S190286 UNIVERSITY OF SUFFOLK MODULE TITLE: ADULT NURSING THEORY FOUR: EVIDENCE BASED PRACTICE AND END OF LIFE CARE NT4 PART 1 ASSESSMENT WORD COUNT: 3302 WORDS DATE OF SUBMISSION: 28/09/2020 STUDENT...

UNIVERSITY OF SUFFOLK
MODULE TITLE:
ADULT NURSING THEORY FOUR: EVIDENCE BASED PRACTICE AND END OF LIFE CARE
NT4 PART 1 ASSESSMENT
WORD COUNT: 3543 WORDS DATE OF SUBMISSION: 28/09/2020
STUDENT NUMBER: S190286
S190286
1
INTRODUCTION:
The effects of low carbohydrate diet intake in the management of type 2 diabetes among young people is been critically analyzed in this essay. The low carbohydrate diet plays a major role in controlling type 2 diabetes mellitus (T2DM). The study areas, its methodologies, discussions as well as the conclusion has been compared and critically analyzed in this work. The critical appraisal framework has been used for the completion of the chosen research papers. The key issues arising and noted in these articles are thoroughly gone through while analyzing the data in it (Moule. P, et al., 2017).    Comment by Linda Johnson: The written English in this paragraph is weak and a lot of what you say is confusing and unclear.You need to re-write what the title and the criteria for the essay are asking you to do and in the process, name your chosen subject area and the two elements of the research process that you intend to consider in section 3 of the essay.
Type 2 Diabetes mellitus (T2DM) has an increasing incidence rate among the young people aged between 18-35 years. According to Diabetes UK (2019) it is estimated that 4.7 million people are living with type 2 diabetes mellitus (T2DM) in the UK and the number is expected to increase to 5.5 million by 2030. T2DM is one of the oldest diseases affecting humankind and its clinical characteristics were reported by Egyptian manuscripts about 1500 B.C. (Lakhtakia, 2013). However, it has posed a health threat on people’s health and wellbeing in the present time (International Diabetes Federation, 2013). The disease was rarely diagnosed among young people, but due to the increased rate of childhood obesity it has rendered it more common among young people (Hu, 2011). Once it’s referred to as the disease of the West, the disease has now spread to most countries in the world (Hu, 2011); and the UK has reported the highest prevalence rate in Europe with an increased incidence among the young adults of 18-35 years (Ehtisham, et al., 2004).    Comment by Linda Johnson: What type of DM are you referring to here? You need to be consistent in relation to referring to the specific disease chosen.    Comment by Linda Johnson: You need to specify exactly what age group you are referring to from the start and justify it too.
The rationale for choosing this topic is as a result of global increase in T2DM among young people (Hu, 2011), its effects, to determine the usefulness of low-calorie diet in the reduction of type 2 diabetics among young people aged    Comment by Linda Johnson: Where is your evidence for this?
between 18-35 years. Also, this area of study was chosen in order to identify many approaches that can be used to control complications thereby enhancing the quality of life of young people affected with similar comorbidities (Diabetes UK, 2018).    Comment by Linda Johnson: This claim is too vague and generalised for an undergraduate literature search.
Over the years, the prevalence of T2DM among young people have increased tremendously particularly in the UK; hence bringing in different health conditions including type 2 diabetes which was formerly known to be a metabolic disease that is associated with adults (Gelburd, 2017). The studies that were done on this topic have shown that the incidence of T2DM is increasing among young people and one of the contributing factors to this is the obesity epidemic in the United Kingdom's (Dabelea, et al., 2014). In the UK, an estimate of 7000 diagnoses were reported in 2018 among adults above 18 years, according to (Diabetes UK, 2018). It has been observed that this trend is seen globally, which indicates that there is a rise in the number of young people with T2DM and there are cases that have not been identified yet. It explains that T2DM is one of the most common diagnosis among adults of 18-35 years (Gelburd, 2017).    Comment by Linda Johnson: What studies?    Comment by Linda Johnson: But were these in the 18-35 year age group?    Comment by Linda Johnson: It is very difficult to pick out exactly what the literature is saying about your specific age group from what you say in this paragraph. The points are a little jumbled.
Furthermore, the author aims to conduct a literature review in order to explore and understand T2DM in young people as well as distinguishing gaps in study. Therefore, a critical review of primary research of T2DM among young people of age group between 18-35 years, will help to inform good practice in healthcare settings.    Comment by Linda Johnson: You cannot claim an in-depth knowledge of T2DM’ just from conducting the literature search for this essay.
DOES LOW CARBOHYDRATE DIET HELP IN THE CONTROL OF TYPE 2 DIABETES IN YOUNG PEOPLE OF 18-35 YEARS?    Comment by Linda Johnson: This needs to be phrased as a question and you need to specify the age group.
The abbreviation for PICO (P=population, I=intervention, C=comparison and O=outcome) was chosen as a framework for framing a research topic which is widely used as a strategy for formulating a research question (Aslam and Emmanuel, 2010). PICO forms a guideline for framing a research question which enables the researcher to identify the inclusion and exclusion criteria and develop relevant search terms in order to identify appropriate data for the research (Bettany-Saltikov, 2010).    Comment by Linda Johnson: You did not adopt the abbreviation as a framework – you chose the PICO format.
Table 1: PIO and search Terms
    P
    Population of
problem
    Young people with Type
2 Diabetes mellitus
    People, patients, adults,
Type 2 diabetes mellitus (T2DM)
    I
    Intervention
    Intake    of carbohydrate diets
    low
    Lifestyle
education training on diet.    Comment by Linda Johnson: There is nothing in here relating to ‘diet’ or ‘low carbohydrate’ – two of the main concepts in your question.
    management, programs    and
    C
    Comparison
    Young people who take low carbohydrate diet with those who does not take
    
    Low Carbohydrate diet and exercises
    O
    Outcome
    Control    of    Type
Diabetes mellitus
    2
    Blood glucose monitoring
An extensive search for relevant literature was done using PIO structure on 20/09/2020 on PubMed Central and CINAHL search engine. Although, most of the articles obtained were duplicates of PubMed Central. The first search, Boolean operand was AND OR was used. This method would help to have a wider view on the study subjects by providing focused data and surveillance. The words such as low-calorie diet, glycaemic and youths were also applied in the report (Aslam and Emmanuel, 2010). The aim of using varieties of Boolean operand was to generate relevant results and articles. The use of AND facilitated the addition of other synonyms in the search engine, especially the PubMed Central. The Boolean operand was used cautiously to ensure the usage of appropriate databases that generate data (Guh, et al., 2009).    Comment by Linda Johnson: Why are these not included in your search terms above – if you actually used them to search?    Comment by Linda Johnson: Your knowledge and understanding of the Boolean variables and how to use them is weak in this paragraph and some points you make are confusing and hard to understand.
Table 2: Inclusion and Exclusion Criteria
    
    Inclusion Criteria
    Exclusion Criteria
    Population
    Young people aged 18 to
35 with Type 2 Diabetes mellitus
    Adults and children with Type 1 Diabetes mellitus and people more than 35 years and less than 18 years.    Comment by Linda Johnson: You are also excluding adults over 35 with T2DM and young people under 18 with T2DM.
    Intervention
    Structured and organized diabetic    education programs and promotion of low carbohydrates
intake
    Internet help
    sources,
    self-
    Comparison
    Population of young people who take low carbohydrate diet and those who take a normal diet
    
    Obese (or) over weight people
    Outcome
    Control    of    Type
Diabetes mellitus through proper low carbohydrate diet    Comment by Linda Johnson: What types of control are you referring to exactly?
    2
    Depression as they may be under medications which alter the glucose levels in the body    Comment by Linda Johnson: This is a strange thing to exclude – what is your justification?
Inclusion and exclusion criteria help the researcher to identify appropriate studies which relates to the research concept under study (Hagen-Zanker and Mallet, 2013). It is very important to map out a clear inclusion and exclusion criteria in a research as it allows the study to remain focused and enables the researcher to select relevant articles that meet the prespecified criteria (Aveyard, 2010). Furthermore, inclusion and exclusion criteria in a systematic literature search provides the researcher the chance to show detailed work of how the articles were selected. Hence, the above table shows the inclusion and exclusion criteria table using PIO.     Comment by Linda Johnson: You need to explain some of what you included in the table above – particularly justifying your exclusion criteria.
The search was not limited to a particular country such as the United Kingdom's (Hagen-Zanker and Mallet, 2013), and the adults and children with type 1 diabetes were excluded from the study because they were not among the considered targets for the study.    Comment by Linda Johnson: I have separated this out as here you are referring to the limiters found on individual databases. Inclusion and exclusion criteria need to refer specifically to the concepts in your question. This should be part of an explanation of why you chose specific limiters and how you applied them.
The literature search from PubMed Central and CINAHL database using advanced search generated a total of 39,058 articles from PubMed Central and 9,046 articles from CINAHL starting from 2010 to 2020. The articles were further reduced to 452 after removing duplicated articles. The number was reduced by removing the exclusion criteria like articles not written in English Language and peer reviewed articles to 824. The 824 articles were thoroughly explored by their full texts, abstract and titles. The abstract was read and if found eligible, the full text will be downloaded. Finally, a total of 2 articles were retrieved while the other articles were excluded as they do not meet the inclusion criteria. However, some of the excluded articles were kept and will be used during discussion of...