An exclusion policy was applied to papers which were older than 10 yrs. The preferential inclusion criteria allowed for papers less than 8 years old to be considered and which, after being critically appraised, were considered to offer a substantial and informative contribution to the evidence base
Literature Review
The evidence level IIb study by Donicová, Broz & Sorin (2011) is a well-constructed comparative analysis of the impact of the level of nursing knowledge on diabetic outcomes across eight European countries. It finds that patient outcomes, in Type 2 diabetes care, are dependent on many confounding factors. The authors demonstrate that healthcare delivery systems in the various counties, although superficially similar, have wide …show more content…
A critical analysis of this study demonstrates that difficulties encountered in obtaining accurate and relevant information. The analysed data is frequently found to be incomplete with many undiagnosed cases in a population. Output bias is noted in terms of consequent under-reporting of morbidity status. Accuracy of national recording of the outcomes, in terms of complications, most notably amputations, blindness, and renal failure, is also hugely variable. Direct comparisons are problematic insofar as state-funded and private systems co-exist and have different outcome measures. The various healthcare systems have the primary healthcare provided by different grades of healthcare professional (viz. diabetologists, endocrinologists, internal medicine physicians, family specialists and specialist diabetic nurses), many of which are located in the large centres of population and there are other skill mixes in rural populations. Because this study considered and contrasted different populations they found, as an illustrative example that specialised foot care facilities could vary from being easily accessible to completely non-existent, across the populations …show more content…
The huge evidence level IIa study by Young, Furler, Vale, Walker Segal, et al. (2014),The PEACH study, which was a cluster randomised controlled trial with a telephone-based intervention which used nurses to individually coach people with type 2 diabetes to adhere with their treatment plan to improve diabetes care as measured by serial HbA1c measurements over an 18 month study period. This study was particularly notable because it also used other endpoints such as renal function (assessed by estimated glomerular filtration rate and urinary albumin to creatinine ratio), the lipid profile, (assessed by total, HDL and LDL cholesterol and triglyceride levels), and other indices such as blood pressure, waist circumference, BMI and smoking status, which made the outcomes highly generalizable and comparable with other studies. Additional measurements included quality of life index, levels of depression and any degree of escalation of pharmaceutical treatment. The relevance of this study to the thrust of this literature review is that it clearly demonstrates that better adherence to the diabetic regime is associated with better outcomes for the
Literature Review
The evidence level IIb study by Donicová, Broz & Sorin (2011) is a well-constructed comparative analysis of the impact of the level of nursing knowledge on diabetic outcomes across eight European countries. It finds that patient outcomes, in Type 2 diabetes care, are dependent on many confounding factors. The authors demonstrate that healthcare delivery systems in the various counties, although superficially similar, have wide …show more content…
A critical analysis of this study demonstrates that difficulties encountered in obtaining accurate and relevant information. The analysed data is frequently found to be incomplete with many undiagnosed cases in a population. Output bias is noted in terms of consequent under-reporting of morbidity status. Accuracy of national recording of the outcomes, in terms of complications, most notably amputations, blindness, and renal failure, is also hugely variable. Direct comparisons are problematic insofar as state-funded and private systems co-exist and have different outcome measures. The various healthcare systems have the primary healthcare provided by different grades of healthcare professional (viz. diabetologists, endocrinologists, internal medicine physicians, family specialists and specialist diabetic nurses), many of which are located in the large centres of population and there are other skill mixes in rural populations. Because this study considered and contrasted different populations they found, as an illustrative example that specialised foot care facilities could vary from being easily accessible to completely non-existent, across the populations …show more content…
The huge evidence level IIa study by Young, Furler, Vale, Walker Segal, et al. (2014),The PEACH study, which was a cluster randomised controlled trial with a telephone-based intervention which used nurses to individually coach people with type 2 diabetes to adhere with their treatment plan to improve diabetes care as measured by serial HbA1c measurements over an 18 month study period. This study was particularly notable because it also used other endpoints such as renal function (assessed by estimated glomerular filtration rate and urinary albumin to creatinine ratio), the lipid profile, (assessed by total, HDL and LDL cholesterol and triglyceride levels), and other indices such as blood pressure, waist circumference, BMI and smoking status, which made the outcomes highly generalizable and comparable with other studies. Additional measurements included quality of life index, levels of depression and any degree of escalation of pharmaceutical treatment. The relevance of this study to the thrust of this literature review is that it clearly demonstrates that better adherence to the diabetic regime is associated with better outcomes for the