Section 1: Research Question
The number of people with diabetes in the United States is alarming as it continues to increase each year (Moghissi, et al., 2009). Diabetes is a critical illness that can be managed through many means such as diet, oral medications, and proper use of insulin to control blood sugar, and physical activity. Diabetes management is very important because it helps in reducing risk factors associated with cardiovascular diseases such as tobacco use, high cholesterol, and high blood pressure (Moghissi, et al., 2009). There a number of outpatient diabetes care and educations centers in the United States, which offer educations to patients referred to these centers. On the other hand, inpatient care for individuals with diabetes is available in hospitals and a survey conducted in 2009 indicated that around 22% of inpatient days are occupied by individuals with diabetes (Moghissi, et al., 2009). People with diabetes have faced different issues in outpatient care as well as in inpatient care. Based on the two types of diabetes management care, the following questions about the population, intervention, comparison, Outcome, and Time frame or PICOT were developed.
Narrative Question: What is the effectiveness of managing diabetes through inpatient diabetes management and education compared to outpatient care and education, and roles of nurses in supporting patient involvement and self-management?
PICOT Question: In patients with diabetes type 2, how do inpatient diabetes management and education compared to outpatient care and education improve glycemic control over a period of 6 months?
P: What is the patient population? Patients with diabetes type 2
I: What is the intervention of interest? An inpatient diabetes management and education program
C: What is the comparison of interest? Outpatient diabetes care and educations programs offered in diabetes outpatient centers
O: What is the outcome of interest? Improved glycemic control in patients with type 2 diabetes
T: What is the time frame? A period of 6 months
Section 2: Database Search
PICOT Search and Limitations
After framing the research question, the right approach is needed to locate, assess, and evaluate the available evidence. The search strategy can be done using background information or foreground information. Background information offers the best way to identify general information about the PICOT question. However, with properly planned search strategy, the search of evidence for the PICOT question mostly deals with foreground information search that is narrowed (Rios, Ye, & Thabane, 2010). The result is relevant abstracts, books, or full articles that are filtered and with applied limitations.
The first step in the search for the database articles for the PICOT question was through the use of background information. In this case, the background information was unfiltered information that led to a wide pool of journal articles. Furthermore, the strategy of using the background information only enabled me to answer a general background question on the topic of comparing inpatient diabetes management and education, and outpatient diabetes care and education. As a result, the sources for general background question were numerous and included book entries, chapters, and appendices in books, monographs, and review articles. To locate the overview of inpatient and outpatient type diabetes care and education, the Medline database was a convenient and valid source of reviewed articles. Google Scholar provided a variety scholarly publications abstracts, books, theses, and peer-reviewed articles.
Foreground questions look for evidence to answer request for nursing information associated to a particular patient, an involvement, or therapy. At this point, the PICOT aspects assist in focusing the foreground question (Riva, Malik , Burnie, Endicott, & Busse, 2012). P: Patients with diabetes type 2, I: An inpatient diabetes management and education program, C: Outpatient diabetes care and educations programs offered in diabetes outpatient centers, and O: Improved glycemic control in patients with type 2 diabetes, T: A period of 6 months.
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In order to narrow the background information search results, several strategies came into play. First, the search involved selecting topic terms that were more specific. For instance, instead of using ‘inpatients diabetes management,’ ‘inpatient glycemic control’ was used. Using the entire research topic was not helpful because some databases were returning ‘no results found’ while others were giving irrelevant information. This meant that the topic had to be rephrased for a number of times and even use online libraries to search for synonyms to offer the best results. For some databases, the attempts to get the right resources from the database were and lots of trial and error was done to determine the best and easiest way out (Shariff, et al., 2013). The chart below shows the results obtained after searching three databases namely Medline, Google Scholar, and CINAHL.
Table 1: Database Search Results
|Database||Search Terms||Number of Results|
|Medline||Inpatient diabetes care and education, outpatient diabetes care, inpatient glycemic control, outpatient glycemic control||733|
|Google Scholar||Inpatient diabetes care and education, outpatient diabetes care, inpatient glycemic control, outpatient glycemic control||19,300|
|CINAHL||Inpatient diabetes care and education, outpatient diabetes care, inpatient glycemic control, outpatient glycemic control||161|
Section 3: Limiting the Search
Filtration or use of limits for different databases differ and include, filtration by publication types; dates of publication; and filtration by topic category. When research results are filtered through database limits, the filtration included selecting case studies, news articles, systematic reviews, editorials, and clinical trials among others (Anders & Evans, 2010). Such form of filtration ensures that the retrieved research offers high-level evidence since only rigorous methodology was used. When the research involves using only the most recent literature, the most appropriate way is to use date of publication limits on the topic.
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Another common filtration method is limit by age group which is very useful especially in limiting the set of results by a given age group that is relevant for the topic and it eliminates the need to include limiting keywords (Anders & Evans, 2010). In this database search, there was no need to limit the search results by age, although, such limitation is vital for other research topics. Filtration by publication types was also used. Different types of publications to choose from were journals, videotapes, portable guides, summaries, reports, fact sheets, bulletins, and newsletters. Through this filtration, it was possible to search for each publication type differently. Finally, the set of search results was sort by peer-reviewed articles or other subsets of the topic that may be available especially in Google Scholar, Medline, and CINAHL databases. However, there is another form of database filtration that involves the use of ‘full text’ or ‘full text available’ was avoided because using this form of limitation meant that the search results were further limited to just articles available from individual service. After filtration the following results were obtained:
Table 2: Database Search Results
|Database||Search Terms||Number of Results|
After searching the Cochrane Library, no meta-analysis or meta-study was found to be related to the research topic. However, the Cochrane Library rendered numerous journal articles on high-quality evidence for health care. There were a number of articles on inpatient diabetes care alone or outpatient diabetes care alone, but there was no study that had compared the two types of care.