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RunningHead: PICOT Question 1
RunningHead: PICOT Question 7
PICOT Question
Avery Bryan
NRS-433V
Professor Christine Vannelli
May 19, 2019
Clinical Problem
A report from the Center for Disease Control and Prevention in
2015 revealed that (9.4%) 30.3 million Americans are diabetic
and 84.1 million have prediabetes. This is a total population of
over 100 million is at risk of developing type 2 diabetes which
is a growing health problem being the seventh leading cause of
death in the U.S. An estimated 1.5 million new cases were
among 18-year old bracket and the rates of diagnosed diabetes
increased proportionally to age. Below 44 years accounted for
4%, below 64 years at 17 % and 25% for those above 65 years
across both genders. One-third of adults in America has
prediabetes but sadly, they are unaware despite reports released
by The National Diabetes Statistics Report every year. These
reports elaborate on prevalence and incidence, prediabetes,
long-term complications, risk factors, mortality, and cost.
Diabetes poses the risk of serious complications like death,
blindness, stroke, kidney disorders, cardiac diseases and health
problems that lead to amputation of legs. However, the risks can
be mitigated through physical body activities, proper dieting
and prescribed use of insulin and other related measures to
control the blood sugar levels. Diabetes Prevention Program
was funded by NIH to research a yearly evidence-based program
to improve healthy weight loss through diet and physical
activities. There also efforts to determine the effectiveness of
public service campaigns in improving the real-life experience
in the diagnosis and treatment of diabetes.
PICOT Question.
The population affected by diabetes cuts across all ages, gender,
race, and ethnicity. The prevalence is significantly high from 18
years and it increases with age to about 25% above 65 years. In
terms of gender, men are at higher risk accounting for 37%
while women are at 30% across races and educational levels. On
races, the rates were higher among Indians/Alaska natives at
15%, non-Hispanic blacks at 12.7% and Hispanics at 12%.
Among Asians, the rates were lower at 8% and 7.4% for non-
Hispanic whites.
Intervention indicator for diabetes shows that individuals who
do not observe a healthy diet are more exposed to the disease.
Some risk behaviors include lack of exercise and excessive
intake of junk foods that lead to obesity and increased blood
sugar levels. Diabetes prevalence varied according to education
levels were those with less than high school education at 12.6%
and 7.2% for those higher than high school education.
Comparison and use of a control group from the popularity of
Complementary and Alternative Medicine and Traditional
Chinese Medicine showed distinct knowledge of diabetes, blood
sugar control, and self-care. The experimental group received
education through interactive multimedia for three months while
the control group received a routine patient education for 3
months.
The outcome of diabetes includes risk factors and accuracy of
diagnosis. Obesity, impaired glucose tolerance, insulin
resistance, ethnic background, age, and sedentary lifestyle are
the leading factors. Diagnosis is usually accurate by
determining the blood sugar levels and analyzing genetic
combinations to establish the possibility of prediabetes
condition. Adverse effects of diabetes like blindness and
amputations occur to patients who have delayed in seeking
medication but early treatment can prevent such cases.
The Time it takes for interventions to be effective can be two
years just as The National Diabetes Statistics Report is released.
The report provides relevant information on prevalence, risks,
and complications, mortality, and costs in America. Such
information can be used to determine how effective the
interventions are in controlling diabetes.
Literature Evaluation Table
Qualitative
Criteria
Article 1
Article 2
Article 3
Author, Journal (peer-reviewed) working link to access the
article
Campbell, R., Pound, P., Pope, C., Britten, N., Pill, R., Morgan,
M., & Donovan, J
https://www.sciencedirect.com/science/article/abs/pii/S0277953
602000643
Greenhalgh, T.
https://europepmc.org/abstract/med/12227121
Jansink, R., Braspenning, J., van der Weijden, T., Elwyn, G., &
Grol, R
https://bmcfampract.biomedcentral.com/articles/10.1186/1471-
2296-11-41
Article Title and year Published
Evaluating meta-ethnography: a synthesis of qualitative
research on lay experiences of diabetes and diabetes
care. Social science & medicine, 56(4), 671-684
(2003)
Integrating qualitative research into evidence-based practice.
Endocrinology and metabolism clinics of North America, 31(3),
583-601. (2002)
Primary care nurses struggle with lifestyle counseling in
diabetes care: a qualitative analysis. BMC family
practice, 11(1), 41.
(2010)
Research Question (Qualitative/ Quantitative) Purpose of the
study
To purposely evaluate adult patients’ perspective of diabetes
Provide a rigorous study in diagnosis, prognosis, prevalence,
and therapy to clinical decision-making in endocrinology
To develop an implementation strategy to improve lifestyle
behavior change in diabetes patients
Design, (Type of Qualitative or Quantitative) research
A quasi-experimental design was used
Exploratory qualitative analysis of data
The retrospective cohort analysis study
Setting/ Sample
Diabetes patients and prediabetes and their caregivers were
involved in answering questions about the disease.
The study involved medical practitioners and patients of
diabetes.
The research was conducted with nurses in Dutch general
practices to give a view of the challenges they face in advising
patients.
Methods; Interventions/ Instruments
A short self-administered questionnaire was used.
Face to face interviews and collection of written data
Data were obtained from Dutch general practice from nurses
and other professionals.
Analysis
Descriptive statistical analysis using percentages, averages and
standard deviations
The confirmatory data analysis method
Bivariate analysis was used to evaluate the responses
Key Findings from the Research
Caregivers were personally concerned with the patients’
conditions
Diabetes is preventable and if patients and those at risk make
efforts to control it
It is possible to make positive changes in the endocrinology
field like diabetes using comprehensive research
Nurses lack the skills for counseling the patients and they use
the traditional approach to train patients
Recommendations for the study
There should be consistent screening and provision of proper
guidelines to patients by medical officers and caregivers
The public should be provided with sufficient information
concerning the importance of physical exercises
Nurses should be trained on how to impact motivation in
patients towards changing lifestyle in regards to controlling
diabetes.
Explanation of how Article supports the Capstone
The article is connected to the topic by providing suggestions to
control diabetes
The articles also give an insight into the role of caregivers and
medical practitioners
The article is important to the project because physical exercise
is one of the important measures in regulating blood sugar
levels
This article is important because it shows how motivating
patients to change lifestyle can impact the fight against
diabetes.
It also shows that nurses play an important role in changing
lifestyles.
Quantitative
Criteria
Article 1
Article 2
Article 3
Author, Journal (peer-reviewed) working link to access the
article
Lanza, I. R., Zhang, S., Ward, L. E., Karakelides, H., Raftery,
D., & Nair, K. S
https://journals.plos.org/plosone/article?id=10.1371/journal.pon
e.0010538
Singh, G. M., Danaei, G., Farzadfar, F., Stevens, G. A.,
Woodward, M., Wormser, D., ... & Di Angelantonio, E
https://journals.plos.org/plosone/article?id=10.1371/journal.pon
e.0065174
https://europepmc.org/abstract/med/3073901
Article Title and year Published
Quantitative metabolomics by 1H-NMR and LC-MS/MS
confirms altered metabolic pathways in diabetes. PloS one, 5(5),
e10538.
(2010)
The age-specific quantitative effects of metabolic risk factors
on cardiovascular diseases and diabetes: a pooled analysis. PloS
one, 8(7), e65174
(2013)
Research Question (Qualitative/ Quantitative) Purpose of the
study
Analyze pathways known to be affected by insulin deficiency in
the body of diabetes patients
Establish the risk of cardiovascular disease in epidemiological
studies with estimates using effect sizes of age and sex where
possible
Perform an analysis of endocrine and exocrine pancreas in
relation to diabetes
Design, (Type of Qualitative or Quantitative) research
The quasi-experimental method was followed
A cohort pooling study
A case-control study
Setting/ Sample
The study was carried out on patients concerning levels of
insulin and hormones with profound effects on carbohydrates,
fats and protein metabolism.
The study was conducted on the basis of age especially the
elderly who are at higher risk of suffering from diabetes
It was done on immunoperoxidase stained post-mortem tissues
of 15 type-2 diabetes
Methods; Interventions/ Instruments
Basic analysis on urine cotinine, heart rate variability, and
psychiatric scale.
Average of 123 cohorts provided about 1.4 million individuals
and 52000 CVD cases. The data was obtained through interview
and lab tests.
Data came from 15 type-2 diabetes patients with 10 matched age
control sets
Analysis
Confirmatory data analysis was used for the data.
SPSS 22 version was used
Descriptive statistical analysis was used
Key Findings from the Research
This study showed that the metabolism concept applied to the
clinical situation of acute insulin deprivation as associated with
insulin deficiency.
Each metabolic risk factor was robustly related to
Cardiovascular disorder.
Impaired insulin secretion in type 2 diabetes may be due to a
decrease in B-cells and disruption on the islet structure.
Recommendations for the study
Insulin deficiency is linked to insulin deprivation which affects
metabolism and causes abnormalities.
Due to the increased risk factor of diabetes with age, the elderly
should receive special care to minimize the prevalence.
There should be measures to reduce the increase in A-cells in
order to prevent hyperglucagonemia and diabetic subjects.
Explanation of how Article supports the Capstone
The article is important to the capstone because it relates to
insulin and the role of hormones in dealing with diabetes.
The study provided robust, comparable and clear estimates of
how the risk factors related to CVD and diabetes.
This is important in relating the effect of A-cells and B-cells in
diabetes patients.
Poetry Analysis: “The Raven” Homework Assignment
Carefully read Edgar Allan Poe’s “The Raven.” Then, use your
lecture notes to help you answer the following questions.
· What kind of poem is “The Raven”? (Narrative? Ode? Epic?
Etc.) Why do you think so?
· How many stanzas does the poem contain? How many lines are
in each stanza?
· Plot the rhyme scheme (end rhyme) of the first stanza of the
poem.
· How does this poem sound when read aloud? Melodic?
Cacophonic? What makes the poem sound the way it does?
· How would you describe the rhythm of “The Raven”?
· “The Raven” features extensive use of internal rhyme. Find
and list examples of internal rhyme.
· Give at least one example of each of the following:
Assonance, consonance, and alliteration.
· Describe the setting of “The Raven.” How does the setting
contribute to the mood of the poem?
· Describe the speaker’s tone in “The Raven.”
· Paraphrase the literal action of the poem, stanza by stanza.
What is actually going on?
· “The Raven” is full of imagery (sensory details.) List at least
3 examples of this.
· Locate and describe at least 3 allusions (references) in “The
Raven.”
· Find examples of symbolism in the poem; which objects do
you think are symbolic, and why do you say so?
· Look for at least 1 example of personification, and at least 1
example of either metaphor or simile.
· Notice the extensive use of repetition in “The Raven”; which
words / phrases do you see repeated, and to what effect?
· Take note of the syntax (sentence structure) of the poem, as
well as its language and diction (word choice.) What effect do
you think these elements have on the poem?
· What would you say is the theme (purpose) of “The Raven”?
Why?
THE RAVEN
by Edgar Allan Poe
Once upon a midnight dreary, while I pondered, weak and
weary,
Over many a quaint and curious volume of forgotten lore,
While I nodded, nearly napping, suddenly there came a tapping,
As of someone gently rapping, rapping at my chamber door.
" 'Tis some visitor," I muttered, "tapping at my chamber door;
Only this, and nothing more."
Ah, distinctly I remember, it was in the bleak December,
And each separate dying ember wrought its ghost upon the
floor.
Eagerly I wished the morrow; vainly I had sought to borrow
From my books surcease of sorrow, sorrow for the lost Lenore,.
For the rare and radiant maiden whom the angels name Lenore,
Nameless here forevermore.
And the silken sad uncertain rustling of each purple curtain
Thrilled me---filled me with fantastic terrors never felt before;
So that now, to still the beating of my heart, I stood repeating,
" 'Tis some visitor entreating entrance at my chamber door,
Some late visitor entreating entrance at my chamber door.
This it is, and nothing more."
Presently my soul grew stronger; hesitating then no longer,
"Sir," said I, "or madam, truly your forgiveness I implore;
But the fact is, I was napping, and so gently you came rapping,
And so faintly you came tapping, tapping at my chamber door,
That I scarce was sure I heard you." Here I opened wide the
door;---
Darkness there, and nothing more.
Deep into the darkness peering, long I stood there, wondering,
fearing
Doubting, dreaming dreams no mortals ever dared to dream
before;
But the silence was unbroken, and the stillness gave no token,
And the only word there spoken was the whispered word,
Lenore?, This I whispered, and an echo murmured back the
word,
"Lenore!" Merely this, and nothing more.
Back into the chamber turning, all my soul within me burning,
Soon again I heard a tapping, something louder than before,
"Surely," said I, "surely, that is something at my window
lattice.
Let me see, then, what thereat is, and this mystery explore.
Let my heart be still a moment, and this mystery explore.
" 'Tis the wind, and nothing more."
Open here I flung the shutter, when, with many a flirt and
flutter,
In there stepped a stately raven, of the saintly days of yore.
Not the least obeisance made he; not a minute stopped or stayed
he;
But with mien of lord or lady, perched above my chamber door.
Perched upon a bust of Pallas, just above my chamber door,
Perched, and sat, and nothing more.
Then this ebony bird beguiling my sad fancy into smiling,
By the grave and stern decorum of the countenance it wore,
"Though thy crest be shorn and shaven thou," I said, "art sure
no craven,
Ghastly, grim, and ancient raven, wandering from the nightly
shore.
Tell me what the lordly name is on the Night's Plutonian shore."
Quoth the raven, "Nevermore."
Much I marvelled this ungainly fowl to hear discourse so
plainly,
Though its answer little meaning, little relevancy bore;
For we cannot help agreeing that no living human being
Ever yet was blessed with seeing bird above his chamber door,
Bird or beast upon the sculptured bust above his chamber door,
With such name as "Nevermore."
But the raven, sitting lonely on that placid bust, spoke only
That one word, as if his soul in that one word he did outpour.
Nothing further then he uttered; not a feather then he fluttered;
Till I scarcely more than muttered, "Other friends have flown
before;
On the morrow he will leave me, as my hopes have flown
before."
Then the bird said, "Nevermore."
Startled at the stillness broken by reply so aptly spoken,
"Doubtless," said I, "what it utters is its only stock and store,
Caught from some unhappy master, whom unmerciful disaster
Followed fast and followed faster, till his songs one burden
bore,---
Till the dirges of his hope that melancholy burden bore
Of "Never---nevermore."
But the raven still beguiling all my sad soul into smiling,
Straight I wheeled a cushioned seat in front of bird, and bust
and door;
Then, upon the velvet sinking, I betook myself to linking
Fancy unto fancy, thinking what this ominous bird of yore --
What this grim, ungainly, ghastly, gaunt and ominous bird of
yore
Meant in croaking "Nevermore."
Thus I sat engaged in guessing, but no syllable expressing
To the fowl, whose fiery eyes now burned into my bosom's core;
This and more I sat divining, with my head at ease reclining
On the cushion's velvet lining that the lamplight gloated o'er,
But whose velvet violet lining with the lamplight gloating o'er
She shall press, ah, nevermore!
Then, methought, the air grew denser, perfumed from an unseen
censer
Swung by seraphim whose footfalls tinkled on the tufted floor.
"Wretch," I cried, "thy God hath lent thee -- by these angels he
hath
Sent thee respite---respite and nepenthe from thy memories of
Lenore!
Quaff, O quaff this kind nepenthe, and forget this lost Lenore!"
Quoth the raven, "Nevermore!"
"Prophet!" said I, "thing of evil!--prophet still, if bird or devil!
Whether tempter sent, or whether tempest tossed thee here
ashore,
Desolate, yet all undaunted, on this desert land enchanted--
On this home by horror haunted--tell me truly, I implore:
Is there--is there balm in Gilead?--tell me--tell me I implore!"
Quoth the raven, "Nevermore."
"Prophet!" said I, "thing of evil--prophet still, if bird or devil!
By that heaven that bends above us--by that God we both adore-
-
Tell this soul with sorrow laden, if, within the distant Aidenn,
It shall clasp a sainted maiden, whom the angels name Lenore---
Clasp a rare and radiant maiden, whom the angels name Lenore?
Quoth the raven, "Nevermore."
"Be that word our sign of parting, bird or fiend!" I shrieked,
upstarting--
"Get thee back into the tempest and the Night's Plutonian shore!
Leave no black plume as a token of that lie thy soul hath
spoken!
Leave my loneliness unbroken! -- quit the bust above my door!
Take thy beak from out my heart, and take thy form from off my
door!"
Quoth the raven, "Nevermore."
And the raven, never flitting, still is sitting, still is sitting
On the pallid bust of Pallas just above my chamber door;
And his eyes have all the seeming of a demon's that is
dreaming.
And the lamplight o'er him streaming throws his shadow on the
floor;
And my soul from out that shadow that lies floating on the floor
Shall be lifted---nevermore!
Richard Cory
(by Edwin Arlington Robinson)
Whenever Richard Cory went down town,
We people on the pavement looked at him;
He was a gentleman from sole to crown,
Clean favored, and imperially slim.
And he was always quietly arrayed,
And he was always human when he talked;
But still he fluttered pulses when he said,
"Good-morning," and he glittered when he walked.
And he was rich - yes, richer than a king,
And admirably schooled in every grace;
In fine, we thought that he was everything
To make us wish that we were in his place.
So on we worked, and waited for the light,
And went without the meat, and cursed the bread;
And Richard Cory, one calm summer night,
Went home and put a bullet through his head
Poetry Analysis: Richard Cory Homework
Read Edwin Arlington Robinson’s “Richard Cory” and consider
the following questions. Then, choose any 7 of these questions
and answer them based on what you learned from the Literary
Analysis lecture.
· What type of poem is “Richard Cory”? (Epic, Narrative, Ode,
etc.)
· Describe the poem’s point of view. (Who is speaking?)
· Paraphrase the action of the poem in your own words. (What
literally happens?)
· Look at the poem’s structure; what can you say about its
number of stanzas, lines, etc.?
· Describe the rhythm of the poem.
· Describe the setting of “Richard Cory.”
· How does this poem rhyme? Plot the poem’s end rhyme, and
find examples of sight rhyme, internal rhyme, and repetition.
· Find an example of each of the following: Alliteration,
assonance, and consonance.
· What do you think the theme (purpose) of “Richard Cory”
might be? What does the author want us to learn or understand?
· Do you see anything in the poem that might have symbolic
meaning? Explain.
· Describe the tone of the poem. (Make note of the tone shift at
the end!)
· Describe the poem’s powerful use of situational irony.
· Think about language (formal? casual?) and diction (word
choice); what do these contribute to the poem?
Research Critique Guidelines
To write a critical appraisal that demonstrates comprehension of
the research study conducted, address each component below
for qualitative study in the Topic 2 assignment and the
quantitative study in the Topic 3 assignment.
Successful completion of this assignment requires that you
provide a rationale, include examples, or reference content from
the study in your responses.
Qualitative Study
Background of Study:
· Identify the clinical problem and research problem that led to
the study. What was not known about the clinical problem that,
if understood, could be used to improve health care delivery or
patient outcomes? This gap in knowledge is the research
problem.
· How did the author establish the significance of the study? In
other words, why should the reader care about this study? Look
for statements about human suffering, costs of treatment, or the
number of people affected by the clinical problem.
· Identify the purpose of the study. An author may clearly state
the purpose of the study or may describe the purpose as the
study goals, objectives, or aims.
· List research questions that the study was designed to answer.
If the author does not explicitly provide the questions, attempt
to infer the questions from the answers.
· Were the purpose and research questions related to the
problem?
Method of Study:
· Were qualitative methods appropriate to answer the research
questions?
· Did the author identify a specific perspective from which the
study was developed? If so, what was it?
· Did the author cite quantitative and qualitative studies
relevant to the focus of the study? What other types of literature
did the author include?
· Are the references current? For qualitative studies, the author
may have included studies older than the 5-year limit typically
used for quantitative studies. Findings of older qualitative
studies may be relevant to a qualitative study.
· Did the author evaluate or indicate the weaknesses of the
available studies?
· Did the literature review include adequate information to build
a logical argument?
· When a researcher uses the grounded theory method of
qualitative inquiry, the researcher may develop a framework or
diagram as part of the findings of the study. Was a framework
developed from the study findings?
Results of Study
· What were the study findings?
· What are the implications to nursing?
· Explain how the findings contribute to nursing
knowledge/science. Would this impact practice, education,
administration, or all areas of nursing?
Ethical Considerations
· Was the study approved by an Institutional Review Board?
· Was patient privacy protected?
· Were there ethical considerations regarding the treatment or
lack of?
Conclusion
· Emphasize the importance and congruity of the thesis
statement.
· Provide a logical wrap-up to bring the appraisal to completion
and to leave a lasting impression and take-away points useful in
nursing practice.
· Incorporate a critical appraisal and a brief analysis of the
utility and applicability of the findings to nursing practice.
· Integrate a summary of the knowledge learned.
Quantitative Study
Background of Study:
· Identify the clinical problem and research problem that led to
the study. What was not known about the clinical problem that,
if understood, could be used to improve health care delivery or
patient outcomes? This gap in knowledge is the research
problem.
· How did the author establish the significance of the study? In
other words, why should the reader care about this study? Look
for statements about human suffering, costs of treatment, or the
number of people affected by the clinical problem.
· Identify the purpose of the study. An author may clearly state
the purpose of the study or may describe the purpose as the
study goals, objectives, or aims.
· List research questions that the study was designed to answer.
If the author does not explicitly provide the questions, attempt
to infer the questions from the answers.
· Were the purpose and research questions related to the
problem?
Methods of Study
· Identify the benefits and risks of participation addressed by
the authors. Were there benefits or risks the authors do not
identify?
· Was informed consent obtained from the subjects or
participants?
· Did it seem that the subjects participated voluntarily in the
study?
· Was institutional review board approval obtained from the
agency in which the study was conducted?
· Are the major variables (independent and dependent variables)
identified and defined? What were these variables?
· How were data collected in this study?
· What rationale did the author provide for using this data
collection method?
· Identify the time period for data collection of the study.
· Describe the sequence of data collection events for a
participant.
· Describe the data management and analysis methods used in
the study.
· Did the author discuss how the rigor of the process was
assured? For example, does the author describe maintaining a
paper trail of critical decisions that were made during the
analysis of the data? Was statistical software used to ensure
accuracy of the analysis?
· What measures were used to minimize the effects of researcher
bias (their experiences and perspectives)? For example, did two
researchers independently analyze the data and compare their
analyses?
Results of Study
· What is the researcher's interpretation of findings?
· Are the findings valid or an accurate reflection of reality? Do
you have confidence in the findings?
· What limitations of the study were identified by researchers?
· Was there a coherent logic to the presentation of findings?
· What implications do the findings have for nursing practice?
For example, can the findings of the study be applied to general
nursing practice, to a specific population, or to a specific area
of nursing?
· What suggestions are made for further studies?
Ethical Considerations
· Was the study approved by an Institutional Review Board?
· Was patient privacy protected?
· Were there ethical considerations regarding the treatment or
lack of?
Conclusion
· Emphasize the importance and congruity of the thesis
statement.
· Provide a logical wrap-up to bring the appraisal to completion
and to leave a lasting impression and take-away points useful in
nursing practice.
· Incorporate a critical appraisal and a brief analysis of the
utility and applicability of the findings to nursing practice.
· Integrate a summary of the knowledge learned.
Reference
Burns, N., & Grove, S. (2011). Understanding nursing research
(5th ed.). St. Louis, MO: Elsevier.
© 2016. Grand Canyon University. All Rights Reserved.
4
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  • 1. RunningHead: PICOT Question 1 RunningHead: PICOT Question 7 PICOT Question Avery Bryan NRS-433V Professor Christine Vannelli May 19, 2019 Clinical Problem A report from the Center for Disease Control and Prevention in 2015 revealed that (9.4%) 30.3 million Americans are diabetic and 84.1 million have prediabetes. This is a total population of
  • 2. over 100 million is at risk of developing type 2 diabetes which is a growing health problem being the seventh leading cause of death in the U.S. An estimated 1.5 million new cases were among 18-year old bracket and the rates of diagnosed diabetes increased proportionally to age. Below 44 years accounted for 4%, below 64 years at 17 % and 25% for those above 65 years across both genders. One-third of adults in America has prediabetes but sadly, they are unaware despite reports released by The National Diabetes Statistics Report every year. These reports elaborate on prevalence and incidence, prediabetes, long-term complications, risk factors, mortality, and cost. Diabetes poses the risk of serious complications like death, blindness, stroke, kidney disorders, cardiac diseases and health problems that lead to amputation of legs. However, the risks can be mitigated through physical body activities, proper dieting and prescribed use of insulin and other related measures to control the blood sugar levels. Diabetes Prevention Program was funded by NIH to research a yearly evidence-based program to improve healthy weight loss through diet and physical activities. There also efforts to determine the effectiveness of public service campaigns in improving the real-life experience in the diagnosis and treatment of diabetes. PICOT Question. The population affected by diabetes cuts across all ages, gender, race, and ethnicity. The prevalence is significantly high from 18 years and it increases with age to about 25% above 65 years. In terms of gender, men are at higher risk accounting for 37% while women are at 30% across races and educational levels. On races, the rates were higher among Indians/Alaska natives at 15%, non-Hispanic blacks at 12.7% and Hispanics at 12%. Among Asians, the rates were lower at 8% and 7.4% for non- Hispanic whites. Intervention indicator for diabetes shows that individuals who do not observe a healthy diet are more exposed to the disease. Some risk behaviors include lack of exercise and excessive intake of junk foods that lead to obesity and increased blood
  • 3. sugar levels. Diabetes prevalence varied according to education levels were those with less than high school education at 12.6% and 7.2% for those higher than high school education. Comparison and use of a control group from the popularity of Complementary and Alternative Medicine and Traditional Chinese Medicine showed distinct knowledge of diabetes, blood sugar control, and self-care. The experimental group received education through interactive multimedia for three months while the control group received a routine patient education for 3 months. The outcome of diabetes includes risk factors and accuracy of diagnosis. Obesity, impaired glucose tolerance, insulin resistance, ethnic background, age, and sedentary lifestyle are the leading factors. Diagnosis is usually accurate by determining the blood sugar levels and analyzing genetic combinations to establish the possibility of prediabetes condition. Adverse effects of diabetes like blindness and amputations occur to patients who have delayed in seeking medication but early treatment can prevent such cases. The Time it takes for interventions to be effective can be two years just as The National Diabetes Statistics Report is released. The report provides relevant information on prevalence, risks, and complications, mortality, and costs in America. Such information can be used to determine how effective the interventions are in controlling diabetes. Literature Evaluation Table Qualitative Criteria Article 1 Article 2 Article 3 Author, Journal (peer-reviewed) working link to access the article Campbell, R., Pound, P., Pope, C., Britten, N., Pill, R., Morgan,
  • 4. M., & Donovan, J https://www.sciencedirect.com/science/article/abs/pii/S0277953 602000643 Greenhalgh, T. https://europepmc.org/abstract/med/12227121 Jansink, R., Braspenning, J., van der Weijden, T., Elwyn, G., & Grol, R https://bmcfampract.biomedcentral.com/articles/10.1186/1471- 2296-11-41 Article Title and year Published Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social science & medicine, 56(4), 671-684 (2003) Integrating qualitative research into evidence-based practice. Endocrinology and metabolism clinics of North America, 31(3), 583-601. (2002) Primary care nurses struggle with lifestyle counseling in diabetes care: a qualitative analysis. BMC family practice, 11(1), 41. (2010) Research Question (Qualitative/ Quantitative) Purpose of the study To purposely evaluate adult patients’ perspective of diabetes Provide a rigorous study in diagnosis, prognosis, prevalence, and therapy to clinical decision-making in endocrinology To develop an implementation strategy to improve lifestyle behavior change in diabetes patients
  • 5. Design, (Type of Qualitative or Quantitative) research A quasi-experimental design was used Exploratory qualitative analysis of data The retrospective cohort analysis study Setting/ Sample Diabetes patients and prediabetes and their caregivers were involved in answering questions about the disease. The study involved medical practitioners and patients of diabetes. The research was conducted with nurses in Dutch general practices to give a view of the challenges they face in advising patients. Methods; Interventions/ Instruments A short self-administered questionnaire was used. Face to face interviews and collection of written data Data were obtained from Dutch general practice from nurses and other professionals. Analysis Descriptive statistical analysis using percentages, averages and standard deviations The confirmatory data analysis method Bivariate analysis was used to evaluate the responses Key Findings from the Research Caregivers were personally concerned with the patients’ conditions Diabetes is preventable and if patients and those at risk make efforts to control it It is possible to make positive changes in the endocrinology field like diabetes using comprehensive research Nurses lack the skills for counseling the patients and they use the traditional approach to train patients Recommendations for the study There should be consistent screening and provision of proper guidelines to patients by medical officers and caregivers The public should be provided with sufficient information concerning the importance of physical exercises
  • 6. Nurses should be trained on how to impact motivation in patients towards changing lifestyle in regards to controlling diabetes. Explanation of how Article supports the Capstone The article is connected to the topic by providing suggestions to control diabetes The articles also give an insight into the role of caregivers and medical practitioners The article is important to the project because physical exercise is one of the important measures in regulating blood sugar levels This article is important because it shows how motivating patients to change lifestyle can impact the fight against diabetes. It also shows that nurses play an important role in changing lifestyles. Quantitative Criteria Article 1 Article 2 Article 3 Author, Journal (peer-reviewed) working link to access the article Lanza, I. R., Zhang, S., Ward, L. E., Karakelides, H., Raftery, D., & Nair, K. S https://journals.plos.org/plosone/article?id=10.1371/journal.pon
  • 7. e.0010538 Singh, G. M., Danaei, G., Farzadfar, F., Stevens, G. A., Woodward, M., Wormser, D., ... & Di Angelantonio, E https://journals.plos.org/plosone/article?id=10.1371/journal.pon e.0065174 https://europepmc.org/abstract/med/3073901 Article Title and year Published Quantitative metabolomics by 1H-NMR and LC-MS/MS confirms altered metabolic pathways in diabetes. PloS one, 5(5), e10538. (2010) The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PloS one, 8(7), e65174 (2013) Research Question (Qualitative/ Quantitative) Purpose of the study Analyze pathways known to be affected by insulin deficiency in the body of diabetes patients Establish the risk of cardiovascular disease in epidemiological studies with estimates using effect sizes of age and sex where possible Perform an analysis of endocrine and exocrine pancreas in relation to diabetes Design, (Type of Qualitative or Quantitative) research The quasi-experimental method was followed A cohort pooling study A case-control study Setting/ Sample The study was carried out on patients concerning levels of
  • 8. insulin and hormones with profound effects on carbohydrates, fats and protein metabolism. The study was conducted on the basis of age especially the elderly who are at higher risk of suffering from diabetes It was done on immunoperoxidase stained post-mortem tissues of 15 type-2 diabetes Methods; Interventions/ Instruments Basic analysis on urine cotinine, heart rate variability, and psychiatric scale. Average of 123 cohorts provided about 1.4 million individuals and 52000 CVD cases. The data was obtained through interview and lab tests. Data came from 15 type-2 diabetes patients with 10 matched age control sets Analysis Confirmatory data analysis was used for the data. SPSS 22 version was used Descriptive statistical analysis was used Key Findings from the Research This study showed that the metabolism concept applied to the clinical situation of acute insulin deprivation as associated with insulin deficiency. Each metabolic risk factor was robustly related to Cardiovascular disorder. Impaired insulin secretion in type 2 diabetes may be due to a decrease in B-cells and disruption on the islet structure. Recommendations for the study Insulin deficiency is linked to insulin deprivation which affects metabolism and causes abnormalities. Due to the increased risk factor of diabetes with age, the elderly should receive special care to minimize the prevalence. There should be measures to reduce the increase in A-cells in order to prevent hyperglucagonemia and diabetic subjects. Explanation of how Article supports the Capstone The article is important to the capstone because it relates to insulin and the role of hormones in dealing with diabetes.
  • 9. The study provided robust, comparable and clear estimates of how the risk factors related to CVD and diabetes. This is important in relating the effect of A-cells and B-cells in diabetes patients. Poetry Analysis: “The Raven” Homework Assignment Carefully read Edgar Allan Poe’s “The Raven.” Then, use your lecture notes to help you answer the following questions. · What kind of poem is “The Raven”? (Narrative? Ode? Epic? Etc.) Why do you think so? · How many stanzas does the poem contain? How many lines are in each stanza? · Plot the rhyme scheme (end rhyme) of the first stanza of the poem. · How does this poem sound when read aloud? Melodic? Cacophonic? What makes the poem sound the way it does? · How would you describe the rhythm of “The Raven”? · “The Raven” features extensive use of internal rhyme. Find and list examples of internal rhyme.
  • 10. · Give at least one example of each of the following: Assonance, consonance, and alliteration. · Describe the setting of “The Raven.” How does the setting contribute to the mood of the poem? · Describe the speaker’s tone in “The Raven.” · Paraphrase the literal action of the poem, stanza by stanza. What is actually going on? · “The Raven” is full of imagery (sensory details.) List at least 3 examples of this. · Locate and describe at least 3 allusions (references) in “The Raven.” · Find examples of symbolism in the poem; which objects do you think are symbolic, and why do you say so? · Look for at least 1 example of personification, and at least 1 example of either metaphor or simile. · Notice the extensive use of repetition in “The Raven”; which words / phrases do you see repeated, and to what effect?
  • 11. · Take note of the syntax (sentence structure) of the poem, as well as its language and diction (word choice.) What effect do you think these elements have on the poem? · What would you say is the theme (purpose) of “The Raven”? Why? THE RAVEN by Edgar Allan Poe Once upon a midnight dreary, while I pondered, weak and weary, Over many a quaint and curious volume of forgotten lore, While I nodded, nearly napping, suddenly there came a tapping, As of someone gently rapping, rapping at my chamber door. " 'Tis some visitor," I muttered, "tapping at my chamber door; Only this, and nothing more." Ah, distinctly I remember, it was in the bleak December, And each separate dying ember wrought its ghost upon the floor. Eagerly I wished the morrow; vainly I had sought to borrow From my books surcease of sorrow, sorrow for the lost Lenore,. For the rare and radiant maiden whom the angels name Lenore, Nameless here forevermore. And the silken sad uncertain rustling of each purple curtain Thrilled me---filled me with fantastic terrors never felt before; So that now, to still the beating of my heart, I stood repeating, " 'Tis some visitor entreating entrance at my chamber door, Some late visitor entreating entrance at my chamber door. This it is, and nothing more."
  • 12. Presently my soul grew stronger; hesitating then no longer, "Sir," said I, "or madam, truly your forgiveness I implore; But the fact is, I was napping, and so gently you came rapping, And so faintly you came tapping, tapping at my chamber door, That I scarce was sure I heard you." Here I opened wide the door;--- Darkness there, and nothing more. Deep into the darkness peering, long I stood there, wondering, fearing Doubting, dreaming dreams no mortals ever dared to dream before; But the silence was unbroken, and the stillness gave no token, And the only word there spoken was the whispered word, Lenore?, This I whispered, and an echo murmured back the word, "Lenore!" Merely this, and nothing more. Back into the chamber turning, all my soul within me burning, Soon again I heard a tapping, something louder than before, "Surely," said I, "surely, that is something at my window lattice. Let me see, then, what thereat is, and this mystery explore. Let my heart be still a moment, and this mystery explore. " 'Tis the wind, and nothing more." Open here I flung the shutter, when, with many a flirt and flutter, In there stepped a stately raven, of the saintly days of yore. Not the least obeisance made he; not a minute stopped or stayed he; But with mien of lord or lady, perched above my chamber door. Perched upon a bust of Pallas, just above my chamber door, Perched, and sat, and nothing more.
  • 13. Then this ebony bird beguiling my sad fancy into smiling, By the grave and stern decorum of the countenance it wore, "Though thy crest be shorn and shaven thou," I said, "art sure no craven, Ghastly, grim, and ancient raven, wandering from the nightly shore. Tell me what the lordly name is on the Night's Plutonian shore." Quoth the raven, "Nevermore." Much I marvelled this ungainly fowl to hear discourse so plainly, Though its answer little meaning, little relevancy bore; For we cannot help agreeing that no living human being Ever yet was blessed with seeing bird above his chamber door, Bird or beast upon the sculptured bust above his chamber door, With such name as "Nevermore." But the raven, sitting lonely on that placid bust, spoke only That one word, as if his soul in that one word he did outpour. Nothing further then he uttered; not a feather then he fluttered; Till I scarcely more than muttered, "Other friends have flown before; On the morrow he will leave me, as my hopes have flown before." Then the bird said, "Nevermore." Startled at the stillness broken by reply so aptly spoken, "Doubtless," said I, "what it utters is its only stock and store, Caught from some unhappy master, whom unmerciful disaster Followed fast and followed faster, till his songs one burden bore,--- Till the dirges of his hope that melancholy burden bore Of "Never---nevermore." But the raven still beguiling all my sad soul into smiling, Straight I wheeled a cushioned seat in front of bird, and bust
  • 14. and door; Then, upon the velvet sinking, I betook myself to linking Fancy unto fancy, thinking what this ominous bird of yore -- What this grim, ungainly, ghastly, gaunt and ominous bird of yore Meant in croaking "Nevermore." Thus I sat engaged in guessing, but no syllable expressing To the fowl, whose fiery eyes now burned into my bosom's core; This and more I sat divining, with my head at ease reclining On the cushion's velvet lining that the lamplight gloated o'er, But whose velvet violet lining with the lamplight gloating o'er She shall press, ah, nevermore! Then, methought, the air grew denser, perfumed from an unseen censer Swung by seraphim whose footfalls tinkled on the tufted floor. "Wretch," I cried, "thy God hath lent thee -- by these angels he hath Sent thee respite---respite and nepenthe from thy memories of Lenore! Quaff, O quaff this kind nepenthe, and forget this lost Lenore!" Quoth the raven, "Nevermore!" "Prophet!" said I, "thing of evil!--prophet still, if bird or devil! Whether tempter sent, or whether tempest tossed thee here ashore, Desolate, yet all undaunted, on this desert land enchanted-- On this home by horror haunted--tell me truly, I implore: Is there--is there balm in Gilead?--tell me--tell me I implore!" Quoth the raven, "Nevermore." "Prophet!" said I, "thing of evil--prophet still, if bird or devil! By that heaven that bends above us--by that God we both adore- - Tell this soul with sorrow laden, if, within the distant Aidenn,
  • 15. It shall clasp a sainted maiden, whom the angels name Lenore--- Clasp a rare and radiant maiden, whom the angels name Lenore? Quoth the raven, "Nevermore." "Be that word our sign of parting, bird or fiend!" I shrieked, upstarting-- "Get thee back into the tempest and the Night's Plutonian shore! Leave no black plume as a token of that lie thy soul hath spoken! Leave my loneliness unbroken! -- quit the bust above my door! Take thy beak from out my heart, and take thy form from off my door!" Quoth the raven, "Nevermore." And the raven, never flitting, still is sitting, still is sitting On the pallid bust of Pallas just above my chamber door; And his eyes have all the seeming of a demon's that is dreaming. And the lamplight o'er him streaming throws his shadow on the floor; And my soul from out that shadow that lies floating on the floor Shall be lifted---nevermore! Richard Cory (by Edwin Arlington Robinson) Whenever Richard Cory went down town, We people on the pavement looked at him; He was a gentleman from sole to crown, Clean favored, and imperially slim. And he was always quietly arrayed, And he was always human when he talked; But still he fluttered pulses when he said,
  • 16. "Good-morning," and he glittered when he walked. And he was rich - yes, richer than a king, And admirably schooled in every grace; In fine, we thought that he was everything To make us wish that we were in his place. So on we worked, and waited for the light, And went without the meat, and cursed the bread; And Richard Cory, one calm summer night, Went home and put a bullet through his head Poetry Analysis: Richard Cory Homework Read Edwin Arlington Robinson’s “Richard Cory” and consider the following questions. Then, choose any 7 of these questions and answer them based on what you learned from the Literary Analysis lecture. · What type of poem is “Richard Cory”? (Epic, Narrative, Ode, etc.) · Describe the poem’s point of view. (Who is speaking?) · Paraphrase the action of the poem in your own words. (What literally happens?) · Look at the poem’s structure; what can you say about its number of stanzas, lines, etc.? · Describe the rhythm of the poem. · Describe the setting of “Richard Cory.”
  • 17. · How does this poem rhyme? Plot the poem’s end rhyme, and find examples of sight rhyme, internal rhyme, and repetition. · Find an example of each of the following: Alliteration, assonance, and consonance. · What do you think the theme (purpose) of “Richard Cory” might be? What does the author want us to learn or understand? · Do you see anything in the poem that might have symbolic meaning? Explain. · Describe the tone of the poem. (Make note of the tone shift at the end!) · Describe the poem’s powerful use of situational irony. · Think about language (formal? casual?) and diction (word choice); what do these contribute to the poem? Research Critique Guidelines To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment. Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from
  • 18. the study in your responses. Qualitative Study Background of Study: · Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. · How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. · Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. · List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. · Were the purpose and research questions related to the problem? Method of Study: · Were qualitative methods appropriate to answer the research questions? · Did the author identify a specific perspective from which the study was developed? If so, what was it? · Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? · Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study. · Did the author evaluate or indicate the weaknesses of the available studies? · Did the literature review include adequate information to build a logical argument?
  • 19. · When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Results of Study · What were the study findings? · What are the implications to nursing? · Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing? Ethical Considerations · Was the study approved by an Institutional Review Board? · Was patient privacy protected? · Were there ethical considerations regarding the treatment or lack of? Conclusion · Emphasize the importance and congruity of the thesis statement. · Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. · Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. · Integrate a summary of the knowledge learned. Quantitative Study Background of Study: · Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. · How did the author establish the significance of the study? In
  • 20. other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. · Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. · List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. · Were the purpose and research questions related to the problem? Methods of Study · Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify? · Was informed consent obtained from the subjects or participants? · Did it seem that the subjects participated voluntarily in the study? · Was institutional review board approval obtained from the agency in which the study was conducted? · Are the major variables (independent and dependent variables) identified and defined? What were these variables? · How were data collected in this study? · What rationale did the author provide for using this data collection method? · Identify the time period for data collection of the study. · Describe the sequence of data collection events for a participant. · Describe the data management and analysis methods used in the study. · Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?
  • 21. · What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses? Results of Study · What is the researcher's interpretation of findings? · Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? · What limitations of the study were identified by researchers? · Was there a coherent logic to the presentation of findings? · What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing? · What suggestions are made for further studies? Ethical Considerations · Was the study approved by an Institutional Review Board? · Was patient privacy protected? · Were there ethical considerations regarding the treatment or lack of? Conclusion · Emphasize the importance and congruity of the thesis statement. · Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. · Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. · Integrate a summary of the knowledge learned. Reference Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier. © 2016. Grand Canyon University. All Rights Reserved. 4