treatment to the patients 
  • To determine the practices that are useful for the treatment of the diabetic care patients 
  • To maintain the quality and integrity of the system

In order to conduct the research, the research questions are needed to be formed. they will also provide the fruitful result for the research. They are as follows:

  • Who are targets of the diabetes mellitus? 
  • What are the prevalent methods methods of the treatment for the diabetic patients?
  • How the patients can be treated in a better way?
  • Is maintaining a proper lifestyle can be an effective method of treating diabetes mellitus? 
  • Is the prevalent healthcare cost for effective management of Diabetes Mellitus is affordable?

Methodology

In order to conduct the research, the methodology needs to be used. The different type of methodologies has been used in this research in order to conduct the research successfully. The application of the different methodologies and techniques are useful to extract the outcome of the research. 

Research philosophy:

The realism, the interpretism and the positivism are the different kind of the research philosophy that is to be commonly used in the researches. The positivism is the most common philosophy used in the researches as by the use of it, the logical flow of the data maintains (Shrivastava, Shrivastava, and Ramasamy, 2013).

Strengths:

  • It is a prevalent scientific philosophy that intends to cater the logical enquiry in order to fathom the ultimate causes derived from some external source

Weakness:

  • The prior weakness of this research philosophy is the external origin of information needs to confine itself within the study of relations prevalent among the existing variables 

Research approach

There are two types of approach used in the research. they are the inductive and the deductive approach. In order to conduct this research, the researcher has followed deductive approach (Bakker et al. 2017). Through the vast and the useful research, the aim and the objectives of the research can be achieved and the positive outcome can be reached. 

The main advantage of adapting inductive approach is to devise the investigation under the strata of evidences, which need to be accumulated in phases as per the progress of the approach. On the other hand, deductive method introduces an instinctive approach within the framework where the consequences have been evaluated immediately after performing the desired act. 

Research design:

In order to conduct a research, there are the three designs that can be used. They are the analytical design, the exploratory design and the explanatory design. In order to carry out the design of the research in a proper way, the researcher uses the analytical or the descriptive design as it will help to conduct the research properly and have the desired outcome (Bansal et al. 2015). 

Research strategy:

There are many strategies that can help the research to be conducted and extract the outcome from it. The strategies have included the interview, surveys and the case studies (Bruni et. al. 2014). In this case, the research strategy that has been used in order to conduct the research, the semi-structured interviews of the three physicians practiced in the New Medical Centre of the UAE and the three patients who are suffering from the type 1 or juvenile type 2 and the gestational diabetes has been done. 

Data collection:

In order to conduct the research, the qualitative method of the data collection has been used. In order to collect the data for conducting the research, the six people from the New Medical Centre of the UAE have been used. Among them, there are three physicians practiced in the New Medical Centre of the UAE and the three patients who are suffering from the type 1 or juvenile diabetes and the gestational diabetes. 

Sampling:

The study itself pertains an urge to imbibe the purposive Sampling approach As the research is based on the evidences of the exploring practices in the improvement of the diabetic patients, in order to conduct the research, the healthcare professionals who are specialized in the diabetic care management and the diabetic patients who are under treatment of the New Medical Centre of the UAE has been taken. The total numbers of the sample that have been taken for the research are six people. They have been used in order to conduct the research. 

Ethical consideration: 

In order to conduct the research, the researcher needs to follow some of the ruled and regulations. While conducting the research, the researcher has to follow the data protection act 1998. This act will help the researcher to have the data that are required to conduct the research (But et al. 2015). In accordance to the data protection act and the ethical issues of the research, the researcher cannot force the people or the respondents to give their opinion on the research questions. Moreover, in order to conduct the research, the researcher will not follow any unethical way. However, there are instances where the researcher has followed the unethical purpose to conduct the research and have the required data in order to have successful research (Holt, De Groot,. and Golden, 2014). Apart from it, the researcher cannot force any of the respondents to provide any personal data in order to conduct the research successfully. Moreover, it is the choice of the respondents to give their opinion with the use of their personal information. 

Limitation of the research:

In order to conduct the research, the researcher has to face many limitations and problems. Among these limitations, the restriction of the time is the most important limitations. Apart from it, the money is another limitation that the researcher has experienced, as in order to conduct the research, the sponsor is needed to provide the money (Simó and Hernández, 2015). Moreover, in order to conduct the research, the secondary sources of information are provided from the books and journals. These sources are outdated and the biased in most of the cases.

Special technique used

In order to conduct the research, the primary and the secondary sources have been used. In order to analyze result of the research, the interview result of the taken samples, that is the three patients who are suffering from the type 1 or juvenile type 2 and the gestational diabetes and the three physicians practiced in the New Medical Centre of the UAE (Zimmet et al. 2014). The result of the interviews needs to be analyzed in order to get the exact result of the analysis. On the basis of this analysis, the development of the treatment of the diabetic care patients will be done. 

On the other hand, the secondary sources of the diabetes mellitus have been used for the treatment of the patients. There are recent and relevant books and journals available on the subject. These literatures are useful as they provide the knowledge on the mentioned topic and also provide the required information regarding the treatment which will help the researcher to conduct the research successfully. 

Main discussion:

In order to discuss the reason of the diabetes mellitus, the research has been done. There are different reasons such the change in lifestyle, the pregnancy problems among the women are some of them. The purpose of the research is to identify the provinces where the changes and improvements can be done in order to bring the development of the diabetic care patients. It is the aim of the patients as well as the physicians to have a uniform method of treatment in order to treat the patient properly. As the cases of the type 2 diabetes are on a rise, the uniform method treatments are needed to prevent the cases as well as curing the patients. All the methods of the treatments are not been used in all the countries of the world. The method of the treatment is varied and there are differences in the procedure of the treatment according to the countries. Moreover, there are advantages and the disadvantages of these procedures of the treatment in the different countries. In order to define those problems and the solutions, the research will be fruitful. In order to increase the effectiveness of treatment, the research is needed. Moreover, it will be beneficial for the patients who are suffering for a long time and also the healthcare professionals who are also in search of the better method of the treatment. On the other hand, the better method is required in order to provide the researcher a better way of the management of the diabetic care. As the juvenile and the type 2 diabetes are increasing day by day, the development in the way of the treatment and also the prevention methods of the diseases are required. The research has been used the samples from the healthcare sector of the UAE. The opinion of the patients and the doctors has been used in order to conduct the research successfully. Also the secondary sources of the information such as the books and the journals have been used here in order to perform the research work successfully. 

Conclusion and Recommendation

      This study has been every effective in the analysis of the need for improving the quality in the care and treatment for diabetes mellitus. In this research work, there has been efforts to determine what measures would be appropriate so that the patients can be provided best treatment and care for detection and treatment of diabetes. The healthcare personnel needs to have a better monitoring over the patients and proper records need to be maintained for better management of diabetes. Healthcare initiatives need to focus on better management initiatives so that a direction can be given to the health services. In the present scenario, as it has been discussed above, the complexities in the diabetes mellitus disease has increased and it has become very chronic at all age levels and there are added pressures on the healthcare personnel to deliver their best for treating the patients and give them the best care. There is also an added concern to continually evolve with the technological development and to integrate the medical facilities as per the technological requirements. Thus there is greater need for technological development as well as human resource development in the health care departments. Facilities and equipments in the medical sector demands better strategies from the external support for overall improvement in the healthcare quality system. 



Recommendation 

  • It is required that there should be better use of the EHR technology so as to improve the delivery of the services in the healthcare system (World Health Organization, 2014). Heath service personnel should make efforts so that the medical errors can be minimized and diabetes can be detected on time and proper treatment can be provided for minimizing the effects of diabetes through the information procured through EHR technology.
  • Standardizing and effective prioritizing in the treatment of diabetes mellitus is every important so as an effective procedure can be used for monitoring the activities of the patients on a regular basis. It is required that all the healthcare centers follow a set guideline for controlling the procedures and activities in the healthcare departments.
  •  There is thus a need for regular monitoring of the activities of the healthcare personnel and nursing staff so that any error can be detected in time and safety of the patients can be ensured (Flottorp, Jamtvedt, Gibis and McKee, 2010). The doctors and the personnel need to be updated and for treating NIDDM, regular monitoring and effective team work is required. Provisions also need to be made in healthcare centers to help the patients in self management of diabetes (Verma, Mahajan and Khadayate, 2015)
  • To maintain proper records and for ensuring proper documentation, electronic records is suggested. The electronic records would help to keep a track of the patients and the services. 
  • The healthcare personnel and nurses should be given better training facilities so that they can accomplish their tasks in a better manner and the safety of the patients can be ensured.
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