Signature Assignment Practice Change Simulation Assignment Description: ( I will complete the video recording) Create a 7-9 minute video that reflects upon the clinical problem that you have identifie

Identifying A Clinical Question

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Aspen University

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The most critical step for carrying out suitable medical research begins with the formulation of a suitable question. There are various methods available to develop a suitable question for research purposes. However, the PICOT technique is one of the most efficient methods available to the health researchers for formulating a suitable research question. It guides the researcher in accessing the required result for the clinical question positively (Abbade et al., 2016). There are five key components of the PICOT technique that need to be evaluated efficiently to develop a suitable clinical question, including patient disease, intervention, comparison of intervention, outcome, and time.

Formulation of a Clinical Question

It is imperative to understand and analyze each of the five components of the PICOT technique before developing a suitable research question. The study's current population is the fat people who have inherited their obesity issues from their families. Most of the people in their families are facing obesity issues without additional eating habits. The Intervention or issue of interest underlying in the clinical question is related to disease exposure (Elias, Polancich, Jones, & Colvin, 2015). It means that the researcher is interested in evaluating these people's potential to experience the same obesity issue in the future. The researcher aims to compare the Intervention with another issue that is prognostic factor B to evaluate the available strategies for the individual to overcome the same issue effectively (Abbade et al., 2016). The main outcome for the research is the risk of occurrence of the adverse outcomes. It means that the researcher is interested in evaluating the potential of individuals with obesity history in the family to experience the same issue. It will benefit in identifying proactive medication or treatment for eradicating the issue at earlier stages without taking corrective actions (Elias, Polancich, Jones, & Colvin, 2015). The time involved in the research study is about six months. The researcher is interested in exploring the intervention techniques supporting the individuals for avoiding the same issue experienced by their family members and being transferred through inheritance.

After defining all the research question components using the PICOT question, it is now essential to determine the question in PICOT form. As the clinical question is related to the prediction category; therefore, the researcher will use a prediction template informing that.

In (P), how does (I) compared to (C) predict (O) over (T)?

The clinical question developed as per the above template, which will be used in the rest of the study as a clinical question is as follow:

"In patients with obesity history in their family i.e., BME > 30 kg/m2, how much intake of dietary carbohydrate intake predicts healthy weight maintenance i.e., BME > 25 kg/m2?"

Literature Search related to Clinical Question

Sara et al. (2018) carried out a study to evaluate the relationship between dietary carbohydrate intake and the mortality rate of the consumer, using cohort study and meta-analysis. The study gathered data involving 15 stages from about 428 participants aging between 45-64 years to inform a strong association between high and low consumption of dietary carbohydrate intake with the mortality rate. Suppose the carbohydrate patterns favor animal-derived proteins; in that case, it leads to higher mortality, where it is low mortality in carbohydrate pattern generation by vegetable, nuts, and peanut butter (Sara et al., 2018). It means that food is critical apart from just dietary carbohydrate intake by the individuals experiencing obesity issues in the family.

A study conducted by Feinmann et al. (2015) evaluated the restriction of dietary carbohydrates as an approach for diabetes management. The study used an evidence-based and critical review approach. It informs that the dietary carbohydrate results in better obesity management by the individuals. Even if the carbohydrates are replaced with fats or proteins, it will still benefit both types of people with diabetes, leading to weight loss, better glycemic control, reduction in medication, and cardiovascular risk matters (Feinmann et al., 2015). Therefore, there is no clear evidence available to restrict dietary carbohydrates for receiving better results in dietary management.

Sakurai et al. (2015) carried out a study to evaluate multiple factors like incident risk or type-2 diabetes and the presence of obesity-related to dietary carbohydrate intake in Japanese men. The study used about 2,006 male factory employees to gather information through a questionnaire after administering their diet history with macronutrients. The study identified the development of diabetes by about 232 patients during the course (Sakurai et al., 2015). The study findings revealed that if there is high consumption of carbohydrates, the chances of developing a higher risk of diabetes were higher in obese participants but not in the other ones. Obese patients must reduce their carbohydrate intake by less than 65%.

Ebbeling et al. (2018) conducted a study to evaluate the effect of low carbohydrate diet on energy expenses during weight loss maintenance using randomized trials. The study involved 164 adults aging between 18 – 65 years with BMI > 25 for the research. The study findings reveal that if the individual is consistent with the carbohydrate-insulin model, then the decrease of dietary carbohydrate certainly contributes to increased energy expenses during weight loss maintenance (Ebbeling et al., 2018). It provides certain benefits to the individuals in successfully treating obesity, especially the men with high insulin secretion.

Hall & Chung (2018) carried out a study to evaluate the impact of low carbohydrates diet on treating obesity and type-2 patients using a systematic review technique. The study findings inform that various benefits are waiting for individuals to receive proper obesity treatment with low carbohydrate intake (Hall & Chung, 2018). However, long-term complications exist in this regard that needs to be considered positively, like adverse influence over the control of metabolism, glucose, and lipids.

Identification of best Support Nursing Intervention

It is imperative to mention that all the research studies evaluated in the literature review are quality sources and carry high reliability. However, this section's main focus is to identify the most credible source for the PICOT question developed in the first section of the study. With the same consideration, Sara et al. (2018) provide the best support to the PICOT question as it conducts the study using cohort study and meta-analysis. Moreover, it attempts to establish a link between the adverse impacts waiting for potential patients of obesity. The authors have positively controlled the study to ensure the achievement of quality results (Sara et al., 2018). Moreover, the publication date, author credibility, journal reputation, etc. all add to the reliability and validity for answering the PICOT question developed earlier in the study.

Feinmann et al. (2015) also used the critical review and evidence-based approaches for responding to the question developed in the study; however, the study's main focus lies over the treatment of diabetes management instead of weight management is not relevant with the PICOT question. Sakurai et al. (2015) used a cohort study to respond to the questions developed in the study; however, the study is marginally focused on the Japanese race. Therefore, further research will be required to ensure the implementation of the research results obtained in this study over individuals living in a different environment with different intakes and working habits.

Ebbeling et al. (2018) carried out the study using random trials focusing on the impact of low carbohydrate diet on energy expenses during weight loss maintenance. This study is a strong competitor of the selected study for PICOT question; however, the earlier study had been mainly selected because of the credibility of the authors and publication journal. Hall & Chung (2018) carried out the study using qualitative analysis that is not a suitable methodology for the type of PICOT question developed in this study. Moreover, some ambiguous results of the study demand further research; therefore, this source has been left out.

Conclusion

The creation of an appropriate question is the foundation of carrying out any medical research. Research is critical in the medical field that always requires solid resources to be incorporated to achieve reasonable results. Developing a research question may involve various methods; however, the PICOT technique is the best among all methods. It offers various tools that help the researchers formulate appropriate research questions to be used in medical research. Among the five components of the PICOT technique, the most valuable component is the comparison of intervention. Identifying a clinical question is critical, and it should be formulated using any of the methods available in the medical field.

References

Abbade, L. P., Wang, M., Sriganesh, K., Mbuagbaw, L., & Thabane, L. (2016). Framing of research question using the PICOT format in randomised controlled trials of venous ulcer disease: A protocol for a systematic survey of the literature. BMJ Open,6(11). doi:10.1136/bmjopen-2016-013175

Ebbeling, C. B., Feldman, H. A., Klein, G. L., Wong, J. M., Bielak, L., Steltz, S. K., . . . Ludwig, D. S. (2018). Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: Randomized trial. Bmj. doi:10.1136/bmj.k4583

Elias, B. L., Polancich, S., Jones, C., & Colvin, S. (2015). Evolving the PICOT Method for the Digital Age: The PICOT-D. Journal of Nursing Education,54(10), 594-599. doi:10.3928/01484834-20150916-09

Feinman, R. D., Pogozelski, W. K., Astrup, A., Bernstein, R. K., Fine, E. J., Westman, E. C., . . . Worm, N. (2015). Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition,31(1), 1-13. doi:10.1016/j.nut.2014.06.011

Hall, K. D., & Chung, S. T. (2018). Low-carbohydrate diets for the treatment of obesity and type 2 diabetes. Current Opinion in Clinical Nutrition & Metabolic Care,21(4), 308-312. doi:10.1097/mco.0000000000000470

Sakurai, M., Nakamura, K., Miura, K., Takamura, T., Yoshita, K., Nagasawa, S., . . . Nakagawa, H. (2015). Dietary carbohydrate intake, presence of obesity and the incident risk of type 2 diabetes in Japanese men. Journal of Diabetes Investigation,7(3), 343-351. doi:10.1111/jdi.12433

Sara, S. B., B, C., S, C., M, H., A, S., Lm, S., . . . Sd, S. (2019). Dietary carbohydrate intake and mortality: A prospective cohort study and meta-analysis. Yearbook of Paediatric Endocrinology. doi:10.1530/ey.16.12.9