NR 505 Week 2: Collaboration Cafe

NR 505 Week 2: Collaboration Cafe PICOT Question:

In children with ADHD (P), what is the effect of behavioral therapy (I) in comparison to medication (C) on improving behavioral issues associated with ADHD (O) to be completed over 6 months (T).

(P) Population: The population I am focusing on is children diagnosed with attention deficient/hyperactivity disorder (ADHD). Many children are diagnosed with ADHD. I focus on this population because some children outgrow ADHD as they become adolescents or young adults. All children with ADHD deserves the chance to be successful in school, work, and everyday life.   

 (I) Intervention: The intervention I am focusing on is behavioral therapy for all children diagnosed with ADHD.  While medications treat the symptoms of hyperactivity and impulsivity, children need to be taught coping skills to help manage negative behaviors and emotions. Behavioral therapy would give both the child and parents the necessary coping skills to manage behaviors and emotions and can continue to use them into adulthood. Behavioral therapy gives a more long term focus.

(C) Comparison: Medication given to treat ADHD helps with the symptoms of hyperactivity and impulsivity. But what effect does medication have on managing emotions? However, most ADHD medication have a short life and the effects wears off within 8 hours after taking it. Some parents choose not to give medication to the child when not in school, while others may choose not to give medication at all due to the side effects.

(O) Outcome: I am hoping my research of behavioral therapy being a required part of ADHD treatment will show results of improved behavioral issues and improved management of the intense emotions the children may experience. Results can be measured by using a SNAP-IV scale and Conners rating scale filled out by both teachers and parents. 

(T) Time: Time frame I am using to demonstrate expected outcome is six months. SNAP-IV and Conners rating scale and demonstration of coping skills can show ongoing improvement for each child.

​Obesity among children and adolescents is a critical problem in developing and developed nations. An increase in body weight is linked to sleep apnea, asthma, fatty liver disease, impaired balance, cardiovascular disease, high cholesterol levels, orthopedic problems, and insulin resistance and glucose intolerance. Researchers argue that the implementation of physical activity and dietary interventions in obese and overweight children leads to improvements in body composition. Consequentially, education on healthy eating and exercise can lower body weight, body fat percentage, and BMI in low-income children ages 7 and 17 years compared to no education over one year. Education affects behavior, anthropometry, attitudes, and knowledge to facilitate changes in decision-making among study participants. Children in such a study have the capacity to make lasting improvements in their short and long-term health. The improvements are dependent on several factors, including the quality of the programs and instructions, family support, cost of food, low participant burden, and a supportive social environment at home and school. Children with greater social support from their family, friends, and teachers are more likely to experience behavioral changes. Their families play a vital role in influencing their dietary practices and physical activity levels. The comparison group serves as a control group to measure the significant impact that education has on the children’s body composition to encourage behavioral and policy changes in future. No intervention effects can be identified in the comparison groupthat does not receive education. Intervention children are more likely to participate in specific physical activity intensities and modes, as well as evidence-based dietary plans, which guarantee better weight management than their counterparts in the control group.  Intervention children will also report less sedentary time and family-focused tasks that enhance the relationships they have with their parents or guardians.

References

Grace, J., Biggs, C., Naicker, A., & Moss, S. (2021). Effect of physical activity and nutrition education on body mass index, blood pressure and biochemical variables in overweight and obese adolescents. Annals of Global Health, 87(1). doi: 10.5334/aogh.3147

Wang, D., & Fawzi, W. W. (2020). Impacts of school feeding on educational and health outcomes of school-age children and adolescents in low-and middle-income countries: protocol for a systematic review and meta-analysis. Systematic reviews, 9(1), 1-8. https://doi.org/10.1186/s13643-020-01317-6

    I agree that NPs, as primary care providers, can have significant impact on preventing childhood obesity. It is really good PICOT subject to improve obesity issue and it is interesting to work on it. It is crucial to begin education about healthy eating habits and importance of everyday physical activities since early age. It is significant that you mention low-income children as your (P) population  in addressing this issue. As it is mentioned in evidence-based literature, healthy eating habits begin at home (Deavenport-Saman et al., 2019), and for undeserved and low-income families it is everyday struggle to get significant amount of food for family, not even mention to have an access to healthier and better quality food. Unfortunately, to increase physical activity among low-income children can also be a challenge to the limited resources for this population. From what I mentioned above, I am really curious to see what you are planning to implement in order to achieve planned outcome. It might be very useful for any of us in our future practice.

Thank you and good luck with your PICOT assignment.

Lesya

References

 Deavenport-Saman, A., Piridzhanyan, A., Solomon, O., Phillips, Z., Kuo, T., & Yin, L. (2019).

Early childhood obesity among underserved families: A multilevel community-academic partnership. American Journal of Public Health (1971), 109(4), 593–596. https://doi.org/10.2105/AJPH.2018.304906

Greeting Every one,

                     PICOT.

P- Pre diabetic Adults patients 18 years and older in the primary care provider (PCP)

I – In walking 30 minutes a day , 4 – 5 days per week and diet modification  primary methods of weight reduction.

C- Not exercising, walking and diet mortification compared to not exercising, walking or diet change affects a  pre diabetic                      patient overall health

O-  Patient will be able to lose 30 lbs .

 T- Twelve months is an adequate time to observe weight loss changes among patients.

                          PICOT question  

P- In pre-diabetic adults patients 18 years and older in a primary care setting, I- how does , walking 30 minutes a day and  diet modification C-Compared to not walking 30 minutes a day and dieting O- reduce a patients weight by 30lbs T-over 12months?

Of the 2 PICOT questions you posted, I genuinely believe the second is the better choice for research purposes. I feel like it might be very difficult to address your first interventions when it comes to finding evidence. Exercise by itself or diet change by itself is an intervention. Finding evidence of both together might be difficult. I tried to figure out how to clarify if there was significance in either one, or if they need to be done in conjunction, and did not find one vs. the other.  The idea of diet alone, exercise alone, or a combination of diet and exercise crossed my mind.

I also want to mention that 12 months is an excellent time frame. Stepping on the scale daily, which is often what is recommended,  can be a very traumatic thing for people.  And while weighing daily is highly recommended as a strategy, in certain populations, it creates other healthcare issues, like eating disorders and mental health issues (Pacanowski et al., 2023). Weighing once a month or less frequently might be another option to be considered to improve weight while working to be a healthier overall person. The idea of seeing how you lose and maintain the loss and how it affects health is very interesting.

Your PICOT really brought on a lot of ideas for me to research from. I am really looking forward to seeing where this paper goes.  Well done!

Pacanowski, C. R., Dominick, G., Crosby, R. D., Engel, S. G., Cao, L., & Linde, J. A. (2023). Daily self‐weighing compared with an active control causes greater negative affective lability in emerging adult women: A randomized trial. Applied Psychology: Health and Well-Being. https://doi.org/10.1111/aphw.12463

I would pick option 2 as well.  This is a great topic. Diabetes in older adults is associated with a higher absolute risk of cardiovascular disease. Type 2 diabetes prevalence is high in older adults and is expected to rise in the next decades. A careful nutritional evaluation with appropriate tools, combined with a balanced and periodically monitored physical activity, contribute to an effective tailored care plan (G.Sesti et al. 2018). Maybe adding the component of physical activity to your PICOT question can provide more value to your question. 

G. Sesti, R. Antonelli Incalzi, E. Bonora, A. Consoli, A. Giaccari, S. Maggi, G. Paolisso, F. Purrello, G. Vendemiale, N. Ferrara. 2018. Management of diabetes in older adults, Nutrition, Metabolism and Cardiovascular Diseases, Volume 28, Issue 3. https://doi.org/10.1016/j.numecd.2017.11.007

Thank you for addressing prediabetic conditions in adults. Diabetes Mellitus is a common condition that we will see in preventative health while remaining a global crisis in several countries. According to a recent study, “exercise training is an effective means to improve glycemic control in individuals with diabetes mellitus” (Benham et al., 2020). The implementation of proper dieting can also improve hemoglobin A1C levels. Your PICOT question is spot on. If you get the time, please check out the study I have included in the reference. The results are quite interesting. I also am eager to see which intervention is proven to be more effective in improving the body mass index in your analysis. 

References 

Benham, J. L., Booth, J. E., Dunbar, M., Doucette, S., Boulé, N. G., Kenny, G. P., Prud’homme, D., & Sigal, R. J. (2020). Significant dose–response between exercise adherence and hemoglobin a1c change. Medicine and Science in Sports and Exercise, 52(9), 1960–1965. https://doi.org/10.1249/mss.0000000000002339 

I actually like them both, but I feel like with the prevalence of childhood obesity, and the fact that by the time individuals are 40 to 60 years old, they have already created lifelong habits that are harder to break in later years of life. However, if you catch people when in their prime (18 years and older), OR even younger, I feel like you would reach more people who in turn will create real change in their lives. It has been proven time and time again that when you are young, time is truly on your side, your body is typically in prime condition and the younger you are the easier it is to maintain a healthier lifestyle and live out that change.  I also feel like the younger your test group is the more likely your interventions will stick. Since the prevalence of Diabetes and prediabetes in children and adolescents is becoming a growing epidemic, I think it would be beneficial to study the youth to create an environment of prevention rather than just treatment. The incident of type 2 diabetes among the youth from 9 cases to 12.5 cases per 100,000 youth per year in a 10 year span (Leak, Gangrande, & Tester, 2021). Therefore, teaching children early with healthy habits and proper diet and exercise. Currently, 1 in 5 children are obese, and are more likely to continue to be obese through adulthood (Dunford & Popkin, 2020). Diabetes is a growing problem and as nurses we have seen the endless long term complications that come with it from vision loss, to limb amputation. Great topic with endless possibilities! Good luck!

Reference

Dunford, Popkin, B. M., & Ng, S. W. (2020). Recent Trends in Junk Food Intake in U.S. Children and Adolescents, 2003–2016. American Journal of Preventive Medicine, 59(1), 49–58. https://doi.org/10.1016/j.amepre.2020.01.023

Leak, Gangrade, N., & Tester, J. (2021). Facilitators and barriers to preparing and offering whole grains to children diagnosed with prediabetes: qualitative interviews with low-income caregivers. BMC Public Health, 21(1), 931–931. https://doi.org/10.1186/s12889-021-10915-5