University of Kentucky Nursing Issues of Body Mass Index PICOT Discussion
Description
Participating in the Discussion: View and provide feedback on a minimum of 2 peer presentations. You may address some of the following questions in your responses:
Is the PICOT question original, relevant, and interesting?
Is the presentation clear and easy to follow?
Did the presentation provide sufficient evidence to support the presenters recommendations?
Are references accurate, adequate, and balanced?
Does the presentation add to nursing knowledge?
What applications do you see for the content of this presentation to your practice as an NP?
Peer 1:
Leslie Weaks Well, good morning everyone. In this presentation today, we will be discussing adults with BMI greater than or equal to 30 percent, and how effective it is behavioral therapy versus dying alone in achieving a BMI goal of less than 30 percent over a 12 month period. So the concepts that will be reviewed in this discussion include the practice issues of managing patients with a diagnosis of obesity, and how obesity impacts the individual’s physical, social, and mental health. The pico question will be reviewed. Along with literature review of multiple studies that were use in developing a thorough research understanding of the practice issues in health care as it relates to obesity management and patient care. This discussion will also offer recommendations for practice change and a summary of the study findings. So the practice issue that we’re looking at is obesity as a global health problem. So more than 42% of adults living in the US are obese or severely obese obesity. It is often associated with many co-morbidities. Overall effects obesity and lifespan, complexities of obesity treatment and health care costs of obesity. So in the research the World Health Organization reported on obesity published a study in 2021 stating that obesity is a global health problem and is a primary cause for over twice as many deaths per year. The COVID. More than 42% of adults living in the US are obese or severely obese. This statistic is of great concern for all health care provider since obesity is related to many co-morbidities. And that treating obesity can be extremely challenging and complex. Co-morbidities related to obesity include diseases such as diabetes, stroke, high blood pressure, coronary artery disease, lung disease, and many types of cancer. Chronic pain and even mental illness. Overall, effects of obesity-related diseases can reduce a person’s life expectancy by as much as 20 years. Studies have shown that higher BMIs are directly related to shorter lifespan. An increased risk of exacerbating co-morbidities. Studies have also shown that ethnic backgrounds, genetic factors in socio economic status, also play an important role in an individual’s BMI in co-morbidity risks. Obesity treatment is complex and that healthcare providers can not only focused on reducing the patient’s weight, but almost could also must consider genetic, socioeconomic, and the biological factors that may be contributing to the patient’s overall health. In addition, health care costs have skyrocketed due to obesity related co-morbidities over the past several decades. Studies have also identified that the cost of health increases with the increase in the patient’s BMI. Annual health care costs have been estimated to be as much as $200 billion annually. So the pico question that we’re going to address today are, as adults with a BMI greater than or equal to 30 percent. How effective is a behavioral therapy versus died alone in achieving a BMI goal of less than 30 percent over a 12 month period. So the population that we are looking at is that of 42.4% of adults, of adult patients with a BMI equal to or greater than 30 percent and the associated risk of developing obesity-related diseases. The intervention, we’re investigating, the plan intervention is to use a method of behavioral modification therapy to instruct and guide the patient on how to recognize and eliminate unwanted in unhealthy behaviors and provide skills that are geared towards successful weight loss and maintenance behaviors. The National Institute of Diabetes and Digestive and Kidney Disease describes the behavioral interventions as monitoring diet, exercise or physical fitness goal setting, social support, and having a relapse plan in place as successful tools for reaching and maintaining weight loss and BMI goals. The comparison group will follow a structured diet plan for over 12 month period. Each group will participate in a monthly way in which will measure weight and BMI at the time of the visit. The outcome would be the studies to determine that behavioral therapy as a more effective in. Maintaining a BMI of less than 30 percent compared to a diet plan. The outcome will show that behavioral therapy is an effective and safe tool for weight management and improved health and reduce the risk of health related diseases. The timeframe, as mentioned, would be within a 12 month period with a minimum of 12 way ends and therapy sessions for the behavioral therapy group and then 12 way in sessions for the diet only group of final BMI measure of goal attainment and maintenance for the therapy group and diet group will be assessed. Excuse me. The summary of literature review. So key findings from a quantitative and qualitative research analysis was performed here. So several research methods were used to support the evidence and recommendations of this discussion. The quantitative research selected was the Canadian Longitudinal Study on aging. The purpose of this CPLSA was to investigate and collect participant information related to changes by a lot of biological, medical, physiological, social, lifestyle and economic aspects of people’s lives. The researchers looked at quality of life, living with obesity, effects of obesity on aging and the impact obesity has some social functioning health, and mental well-being. The results of the study allowed researchers to address the obvious concerns related to obesity and January interventions and strategies to promote and maintain healthy aging practices. Key findings from this study identified the following. Obesity has a significant impact on physical health, social and mental well-being. Risks of developing physical impairments increases as we age and is often exacerbated by obesity. Obvious concerns related to obesity were identified and interventions and strategies were developed to promote and maintain healthy eating practices. So results of the qualitative study include assessment of current behaviors and desired behaviors and the determinants, a determinant of behavioral change of the participants. Internal and external factors for participation. Positive and negative factors that influence behavioral change. Identification of barriers and providing education and counseling, and identification of treatments, effective treatments and interventions to promote behavior change. So in addition, there was a research performed from mixed method studies and a meta-analysis research. So in these studies, the mixed method studies investigating the effectiveness of an online training tool or educating providers and patients about weight loss interventions and promoting healthy habits. The apps also provided instruction on how to address and difficult conversations related to weight issues. The study’s focus was effective. The studies focused on effectiveness of an online training app to assess the knowledge base and comfort level providers before and after use of an online training tool. The tools provided training interventions for providers and healthy habit formation practices for participants. And the outcome of this study showed that the use of online training programs for healthy psychology, for Health Psychology or effective invaluable tools for the providers and the participants. Meta-analysis research investigated the effectiveness of cognitive behavioral therapy and associated behavioral change techniques on weight loss interventions and the psychological outcomes of obese patients. The purpose of this research was to identify negative thought patterns and behaviors and provide alternative or positive thought patterns that promote positive health behavior changes and improve weight loss effectiveness. That reviewed research indicated that currently there are 93 cognitive behavioral therapy interventions in use today. The research I exit identified five recurring interventions during this study. The five most frequently coded behavioral cognitive therapy equal treatments were goal-setting, self-monitoring of behavior, action planning, social support, and instruction on how to perform the behavior. According to Mirabeau. Key findings of this research included that results of the study concluded that there is encouraging evidence on the effectiveness of cognitive behavioral therapy as part of a weight loss intervention. And for use in trading psychological conditions relating to eating disorders and obesity. The researchers also identified that follow up and program adherence are important factors in successful cognitive behavioral therapy treatment. Research also, research has also discovered promising evidence that using multi-component behavioral interventions was effective in promoting weight loss and reducing the patient’s risk of developing weight related health conditions. So in conclusion of the research performed, key practice, clinical practice guidelines were discovered. So the clinical practice guidelines mention here are from a study that was conducted by the European Association for the Study of obesity. The study was based on the European practical and patient-centered guidelines for adult obesity management and primary care. The goal of this study was to develop concise, practical patient setter and well illustrated guidelines for general practitioners using an evidence-based experimental and clinical studies focusing in particular on high-quality evidence. This study looked at the role of the primary care provider and the care management of patients who meet the criteria for obesity. Researcher successfully identified effective recommendations and guidelines for use in the clinical setting, which laid out a step-by-step plan for the management of patients with obesity. The recommendations for clinical practice include therapeutic communication skills, motivational interviewing techniques, treatment of health related conditions, personal thoughts and feelings related to the body image and quality of light. Identifying key stakeholders such as nutritionists are dietitians, fitness coaches, lifestyle coaches, medical specialists, and nurses, as well as therapists specialized in psychology or psychiatry to address the psychological and help applications of obesity and obesity management. The evidence-based recommendations for practice change. So the recommendations that were concluded from this when implementing a practice change to treat obesity is important for the provider to understand the complexity of treating a patient who is overweight or obese. Step one would be to, for the provider to recognize that obesity is a chronic health condition. Recognize that obesity treatment can be complex in the present presence of additional health conditions. That patients with a diagnosis of obesity will not present with the same symptoms. And recognize that obesity can affect each person differently and with different health issues. So it is important that treatment plants are created to address each patient’s individual health conditions and concerns. Step 2 would be to develop a health assessment plan that includes the following. Perform a thorough physical examination which includes body measurements and the patient’s BMI, and obtain a comprehensive history to identify root causes of weight gain, as well as physical, mental, and psychosocial be barriers. According to the Canadian Medical Association Journal. Step 3 would be developing a partnership with the patient. Partnering with the patient is a critical component to a successful treatment program. The partnership should include discussion of the individualized treatment plan, discussion of nutrition, exercise and behavioral therapy interventions. And or discussion that sets realistic goals and expectations. And of course, setting the expectation for adherence and follow up some recommendations for clinical practice. The key stakeholders also is an important component of the program and is a must if wanting to implement a successful program. So dietitians as part of the program, will work with the patient to formulate a nutrition plan that will meet any dietary needs or restrictions for the patient. Fitness coaches will work with the patient to create an exercise plan that accommodates the patient’s needs and physical abilities and inabilities. Lifestyle, coaches. Play a unique role in that they help the patient to address everyday challenges, promote positive changes, and help the patient transform their desire and goals into reality. Medical specialists are nurses play an important role as well in that they work with the patient in performing health assessments, monitoring and or treating any co-morbidity issues and measuring body composition in condition. Therapists such as psychologists who specialize in the area of behavioral therapy to address the psychological and health implications of obesity and obesity management and to guide the patient through behavioral therapy interventions. In addition, recommendations for clinical practice are as follows. As with any proposed practice change, it is important that we address the fit, feasibility, and appropriateness of the proposed changed into a current practice environment. So the research findings from this pico question, we look at the fit, is, does this fit into an already established clinical practice? So although the clinical practice setting sounds like an ideal fit for incorporating and weight management program. In this research, it may not be a good fit if trying to incorporate all the key stakeholders under one roof. If the practice is seeking to adopt a Behavioral Therapy program alone, there is a better chance of success because there would be a minimal impact and practice change in the current workflow. However, if the providers are seeking to offer an all inclusive weight management program, they should consider a practice setting that would provide simultaneous access to all key stakeholders. An example of this would be a health and wellness type practice or center, which allows patients and providers easy access to health care team members. The feasibility of this, so the feasibility of such a program may not be easily adopted into an already established clinical practice. However, in the presence of a health and wellness type practice setting, this type of program may be easily adapted, been implemented to create a successful and thriving program. Healthcare setting, such as the example given, provides easy access for patients. A supportive environment that is focused on health improvement. It minimizes an office visits to multiple for providers at different locations and offers a much simpler access to care. By making health care access easier for the patient, it will likely increase the chances that the patient will stay committed to the program and continue towards their healthcare goals. So is this practice change appropriate for a current practice? So evidence has shown that a change in clinical practice must happen in order to improve the lives of patients struggling with obesity. As already discussed in this report, obesity is a world health problem. And the percentage of patients diagnosed with obesity is climbing an astronomical rates. Not to mention the number of patients living with co-morbidities related to obesity. As mentioned above, a complete weight management program may not be suitable for an already established clinical setting. However, in the presence of a setting whose primary focus is on all elements of weight management may be the most appropriate setting for such a program. So in conclusion, in this presentation, we addressed the clinical practice issues related to obesity as a global health problems. We discussed the pico question that was investigated. We discussed findings from literature reviews and providing clinical recommendations for practice change. As a result of this set a, it can be concluded that the use of behavioral therapy for weight management has many benefits and has been proven in multiple studies to be an effective tool. However, to implement a successful weight management program would require more than the intervention of behavioral therapy alone. Successful program should include exercise, lifestyle coaches, dietitians, health care specialists as well as therapist. To manage a successful program and for a patient to successfully reach healthy weight goals would require access to multiple ML data modalities. So in conclusion, in this study is performed. There was found to be solid evidence that a Behavioral Therapy program is, is supportive therapy in helping patients achieve weight loss goals? As mentioned though, however, behavioral therapy alone is not the best answer. As we reviewed, incorporating many different key stakeholders would ensure success for the patient and success for the practice to continue supporting the patient and helping them achieve their weight loss goals.
Peer 2:
Second Response to:Blessing DavidHello, my name is blessing David, and today I’m going to be discussing evidence-based practice change. In today’s presentation, I’m going to be discussing the practice issue of heart failure and it’s readmission rates. My related pico question, I review of literature and in supporting recommendations. The practice issue I will discuss today is heart failure and it’s readmission rates. Heart failure is a concerning issue that impacts 64 million people worldwide and 6.5 million in the United States alone. Unfortunately, patients diagnosed with heart failure will require hospitalization at some point in their life. In fact, up to 83 percent are hospitalized at least once and up to 43% are readmitted to the hospital on four different occasions. In 2010, the Affordable Healthcare Act enacted the hospital readmission reduction program, which enforce penalties for hospitals with high readmission rates to reduce the readmission rates, especially in heart failure patients. However, heart failure readmissions continue decline. Patients admitted into the hospital due to heart failure, 20 percent are readmitted within 30 days and 50 percent by six months. Heart failure and it’s readmission rates are so concerning for NP practice due to its prevalence in today’s attack society, patient mortality and cost. Approximately 6.5 million American adults are diagnosed with heart failure, with 60% over the age of 65. Heart failure is responsible for more than 55 thousand deaths yearly in one in five patients die within one year of their initial diagnosis. Heart failure is not only deadly but also costly coming in as one of the most expensive diagnosis is in the nation, costing approximately 32 billion each year. In 2013, an estimated 2.7 billion was spent on heart failure readmissions alone. Cost of heart failure is projected to rise to an exponential 69.7% in 2030, creating a financial burden for patients, institutions and the country. My pico question for this evidence-based practice change is an adult patients with CHF, how does remote home monitoring and compared to no remote monitoring and standard care, reduce readmission rates over six months. My population is adult patients with CHF. Chf effects patients of all ages, predominantly adult patients, especially those over the age of 60. The intervention I will be evaluating is remote monitoring, which consists of various devices such as blood pressure devices, scales, implantable cardiac devices, wearable sensors, and much more in comparison to my intervention is no remote home monitoring with standard practice, which is tails, lifestyle modification, diet and medications. The outcome is to determine if the selected intervention effectively reduces readmission rates of patients who had been previously admitted. Lastly, effect of remote monitoring and its impact on readmission rates will be evaluated over six months. For the literature review, ten articles were reviewed, six quantitative to meta-analysis, one makes methods and one clinical practice guidelines. Of all these articles evaluate the impact of remote monitoring devices had on a readmission rates of heart failure patients. There are several variations of remote home monitoring. The main two categories evaluated were invasive and non-invasive. Invasive home monitoring includes implantable devices such as pacemakers in a ICDs, or implantable devices such as cardio MEMS that can measure a patient’s pulmonary artery pressure. Non-invasive devices include wearable sensors that the patients were 24, 7 to monitor ECG activity, heart rate, respiratory rate, posture, and temperature. Another example of a wearable sensor discussed is the reds device, which measures the fluid in the lungs to touch food overload and eight in the appropriate medication management of heart failure patients. Instead of being worn at all times, the device is applied daily to obtain or eating that may be removed. Another non-invasive home mind device discussed was mobile applications linked to a Bluetooth scale and blood pressure cuff. The blood pressure cuff and scale transmitted recorded data to the patient’s mobile phone, which was then shared with the providers. The last remote home noninvasive sensor discuss was a piezoelectric sensor placed under the mattress to measure physiological signals such as heart rate, respiration rate, breathing patterns, and sleep patterns. The literature review emphasize reoccurring themes such as the impact of heart failure on the population. The importance of reducing, reducing heart failure readmissions, patient adherence as a barrier to use in the need for further research. Heart failure rates are a national issue that affects over 6 million people in the US alone with high rates of readmission, it is a strong predictor of morbidity and mortality. Regardless of recent advances in healthcare heart failure patients are still at a high risk of readmission. This condition is a costly financial burden for the nation, the patient population, and the health care system. The literature did identify a common barrier patient adherence that NP did they use an implementation of remote home monitoring devices, specifically non-invasive devices. Patient’s adherence played a large role in the effectiveness of remote home monitoring and impacted readmission rates. Patients usage of remote home monitoring device a significantly dropped after the first week, dropping from 50 percent to 30 percent. Heart failure patients who experience readmissions reportedly use remote home monitoring devices less than those who did not experience readmission. Lastly, all the studies agreed that further research needs to be conducted regarding remote monitoring devices with large study groups to truly establish the accuracy and benefit of remote home monitoring devices and reducing heart failure readmissions. The evidence-based practice change I am recommending is the implementation of remote home monitoring for heart failure patients. Specifically ones will hospitalizations related to acute heart failure decompensation. Non-invasive remote home monitoring can significantly reduce patient readmission rates and mortality and is an excellent option for patients that do not have an implantable device or do not qualify for one. Studies have shown that using non-invasive remote monitoring devices can reduce heart failure readmission rates by 56 percent. Due to the wide variety of remote monitoring devices, different options can be chosen based on the patient’s needs. For example, for patients with the issue of poor self-management and adherence using an adhesive, wearable device that does not need to be removed could be more practical and is shown to reduce readmission rates and predict worsening heart failure. For patients who have allergies to adhesives or profession not wear device. They use of a piezoelectric sensor placed under the mattress to measure physiological signals transmitted to providers can aid in the reduction of readmissions. For patients who already have implantable devices such as pacemakers or a CDS that can measure pulmonary artery pressure. Using these devices as a remote monitoring device can be extremely practical due to the no added cost, an implantable devices can aid the Heart Failure of readmission reduction from 59% to 22 percent over a six month period. Using remote home monitoring devices also aids providers and better managing patients conditions, their medication and other interventions. For examples, remote home monitoring devices can transmit data to providers, allowing them to make necessary medication adjustments or schedule a follow-up appointment with the cardiologists. These devices can also assess and predict patients worsening heart failure symptoms from 6.5 to 8.5 days prior to readmission through a predictive algorithm. This identification and prediction can allow providers to catch acute decompensation is early and provide necessary interventions to prevent readmissions. Another way too, remote home monitoring devices can reduce readmission rates is by improving patient self-management skills. Patients who did not regularly check their blood pressure or monitor their weight reported a 100 percent increase in monitoring their symptoms, blood pressure, and weight after using remote monitoring devices that consisted of a mobile health app linked to monitoring devices and a weekly telephone calls. These patients report a decrease fear in frustration regarding their health and self-care and an increased sense of autonomy. When patients can better manage their condition, they are less likely to experience readmissions. There are several stakeholders involved in heart failure and reducing readmission rates. One of the major stakeholders is the health care system. Heart failure is a costly condition that is a tremendous burden financially on the health care system in the United States. In 2013.72 billion was spent on heart failure readmissions alone. Hospitals especially experience just how costly heart failure failure and increased readmission rates can be due to the Medicaid penalty. Starting in 2010. Hospitals with high readmission rates experienced penalties of up to 3% of their Medicare reimbursement due to the enforcement and Medicare’s hospital readmission reduction program. Using remote home monitoring to reduce the readmission rates can positively impact the health care system by reducing overall costs and reducing hospital medicare penalties. Insurance companies are another key stakeholder in the use of remote home monitoring devices. Due to remote home monitoring devices feasibility and ability to reduce costs and readmission rates, it can positively impact insurance company’s overall expenditure. Lastly, the largest stakeholder is patients and their families. They use a remote monitoring significantly reduces hospitalization rates, cost and mortality. These devices can prevent costly hospitalization bills for the patient and their family, as well as improve patient’s ability to self-manage their diagnosis and improve outcomes, creating a better quality of life for the patients and thereby their families as well. The use of remote monitoring is a practice change that is not currently use as a standard care practice. Remote monitoring is a solution that over time could be implemented into the discharge process of appropriate heart failure patients in the hospital or clinical settings to prevent first-time admissions and re-admissions. The use of remote monitoring devices, specifically non-invasive devices, will be an added expenditure. However, due to the today’s technology and the use of free mobile apps, cheaper Bluetooth devices such as scales and blood pressure cuffs. The feasible additional costs pale in comparison to the cost of heart failure readmissions. Therefore, remote monitoring can be a valuable resource for hospitals to decrease the readmission Cost. However, using such an intervention would require some undertaking, such as input from informatics, IT, patient education and providers, just to name a few. Although it is an intervention that would require appropriate planning, research, and small additional costs in the long-term, it would benefit the benefits of improved patient outcomes and decreased financial burden on the healthcare system outweigh any potential downfalls. In conclusion, heart failure and it’s readmission rates is a concerning issue in the United States and globally due to the high rates of people diagnosed with heart failure and that are readmitted to the hospital on multiple occasions. My pico question address this concern aiming to determine how the use of remote home monitoring impacted readmission rates over six months and adults with CHF. The literature review shed light on the impact of heart failure, the importance of reducing readmission, and how patient adherence effects they use every home monitoring and the further need to research to fully understand and determine the effectiveness of remote home monitoring. Recommended evidence-based practice change for implementing remote monitoring has proven to be a plausible and feasible option to reduce readmission rates effectively, effectively improving patient outcomes, costs, and financial burden on the healthcare system. Therefore, remote monitoring is unnecessary intervention that should be considered to improve the health of the heart failure population. These are my listed references that were used in this presentation today. Thank you for listening to my presentation. Have a great day.
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