Evidence Based Practice

Questions: 1. ask including PICO? 2. Access- identify best evidence? 3. Appraise: Appraise the evidence for its validity and usefulness? 4. Apply: Describe how you would use this evidence to address the issue? 5. Assess: Identify how you would evaluate your proposed intervention? Answers: Introduction Katherine is a slightly overweight middle-aged woman. Being very physically active and fit during her early days, the stress of the physical exercise had let her suffer from chronic shin splints. This has caused her to suffer from overweight preventing exercise that compounded her to gain weight and lead a sedentary lifestyle. 1. Pico question Among all treatments for chronic shin splints, is massage therapy the best treatment option for Katherine as compared to anti-inflammatory painkillers for better health outcomes? 2. Access Massage therapy is one of the best options that would help to reduce the pain of Katherine. It is an effective non-surgical intervention that would help to reduce the pain and relieves the stress than non-inflammatory painkillers (Dalton, Davies Jones, 2016). The painkillers have side effects as its prolonged use would cause bleeding ulcers in the subject. The massage therapy is beneficial for the reduction of pain in the shin and in relaxing the muscles of the tibialis anterior (Fogarty, 2015). The tibialis anterior is one of the important muscles that tolerate plenty of pressure. The right kind of massage is helpful for the chronic shin splints and helps in calming the tibialis anterior muscle that would greatly relieve the pain (Angoules, 2015). The application of broad pressure on the muscle would help to reduce the triggering pain. 3. Apraise There are types of massage therapy that would help to relieve the chronic pain and also prevent the building up of scar tissue (Winters et al., 2014). The deep tissue massage is useful in relaxation of the muscles and helps the muscles to loosen up. It is also useful in releasing the tightness of muscles and in the reduction of deep pain. There is another kind of relaxation massage that helps to reduce pressure and improves the lymphatic fluid circulation by movement of metabolic wastes taken away from the body (Sathe, 2017). The massage therapy also targets the muscle-tendon joints that help to reduce the recovery time after exercise and helps in increasing flexibility of the muscles (Clement Arvinen-Barrow, 2013). It also helps to reduce the risk of injury that promotes greater mobility. Self-massage is also a good option by identifying the right muscle that would help to reduce the pain. 4. Apply The self-massage therapy is the best treatment for Katherine. The chronic pain of Katherine would reduce with self-massage and helps in healing of the scar tissue (Williamson Arthur, 2013). As Katherine is slightly overweight and leads a sedentary lifestyle, the weight reduction would help to prevent the development of shin splints. Having a balanced diet would help her to maintain her body weight and gain back her fitness. Katherine should wear the right kind of shoes that would relieve her of strain and relax her muscles. After the massage therapy, she would gain back her mobility and in the prevention of risk factors for the development of shin splints. 5. Assess The massage therapy would be effective for Katherine as it would aid in the relaxing of her muscles and relieves her of chronic pain. It would help to improve her mobility and flexibility, in turn, helping to gain back her fitness. It would also improve her joint flexibility and decrease in muscular spasms (Lamott, 2015). The massage therapy would also relieve the tension in the muscles and increases lymph and blood flow circulation. After her flexibility increases, she would be able to increase her mobility and do light exercises that would help her to maintain her weight. References Angoules, A. G. (2015). Medial Tibial Stress Syndrome in Athletes: Diagnostic and Therapeutic Approach.J Nov Physiother,5, e138. Clement, D., Arvinen-Barrow, M. (2013). Sport medicine team influences in psychological rehabilitation.The psychology of sport injury and rehabilitation, 156-170. Dalton, R., Davies, M. B., Jones, A. (2016). Calf and Shin Problems.ABC of Common Soft Tissue Disorders, 72. Fogarty, S. (2015). Massage treatment and medial tibial stress syndrome; A commentary to provoke thought about the way massage therapy is used in the treatment of MTSS.Journal of bodywork and movement therapies,19(3), 447-452. Lamott, A. (2015). Muscular System.Massage Therapy: Principles and Practice, 431. Sathe, A. (2017). Medial tibial stress syndrome: A case study.Saudi Journal of Sports Medicine,17(1), 50. Williamson, B. L., Arthur, C. H. (2013). Shin-splints: common exercise-related syndromes affecting the lower leg.Journal of the Royal Naval Medical Service,100(3), 272-276. Winters, K. K., Kostishak, N., Valovich McLeod, T., Welch, C. E. (2014). Treatment of Medial Tibial Stress Syndrome: A Critical Review.International Journal of Athletic Therapy and Training,19(4), 27-31. Evidence Based Practice Question: Identify a research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children. Answer: Diabetes is a very chronic and complex type of diseases, which is prevalent in almost all individuals. The ongoing support and the self-management of the patient are very crucial in preventing the complications and reducing the future risks of the diseases (Hamman et al,. 2015). The American Diabetes Association's standard care have a recommendation of providing the clinicians, patients, payers and researchers with the diabetes care components, the goals of general treatment for the evaluation of the quality care (American Diabetes Association. (2014). The recommendation includes screening, diagnostic and therapeutic actions that are believed to have the immense effect on the patient's health outcomes. Of late A1C was taken as the reliable source for the diagnosis of diabetes. The A1C level in the hemoglobin is measured as a standardized test in comparison to the international A1C derived glucose from the Diabetes Control and Complications Trials (Ochoa et al,.2014). The measure of A1C provides a measure of chronic glycemic control without the need for fasting or any tried sample, and this measurement relates well with the risk of future diabetes and its complications. The HbA1C test depends on the connection of glucose to haemoglobin, the protein in the RBCs that helps in transporting oxygen. The average life of an RBC being 120 days, the HbA1C test depicts the average of the blood glucose levels in a person over the same course of time. the test result is represented as a percentage and the normal HbA1C level being below 5.7% (Casagrande et al,.2013). According to a study, an aggregate 10,038 members were selected from the Ansung-Ansan cohort. All subjects experienced a 75-g oral glucose resistance test at standard and observed biennially. Barring subjects with a history of diabetes (n = 572), the beneficiary working trademark bend was utilized to assess the indicative exactness of the A1C cut off. The Cox relative dangers model was utilized to anticipate diabetes at 6 years. The study aimed to evaluate the functionality of HbA1C levels in screening for undiagnosed diabetes as an indicator of occurrence of diabetes in the next six years, in an imminent, population based cohort study. This was a vast, forthcoming study of cohort that utilized rigid criteria to analyse diabetes and assessed the convenience of A1C level in diabetes screening and in the forecast of new-onset diabetes. ). It acts a very better indicator of a chronic glycemic level with less preanalytic instability and is much consistent in nature. The outline and standard attributes of the Ansung-Ansan cohort study is a progressing forthcoming, group based partner think about that is a piece of the Korean Health and Genome Study, a group based epidemiological study to examine the patterns in diabetes and related danger components. The standard examination was conducted in 20012002, and subsequent biennial observation will proceed through 2010. The qualification criteria incorporated an age of 4069 years, living arrangement inside the fringes of the review region for no less than 6 months before testing, and adequate mental and physical capacity to take an interest (Bullard et al,.2013). The results depicted that a pattern of 635 members (6.8%), previously had undiagnosed diabetes. A cut-off of 5.9% of HbA1C levels, delivered the most noteworthy total of specificity (91%) and sensitivity (68%). An instance of diabetes occurred in 895 (10.2%) subjects at 6 years. After many alterations and adjustments, it was concluded that men with pattern A1C 5.6% had a 2.4-fold expanded danger and ladies had a 3.1-fold expanded danger of new-onset diabetes (Choi et. al, 2011). The fundamental observation or finding of this study is that the assessment of the levels of HbA1C in human blood is very effective in diagnosing diabetes type 2 and beneficial as an indicator of occurrence of the same in future. A cut-off of HbA1C levels of 5.9% were figured as individuals with undiagnosed diabetes and people with an HbA1C 5.6% had an expanded danger for progression to sort 2 diabetes free of other bewildering variables.. The measure of HbA1C level is taken as a standard one because the data produced by it is the consistent one. The use and acceptance of HbA1C level for the screening of diabetes as a diagnostic tool is for many years because of its accurate standardization. It gives a clear cut-off for both the diabetic patient as well as for the one who have not been treated or undiagnosed. The advantages of A1C over the other ones are that it does not need any timed sample or fasting process (Bullard et al,.2013). References American Diabetes Association. (2014). Standards of medical care in diabetes--2014.Diabetes care,37, S14. Bullard, K. M., Saydah, S. H., Imperatore, G., Cowie, C. C., Gregg, E. W., Geiss, L. S., ... Caspersen, C. J. (2013). Secular changes in US prediabetes prevalence defined by hemoglobin A1c and fasting plasma glucose.Diabetes Care,36(8), 2286-2293. Casagrande, S. S., Fradkin, J. E., Saydah, S. H., Rust, K. F., Cowie, C. C. (2013). The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 19882010.Diabetes care,36(8), 2271-2279. Choi, S. H., Kim, T. H., Lim, S., Park, K. S., Jang, H. C., Cho, N. H. (2011). Hemoglobin A1c as a Diagnostic Tool for Diabetes Screening and New-Onset Diabetes Prediction A 6-year community-based prospective study.Diabetes care,34(4), 944-949. Hamman, R. F., Horton, E., Barrett-Connor, E., Bray, G. A., Christophi, C. A., Crandall, J., ... Knowler, W. C. (2015). Factors affecting the decline in incidence of diabetes in the Diabetes Prevention Program Outcomes Study (DPPOS).Diabetes,64(3), 989-998. Ochoa, P. S., Terrell, B. T., Vega, J. A., Mnjoyan, S. Z., Lu, C., Klein, M. S., Binkley, G. W. (2014). Identification of previously undiagnosed diabetes and prediabetes in the inpatient setting using risk factor and hemoglobin A1C screening.Annals of Pharmacotherapy,48(11), 1434-1439.