Evidence-Based Practice
Evidence-Based Practice is defined as a holistic procedure that involves comprehensively solving the problems of an individual patient at the patient's convenience. As a result, it entails combining specific clinical experience with the most relevant external clinical proof produced through study. Clinical expertise is characterized as a clinician's accumulated experience, clinical skills, and educational background. In order to provide the patient with the best possible treatment, the patient expresses his or her preferences, specific concerns, expectations, and standards (Melnyk 2011). The clinician will then make an effort to determine whether the patient's concerns are operational. A patient's care process is improved through integration. In turn, this enhances a chance to obtain the most desirable clinical results and the achievement of an improved quality of life. This paper illustrates the significance and the steps of the practices processes that are based on evidence in performing specific clinical procedures.
The Formulation of a Well-constructed Question
The Evidence-Based Practice requires the initial step to be the formulation of a well-constructed question, derived from the concerns of the patient with relation to a clinical procedure. The success of asking a proper question lies in the proper examination of the patient. In this case, a patient is a man, aged 67 years. He has a lengthy history characterized with obesity and type two diabetes. He has a typical medical history apart from a knee surgery that was performed about 12 years ago. The patient is aware that his condition increases his risk of heart illnesses and is disappointed that he cannot lose the required weight. The patient is aspiring to see his grandchildren grow into adulthood. His workmate told him that he knows a colleague whose belly was stapled resulting to loss of a lot of weight and thus was relieved from diabetes. The patient requests to know if this procedure works. Considering this concern, the question therefore is, is the patient suffering from obesity and type 2 diabetes, and is bariatric surgical treatment operational than the normal medical therapy about increasing the chances of resolving of diabetes?
Choosing Treatments and Randomized Controlled Trials (RCT)
The type of question stated above is a therapy question. In the study of such questions, there is a need to carefully choose treatments to ensure that they are beneficial and worth the expenses of using them. This is done through the study of randomized controlled trials (RCT). In definition, randomized controlled clinical trials are strategic experiments that examine a treatment to study its influence on the real patients. These studies reduce the possibility of bias while allowing the evaluation of intervention groups compared to control groups. The use of a randomized control trial is a scheduled experiment that can deliver sound evidence of causes and outcomes. In this case, the top evidence is most likely a randomized controlled trial. If several RCT trials are obtained, it is of importance to conduct systematic reviews.
Obtaining and Evaluating the Evidence
In obtaining and evaluating the evidence, it is of importance to choose applicable resources before conducting a search. Using PICO, the search strategy, in this case, will include the patient's problem, the intervention, the comparison, outcome, and the type of study (Schardt 16). In research that was involved in analyzing the efficacy of bariatric surgery, the results proved that it is useful for 16% of people living with type two diabetes and obesity (Sjöström 750). It has also been proven that bariatric surgery is capable of resolving conditions associated with obesity like diabetes type two. This deduction is obtained from the results of Swedish subjects who participated in bariatric surgery as compared to patients who were treated through non-surgical procedures. However, surgeries that are done for morbid obesity should only be considered as a last option after the patient has sought other means like dieting and an increase in physical activity with no success.
Cost Effectiveness of Bariatric Surgery
About cost effectiveness, the Swedish study showed that non-surgical related means of weight loss were expensive and attracted a greater chance of regaining not less than 50% of the weight that was lost in a period of one to two years. The latest systematic reviews have shown that in the United States, the efficiency of weight reduction programs is suboptimal. The decision evaluation model has also revealed that bariatric surgery was associated with an increasing life expectancy pattern when compared to physical activity and diet. According to the 2003 medical data of the United States, there is need to conduct at least 3500 surgeries annually in Ontario (Mokdad 1197). Currently, only 508 surgeries per annum are done.
Conclusion
In conclusion, this research reveals that bariatric surgery can be helpful to patients suffering from obesity and type two diabetes. It is applicable especially to people who have tried to lose weight through other non-surgical processes. The patient, in this case, has already sought other means of losing weight. He also needs to be in good health for him to see his two grandchildren graduate from college. Considering this, I would recommend the patient to undergo a bariatric surgery to resolve his weight and diabetes problem. This will, in turn, improve the patient’s care process while respecting the patient’s values and concerns.
Works Cited
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Mokdad, A. H., Bowman, B. A., Ford, E. S., Vinicor, F., Marks, J. S., & Koplan, J. P. (2001). The continuing epidemics of obesity and diabetes in the United States. Jama, 286(10), 1195-1200.
Schardt, C., Adams, M. B., Owens, T., Keitz, S., & Fontelo, P. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC medical informatics and decision making, 7(1), 16.
Sjöström, L., Narbro, K., Sjöström, C. D., Karason, K., Larsson, B., Wedel, H.... & Bengtsson, C. (2007). Effects of bariatric surgery on mortality in Swedish obese subjects. New England journal of medicine, 357(8), 741-752.
