Appraising Systematic Reviews Essay

Appraising Systematic Reviews Essay

Systematic reviews are significant evidence sources to identify solutions for various practice problems. They employ extensive searches to locate relevant published or unpublished research sources on a particular topic and synthesize the information in these sources to come up with a conclusion. this discussion presents the appraisal of a systematic review related to the diabetes practice problem.

Effects of Diabetes Self-management Education on glycemic control in Latino Adults with type 2 diabetes by (Hildebrand et al., 2020) is the selected systematic review with meta-analysis. I utilized the John Hopkins research appraisal tool on this systematic review source to contribute to addressing the diabetes practice problem.

The research question for the selected study is: Is diabetes self-management education effective in reducing glycosylated hemoglobin (A1c) levels in adult Latinos with type 2 diabetes? The research design adequately answers the research question. The search strategies and methods used to conduct the search were directed to findings that would answer the research question. More so, the results and discussion addressed the research question in that 23 RCT and Quasi-experimental studies that met the inclusion criteria were selected. The study results from these studies were analyzed and discussed. The findings were that culturally tailored DSME programs effectively reduce HbA1c levels among Latino adults with type 2 diabetes.

The search in this research source was comprehensible and reproducible. Based on the information from the published study, the search was comprehensive and reproducible since the key search terms were clearly stated. The key search terms included diabetes, type 2 diabetes mellitus, self-management education, self-care, A1C, Latino, Latina, Hispanic, Spanish-speaking, and Mexican American. The search terms were combined using Boolean operators, truncation, and search strategies to meet each database’s specifications. Additionally, multiple databases were used to locate studies in the search. The databases used included Medline, PsychINFO, WOS, Cochrane, PubMed, and Cinahl. Furthermore, the inclusion and exclusion criteria for the sources identified in the search were succinctly indicated. The eligibility/inclusion criteria included being an RCT or Quasi-experimental study, the study participants being exclusively Latino adults with type 2 diabetes, and the control group did not have any DSME component.

The evidence-based intervention I might consider for translation into practice in a practice change project is diabetes self-management education and support. Inappropriate or ineffective diabetes self-management is one of the challenges facing type 2 diabetes patients, and a major cause of diabetes complications, undesirable patient outcomes and poor quality of life (Reeger et al., 2022). From the evidence summary, DSME has shown effectiveness in improving diabetes self-management behavior, reducing diabetes complications and enhancing patient outcomes for diabetes patient. The study results were also in tandem with review results by Ernawati, Wihastuti & Utami (2021) who found effectiveness of DSME in improving well-being of type 2 diabetes patients. Therefore, I would consider it in a practice change project.

Finally, based on the observable measures from the evidence summary tool, I would use this systematic review to support my practice change project. The systematic review has produced strong and quality evidence on the effectiveness of the diabetes self-management intervention in improving diabetes self-management efficacy and behavior and reducing glycemic levels. Additionally, the systematic review with meta-analysis incorporated multiple Randomized Control Trials that have compared the effectiveness of DSME to routine patient education over time. RCTs are the highest level of evidence, and since the systematic review included RCTs, it is suitable for supporting the practice change project.

The permalink to the selected study is https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087170/.

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References

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of public health research, 10(2), jphr-2021. https://doi.org/10.4081%2Fjphr.2021.2240

Hildebrand, J. A., Billimek, J., Lee, J. A., Sorkin, D. H., Olshansky, E. F., Clancy, S. L., & Evangelista, L. S. (2020). Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis. Patient Education and Counseling, 103(2), 266–275. https://doi.org/10.1016/j.pec.2019.09.009

Regeer, H., van Empelen, P., Bilo, H. J., de Koning, E. J., & Huisman, S. D. (2022). Change is possible: How increased patient activation is associated with favorable changes in well-being, self-management and health outcomes among people with type 2 diabetes mellitus: A prospective longitudinal study. Patient Education and Counseling, 105(4), 821-827. https://doi.org/10.1371/journal.pone.0217771

 

 

John Hopkins Individual Summary Tool

 Practice Question: Is the DSME intervention effective in reducing glycemic levels in Latino adults with type 2 diabetes? 

Date: 11^th February 2023

 

Article Number	Author and Date	Evidence Type	Sample, Sample Size, Setting	Findings That Help Answer the EBP Question	Observable Measures	Limitations	Evidence Level, Quality
102(3)	Hildebrand, J. A., Billimek, J., Lee, J. A., Sorkin, D. H., Olshansky, E. F., Clancy, S. L., & Evangelista, L. S. (2020).	Systematic review with Meta-analysis	23 randomized control trials and quasi-experimental trials on the effect of DSME in reducing glycemic levels for Latino adults with T2DM	The findings show that diabetes self-management education is effective in reducing glycemic levels in adults with type 2 diabetes. The review also found that culturally tailored DSME interventions are best for reducing HbA1c levels.	The article’s main aim was to evaluate the effectiveness of diabetes self-management education in reducing glycemic levels among Latino adults with type 2 diabetes. It was observed from the analysis that heterogenic studies show improvement in glycemic controls in intervention groups after the intervention, showing that DSME in the study population is effective,	The number of RCTs meeting the inclusion criteria was limited. Only peer-reviewed studies were included, which means essential unpublished work may have been left out. The specifics of the interventions were not considered.	Hildebrand et al. (2020) was appraised at level II evidence, Grade A quality. Despite the robustness of the search and inclusion/exclusion criteria, the results of the study have limited generalizability.
105(4)	Regeer, H., van Empelen, P., Bilo, H. J., de Koning, E. J., & Huisman, S. D. (2022)	Prospective longitudinal study	603 type 2 diabetes patients in a group based intervention were followed up in 2 weeks intervals	There was no risk factor associated with patient activation and low patient activation. However, patient activation was associated with emotional well being and positive patient outcomes for type 2 diabetes patients	The study aimed at examining the relationship between risk factors for patient activation and change in patient activation. The observable measures include emotional well-being, diet, weight, exercise and general diet behavior.	The major study limitation is that there was no data on non-responders, thus leaving room for biased responses	Regeer et al. were appraised at level II grade A quality rating. The study results were generalizable and applicable in other similar populations
10(2)	Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021)	Systematic Literature Review	15 articles that studied the effectiveness and impact ofT2DM on the lifestyle changes and self-management in type 2 diabetes patients	The study findings noted an improvement in diabetes self-management and the quality of life for type 2 diabetes patients following DSME interventions	Observable measures in in the studies used in the review were an improvement in self-management activities including glycemic control, blood sugar regulation, exercise and proper diet.	The major limitation in the study is that the review included studies with DSME intervention only, thus may not be used to determine whether it is the best intervention, considering other interventions were not used in comparison.	Ernawati et al. were appraised at level II grade A quality. The review used reproducible and comprehensible, and the results are generalizable.

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Reference list

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of public health research, 10(2), jphr-2021. https://doi.org/10.4081%2Fjphr.2021.2240

Hildebrand, J. A., Billimek, J., Lee, J. A., Sorkin, D. H., Olshansky, E. F., Clancy, S. L., & Evangelista, L. S. (2020). Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis. Patient Education and Counseling, 103(2), 266–275. https://doi.org/10.1016/j.pec.2019.09.009

Regeer, H., van Empelen, P., Bilo, H. J., de Koning, E. J., & Huisman, S. D. (2022). Change is possible: How increased patient activation is associated with favorable changes in well-being, self-management and health outcomes among people with type 2 diabetes mellitus: A prospective longitudinal study. Patient Education and Counseling, 105(4), 821-827. https://doi.org/10.1371/journal.pone.0217771

Purpose
The purpose of this discussion is to demonstrate your understanding of the review and appraisal of a systematic review that includes systematic review with meta-analysis, or meta-synthesis, and to use skills in the appraisal of research studies in your future role as a DNP-prepared nurse. Importantly, you will review the background and intention of the systematic review research study. As you work to find solutions to practice problems, critical review and appraisal of systematic reviews are required.

Instructions
Using the practice problem, you selected in NR715, continue your search and appraisal of evidence by analyzing one systematic review research study. This research study should not be one that was used in NR715. Address the following in the discussion:

Appraise the systematic review research study using the Johns Hopkins Research Appraisal Tool. Transfer your findings to the Johns Hopkins Individual Evidence Summary Tool.
Analyze the evidence summary tool of the research study to address the following in the discussion:
Determine whether the research design—systematic review, systematic review with meta-analysis, or meta-synthesis —answers the research question. Explain your rationale.
Based on information in the published study, explain if the search was comprehensible and reproducible.
Based on the Johns Hopkins Individual Evidence Summary Tool, determine if there is an evidence-based intervention you might consider for translation to practice in a practice change project. Explain your rationale.
Based on the Johns Hopkins Individual Evidence Summary Tool Column Observable Measures, consider if you would use this systematic review research study as support for your selected practice problem. Explain your rationale.
Include your completed Johns Hopkins Individual Evidence Summary Tool and permalink to the selected research study.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

Link (webpage): DNP Discussion Guidelines
Links to an external site.

Course Outcomes  
This discussion enables the student to meet the following course outcomes:

Evaluate selected statistical methods for the purposes of critiquing research to complement the critical appraisal of evidence. (POs 3, 5, 9)
Analyze research and non-research data for the purposes of critical appraisal and judgment of evidence for translation into practice. (POs 1, 3, 5, 7, 9)
Synthesize high-level research and non-research evidence relevant to practice problems. (POs 1, 3, 5, 9)