Research Analysis Common Chronic Diseases

Question: Discuss about the Research Analysis for Common Chronic Diseases. Answer: Introduction The diabetes is one of the most common chronic diseases in the modern form of that is caused due to the elevated level of glucose in the blood. According to Scirica et al. (2013), there are several other physical complications that are associated with the diabetes like cardiac disorders, high blood pressure, problems with vision and many more. The control measure that is taken to cure diabetes depends on the amount of glucose that is present within the body. The intensive insulin therapy is carried out by injecting insulin into the blood, which is necessary for controlling the high blood glucose level. It is also essential to keep the diabetic patient under continuous glucose monitoring process. In this essay, comparative analysis of two journal articles that are related to the treatment of diabetes is done. In the first article, by the agency named Nice-Sugar Study Investigators, (2009) the authors have compared the difference and similarities between the conventional and intensive form of glucose treatment. On the other hand, in the second article by Preiser et al. (2009), the authors have mentioned about the randomized trial of the tight glucose control that is being practiced in the Intensive care Unit. The interpretation of the methods and data collection method that is being used along with the result is done in the essay. There is also many similarities and differences in the two articles that are also mentioned in the essay. The comparison of the result of the research work with the evidence-based literature is an important part that can be applied in the nursing practice. Article 1: Intensive versus Conventional Glucose Control in Critically Ill Patients The researchers have conducted the random method of trial method to collect samples from the surgical patients, who are admitted to the intensive care unit of the hospitals. The patients from 42 hospitals out of which, there are 38 academic tertiary care hospitals and other 4 is community-based hospitals. The ethical issue is one of the prime concerns of a research work, which ensures that the investigators have not adapted any unfair practice to collect data or information for the research work. In this case, the ethics committee of the Sydney University and the University of British Columbia along with every participating healthcare institutes have approved the method of the study. Hence, it can be said the investigators have followed ethical rules to ensure that the result of the analysis is correct and accurate. With the help of random analysis, it is possible for the investigators to accurately and impartially compare the result of the intensive and conventional glucose control. The intravenous injection is being used to accurately control the glucose level of blood. This will help to measure the change in the glucose level after the treatment is done. The data that were collected were verified with the monitors of glucose measurement of the healthcare center. The researchers had checked the medical history of the individual diabetic patient that helped them to compare the effect of intensive insulin theory. The previous treatment history of the patient was also verified, which was useful in comparing the result of each individual form of diabetic treatment. The monitoring of the glucose level of blood of individual patient was until 90 days after discharge from the ICU. The study result was done based on the sample that is collected from 6100 patients. This helped the researchers to gain accuracy in the statistical part of the research, which is nearly 90%. The researchers also gave special attention to data collection that the data, to ensure that no important information gets omitted. The chi-square test that is used in the analysis is of unadjusted type and thus is not able to provide an accurate result. The ratio measurement t ools that are used in this case, includes the Welch's test and Wilcoxon sum or rank test. These tools helped the researchers to get accurate results and therefore, the comparison can be done with full efficiency. It was also essential for the researchers to ensure that the out of all the total participants almost equal number of patients were assigned in the to take conventional glucose control test and intensive glucose control so that it is possible to compare the result of each test with sufficient amount of data. The patients, who are receiving the intensive treatment for diabetes, are provided with a higher dosage of glucose compared to that of the patients undergoing a conventional form of treatment. The researchers had obtained similar type of outcomes for both intensive and conventional type of glucose control. In spite of providing intensive care for glucose, 829 patients died. Thus it can be said that when the blood glucose level reaches to new level, it is not possible to cure a patient even after providing intensive care. Perkovic et al. (2013), believes that with the help of the intensive insulin therapy, it is possible to minimize the risks that are associated with diabetes. However, Miller et al. (2014), on the other hand, mentioned that the intensive care for diabetes can be effective only if the patient follows a strict schedule. Thus, it can be said that the patients, who were in the sample size of the research, were not able to follow a strict schedule that was necessary. There is also the risk of hypoglycemia is associated with the intensive form of treatment. Hence, it is important for the doctors to be extra careful while providing intensive insulin treatment. Nev ertheless, Umpierrez et al. (2015) have shown that with proper time and regular monitoring, it is possible to make the best use of the intensive insulin therapy, which is more effective in case of type I diabetes. The overall result that was obtained at the end of the research work is different from that of the meta-analysis of the intensive insulin therapy. The patients, who were given a high dosage of insulin, have higher risks of facing hypoglycemia. The algorithms that were used in the analysis have helped to provide accurate results as it helped the researchers to compare the result from the baseline of glucose measurement in blood. Another advantage of the findings of this analysis is the greater statistical power it possesses compared to all the previously done trials. Hence, it can be said that the accuracy of the result that is obtained is much more compared to previously done research works. However, there are many side-effects that are associated with the intensive form of treatment as most of the patients in this category had faced cardiac related disorders. The intensive glucose care thus may be an active process of controlling the blood glucose level in diabetic patients. The amount that is injected into the patient is of 180 mg or less so that it is possible to get effective result. It is also important for the nurse to regularly monitor the glucose level in the blood so that it is possible to check the effect of treatment. On the other hand, the risks those are associated with the intensive glucose control need to minimize by the nurse with help of effective skills. Proper and accurate diagnosis is essential so that it is possible to provide accurate treatment. The researcher has also suggested avoiding the use of intensive control insulin therapy as there are essential risks that are associated with this treatment. Article 2: A prospective randomized multi-center controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucotrol study Management of stress-related hyperglycemia was re-emerged after gaining improved outcomes in critically ill patients. The purpose of this research is to compare the effects of intensive insulin therapy with an intermediate glucose control on ICU mortality. The optimal target for glucose control in ICU patients has not been clearly discussed in previous literature. Thus, this study will present the management of glucose in ICU patients (Preiser et al. 2009). Since the report of the improved outcomes related to intensive insulin therapy has been published to tight glucose control in intensive care units, the IIT therapy has been recommended by several health agencies. However, the technique has several issues, in spite of its easy accessibility and inexpensiveness; it is a labor-intensive technique, along with some issues that can limit its external validity and benefits. Thus, this study has significant importance to test the hypothesis that IIT can improve the survival or patients re siding in intensive care units (ICU), compared to glucose control target of 7.8-10 mmol/L. The control target was selected for preventing the adverse effect of severe hyperglycemia and reducing the risk of the hypoglycaemia. The study included a randomized control trial including adult patients who were admitted to 21 participating medico-surgical ICUs. The patient recruitment for the study was started in November 2004. The study was managed well, as it has been approved by the institutional review board of each participating hospital. Informed consent was provided to each participant; respective national standards for informed consent have been followed. The inclusion and exclusion criteria for the study participation have been analyzed and these are significant for this study. It has been seen that patients under 18 years old have been excluded for avoiding additional complications; a patient with a life expectancy lower than 24 hours has also been excluded from the study. The primary endpoint of selection was all-cause related to ICU mortality. The group 1 has been designated for the control group; the data were recorded in the preliminary survey, which helped the author to calculate the sample size n eeded for detecting a 4% decrease in mortality with an error rate of 5%. The sampling was analyzed for understanding. The study design was randomized control trial. Two groups were set, for group 1, the blood glucose target was set for 7.8-10.0 mmol/L and for group 2, BG target was set 4.4-6.1 mmol/L. However, due to unintended protocol violations, the trial was stopped early after 1101 admission. A total of 551 patients were assigned to group 1 (LIT) and 550 patients to group 2 (IIT), whereas 542 samples were analyzed in group 1 and 536 samples were analyzed in group 2. From this analysis, it can be said that the study design was appropriate. A thorough monitoring of patients was done during the study from ICU admission to the discharge of the patient from ICU. The study protocol was applied during the time of admission. The data randomization and stratification provide the justification for the validity of data collection methods. The vital outcomes of patients were recorded until patient's discharge or the 28th day of ICU admission. For hourly monitoring, Roche Diagnostics tool has been used, which has shown to provide accurate results in previous studies (Peyrot et al. 2012). The authors defined the rate of hypoglycemia as the proportion of patients experiencing minimum one episode of hypoglycemia. For comparing with other trials, the percentage of morning BG values was calculated within the assigned range. The statistical analysis was also done. Wilcoxon Mann Whitney test has been reported to be used for comparing the inter-quartile ranges and m edians of variables. In addition, for enhancing the reliability of these data, the author used student- t test for comparing the normally distributed continuous variables Standard deviation and men values (Van den Berghe et al. 2006). Chi-square test was used by the authors for comparing categorical variables. To reduce the chance of the influence of variations in sampling intervention, a univariable and multi-variable regression was performed through a backwards elimination procedure for identifying possible independent factors associated with hypoglycemia and mortality. The confidence level of all the data has been calculated for analyzing the reliability of data. The odd ratios have been used by the authors with confidence interval 95% (Hecking et al. 2012). To ensure that the data are statistically significant, p value was considered less than 0.05. The result was published using the outcomes of the 1,101 patients, who participated in the test. After the death of the 100th patient, the researchers had stared their analysis. The mortality rate was very similar in the ICU hospital to that of the LOS. The morality rate also did not differ in case of the patients who had mean BG of below 6.1 mmol/L and also of those, where the mean BG is above 6.1 mmol/L. The report for organ failure, which was assessed with the help of SOFQ scores, did not show much difference between the two groups along with the indices of other severe illness and a total number of febrile days and the total number of days with anti-infective agents. However, the total number of days for the patients having vasodepressor is quite different. The rate of hypoglycemia was 8.7% in the group I and in case of group II, it was just 2.7%. The main findings of the research paper are about the impact of intensive insulin therapy, which is quite different from the previously done research. With a dosage of 4.4-6.2 mmol/L of BG, there is very little effect on the critically ill patients. There is also the risk of hypoglycemia due to the treatment of intensive insulin therapy. The main difficulty that the researchers faced to make definite conclusion for this analysis is due to the premature interruption of the research work. However, from the discussion part, it is clear that the nurses, who are practicing the intensive insulin therapy among the patient, need to pay extra care to the critically ill patients as there is a high risk of the patients to suffer from hypoglycemia. Similarities and Difference in the two articles In both the above-mentioned research article, the researchers have analyzed about the treatment methods for critically ill patients suffering from high blood glucose level. Both of the studies were conducted upon the patients who were admitted to the intensive care unit of hospital. The main difference between the two research papers is that in case of the first article, the researchers had tried to compare the effect of the difference between the conventional and intensive form of glucose treatment, which includes the intensive insulin therapy. On the other hand, in the case of the second research article the investigators had focused on the effect of controlled intensive insulin therapy among the ICU patients. In result of both the articles, the researchers had made a conclusion that the intensive form of glucose control therapy has negligible effects on the critically ill patients. Moreover, there is also the risk of hypoglycemia, where the concentration of the glucose level in blood goes down significantly. The researchers of both the article have suggested that the nurses, who are incorporating the intensive glucose treatment, need to carefully diagnose and monitor the conditions of the patients. The conventional form of diabetic treatment is much better compared to the intensive glucose treatment as there is not much difference between the two forms of treatment. Moreover, there are no side-effects that are associated with the conversion form of diabetic treatment. 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