FAU Diabetes and ADHD Discussion – Description
Below I have two posts (parts 1 and 2). Please provide a response to each and follow the rubric. Minimum 200 words each with reference (WITHIN THE LAST 5 YEARS).
PART 1
Introduction
Diabetes patients must continuously monitor their blood sugar levels to avoid extremes that might lead to fatalities. Type 1 diabetes patients require continuous monitoring because it helps them regulate their diet, medication, or physical exercise since they are significant triggers. Increasing rates of obesity have sparked the rate at which teenagers have diabetes recently, hence the need to ensure they can effectively monitor their blood sugar levels. There are various blood sugar monitoring methods, including Continuous Glucose Monitoring (CGM), finger sticks, and using a glucose meter. The two articles provide supporting information about the PICOT Outcome, revealing that CGM improves time in target, HbA1C, and glycemic control in teenagers compared to standard blood glucose monitoring methods (SBMG) like finger sticks.
Type of PICOT Question
Intervention
PICOT Question
In teenagers with Type 1 diabetes, what is the effect of Continuous Glucose Monitoring (CGM), compared to the finger stick method, on better blood glucose control?
PICOT Question Outcome
CGM is more effective in monitoring adolescents with Type 1 diabetes because it provides unlimited data and does not rely on the number of times the patient is willing to prick their fingers. It can provide real-time and offline data that the patient can download later. Since it allows for data within short intervals, it detects temporal trends in glucose levels, which is impossible to monitor through finger sticks. Besides, CGM is more desirable because it is less painful, considering it uses sensors instead of needles to remove blood to measure glucose levels. Therefore, CGM is more effective in providing unlimited, accurate, and discrete data among teenagers with Type 1 diabetes.
Article 1
The article by Laffel et al. aims to determine CGM’s effect on glycemic control among adolescents with Type 1 diabetes. Most adolescents and young adults with Type 1 diabetes are not keen on monitoring their glycemic, with only 17% of them attaining the standard target of less than 7.5% and 14% attaining less than 7% (Laffel et al., 2020). The study revealed that CGM significantly improves glycemic control compared to standard methods like finger sticks. Laffel et al. (2021) describe the outcome as a change in Hemoglobin A1c (HbA1C) from baseline to 26 weeks, which they measured through samples from 153 participants. The measure is reliable because it used adolescent data and focused on glycemic metrics relevant to CGM and had a 95% confidence interval. The study is valid because it was a randomized trial with all groups treated and analyzed the same.
Article 2
Thabit et al.’s article proposed that using the CGM system would be more effective in controlling glycemic levels among adolescents compared to Self -Monitoring Blood Glucose (SMBG). According to the study’s findings, CGM use among young people with Type 1 diabetes reduces time to target and lowers HbA1C levels compared to SMBG. When employing CGM instead of SBMG, the time in target increased by 11.1%, and the hemoglobin level dropped by 0.76% (Thabit et al., 2020). The article’s measures are reliable because they produce outcomes relevant to the effectiveness of CGM in controlling HbA1C and glycemic levels among adolescents and has a confidence interval of 95%. The study is valid because it was a randomized crossover trial, which reduces bias, and had specific criteria for selection to reduce the chances of other factors causing the results.
Relevance of 2 Selected Outcomes for Practice
The articles produce relevant results to the PICOT question and healthcare profession because they provide facts about the effectiveness of CGM in monitoring diabetes elements compared to SBMG in teenagers and young adults, which is the target population of our PICOT question. Hemoglobin and glycemic levels among teenagers are significant factors that physicians and caregivers consider during treatment. Since the articles reveal that CGM is more effective in controlling Type 1 diabetes among teenagers and young adults, they directly relate to the PICOT Outcome.
Data Collection Measures
Healthcare practitioners can implement practice change by creating a communication plan and encouraging CGM sensor-wearing among teenagers with Type 1 diabetes. They can collect data that will facilitate the transition by analyzing sample results from prior patients with Type 1 diabetes and how often they discuss their blood glucose with their physician. They can also survey the number of patients using CGM instead of SBMG and use the result to create awareness of sensor wear. Patients and physicians can also easily review data on glucose levels to ensure proper insulin amounts are prescribed and have confidence in keeping or changing the dosages.
References
Laffel, L. M., Kanapka, L. G., Beck, R. W., Bergamo, K., Clements, M. A., Criego, A., DeSalvo, D. J., Goland, R., Hood, K., Liljenquist, D., Messer, L. H., Monzavi, R., Mouse, T. J., Prahalad, P., Sherr, J., Simmons, J. H., Wadwa, R. P., Weinstock, R. S., Willi, S. M., & Miller, K. M. (2020). Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes. JAMA, 323(23), 2388. https://doi.org/10.1001/jama.2020.6940Links to an external site.
Thabit, H., Prabhu, J. N., Mubita, W., Fullwood, C., Azmi, S., Urwin, A., Doughty, I., & Leelarathna, L. (2020). Use of Factory Calibrated Real-Time Continuous Glucose Monitoring Improves Time in Target and Hba1c in a Multiethnic Cohort of Adolescents and Young Adults with Type 1 Diabetes: The Millennials Study. https://doi.org/10.2337/figshare.12616208
PART 2
Introduction:
Attention Deficit Hyperactivity Disorder (ADHD) is a health condition that mainly affects teens and children. However, it can continue into adulthood (Dalsgaard, 2013). According to WebMD (2017), ADHD is a common disorder in children. It adversely affects daily life and makes children encounter difficulties in paying attention and control their impulses. Most of the children diagnosed with ADHD record poor academic performance due to their poor concentration in schools. Moreover, they experience low self-esteem and have problems forming relationships. Some of the symptoms of this disorder include listening to problems, forgetting daily activities, daydreaming, low self-esteem, impulsiveness, mood swings, and depression (Tosto et al., 2015). Most parents with a child diagnosed with ADHD have difficulties in deciding what treatment is best for their child.
PICOT Question:
Type of PICOT Question: Interventional
PICOT Question: In children diagnosed with ADHD, how does the implementation of holistic nursing care for interventions, such as behavioral and cognitive therapy, as well as teaching relaxation techniques like deep breathing exercises, and guided imagery, compare to medication-based treatment in improving attention span and assisting parents in making informed decisions about their children’s treatment options?
PICOT Question Outcome:
To identify behavioral and cognitive therapy, such as deep breathing exercises and guided imagery compared to medication-based treatment in improving the attention span of children with ADHD.
Article 1:
The first article we chose is titled, “Parents’ priorities and preferences for treatment of children with ADHD: Qualitative inquiry in the MADDY study.” The purpose of this study was to investigate how parents’ perceptions on treatment preferences and priorities are influenced by their experiences of raising a kid with ADHD in the family. The study employed a phenomenological qualitative design. Parents of ADHD patients who were participating in a multisite randomized controlled experiment underwent semi-structured interviews. The article addressed the picot topic by addressing the query regarding the type of ADHD treatment that parents would choose for their kids.
The author’s conceptual outcome was that parents, regardless of demographic disparities between sites, expressed similar experiences and identified comparable impediments, preferences, and priorities for ADHD therapies. Families wanted access to family-centered, multimodal treatments for ADHD. Twenty-three parents were interviewed to determine the operational outcome. The average age of the kids was 9.6 years (SD: 1.8 years); 78% of them were boys; and 48% had never been given ADHD medication. From the analysis, two main themes were discernible. ‘Impact of ADHD on families within and outside the house’ was topic 1, and its subthemes were reconfiguring the family life’, ‘trial-and-error of adjustments at school’, and responding to social demands to fit in’. Finding the “right fit” with experts and treatments and issues influencing inequitable access to treatments were the two subthemes under the topic 2 enabling appropriate and accessible treatments for families.
Measurements of validity and reliability are not applicable for this study. However, the study, may serve to guide healthcare services and policy to better support families with children who have ADHD. Parents want a wider variety of ADHD treatment options and more support from healthcare professionals to examine these alternatives because some kids may not respond well to medications. Care could be improved by comprehending and focusing on families’ actual experiences. The results of this study show that systemic adjustments to the healthcare and educational systems are necessary to meet the needs of kids with ADHD.
Article 2:
The second article, “Behavioral treatments effective for children with ADHD,” explored behavioral interventions. The purpose of this study was to determine whether behavioral interventions, based on rater reports, are successful for lowering the symptoms of attention-deficit hyperactivity disorder (ADHD), as well as behavioral issues and impairment. The meta-analysis examined individual participant data, including information from behavioral intervention randomized controlled trials. This study sought to answer our picot question regarding the accessibility of behavioral therapy for ADHD.
The conceptual outcome was based on a total of 62 papers that were eligible, for which the researchers received 23 datasets. Two additional studies that had not yet been published at the time of the initial rise were added for consideration last year. With a mean age of 8.78 years, the 25 trials examined included 2,885 participants (1,936 intervention, 949 control). Parent was usually always the primary reporter in the research. Teacher ratings were only used to one school-based research treatment. Bias agreement risk was significant. Few studies had their trials preregistered, therefore almost all had selective reporting. Interventions aimed at altering children’s and teenagers’ behavior, such as boosting desirable behaviors and reducing undesirable behaviors, were described as behavioral interventions in the author’s conceptual outcome. Also employing therapeutic (cognitive) behavioral methods that follow the concept of mediated treatments. The use of (cognitive) behavioral interventions targeted specifically at the child or teenager, such as behavioral skills training or (cognitive) behavioral therapy. The results of the study showed that behavioral treatments, such as behavioral skills training or (cognitive) behavioral therapy, reduced the symptoms of ADHD, behavioral issues, and overall impairment, with CD and adolescent single parenthood serving as the main moderators.
IPDMA technique was utilized as a measurement instrument to detect behavioral intervention effects and modifiers of outcomes for symptoms of ADHD, ODD, CD, and global impairment in children and adolescents with ADHD for validity and reliability. Parents (for parent-based interventions) and teachers (for school-based interventions) provided the reports that were most relevant to the implementation of the treatment, respectively. Where possible, the researchers used impacts on blinded measures and looked at the potential applications of variables that are frequently used in clinical practice.
Relevance for Practice:
Both of these articles are crucial for ADHD patients. They both present research on techniques that support the treatment of ADHD. The results can be measured and are an important component of an investigator’s evaluation. Both of them contribute to the PICOT question on the factors that aid in the treatment of ADHD. The first article examines several strategies and parents’ preferences; it does not favor one strategy over another but rather focuses on multimodal therapies. The second article only discusses behavioral therapies and why people choose them. To assist our ADHD patients, it is important for nurses to be knowledgeable about various therapies and approaches. Not every patient responds well to treatment. Additionally, not every patient’s response to a treatment is the same. Everyone is unique, so we need to know, based on research, what will benefit our patient.
Data Collection Measures:
The understanding of and receptivity to non-pharmaceutical, alternative treatment alternatives for ADHD among healthcare professionals and educators would be helpful. Data collection measures would involve coordinating care across healthcare and education, as well as a family-centered, multimodal approach to ADHD treatment. support for parents of kids with ADHD in making decisions about ADHD treatments from healthcare professionals and schools. In order to lessen the stigma attached to the disease, healthcare professionals and educational institutions should be informed about the requirements of kids with ADHD and their families.
References
Alexander, E., Arnold. L. E., Bruton, A.M., Camden, K., Hatsu, I., Johnston, J. M., Leung, B.M., Lu, S. V., & Millington, E. (2022). Parents’ priorities and preferences for treatment of children with ADHD: Qualitative inquiry in the MADDY study. Child: Care, Health & Development, 48(5), 852-861. http://doi.org/10.1111/cch.12995Links to an external site..
Knopf, A. (2021). Behavioral treatments effective for children with ADHD. Brown University Child & Adolescent Psychopharmacology Update, 23(8), 1-3. http://doi.org/10.1002/cpu.30597Links to an external site.
Tosto, M. G., Momi, S. K., Asherson, P., & Malki, K. (2015). A systematic review of attention deficit hyperactivity disorder (ADHD) and mathematical ability: current findings and future implications. BMC medicine,13(1), 204.
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