PICOT Statement Literature Evaluation Table Assignment Paper

NRS 490 Week 4 Assignment

PICOT Statement Literature Evaluation Table Details:

In nursing practice, accurate identification and usage of research is essential to achieving successful outcomes. Being able to articulate the information and successfully summarize relevant peer-reviewed articles in a scholarly fashion helps to support the student’s ability and confidence to further develop and synthesize the progressively more complex assignments that constitute the components of the course change proposal Capstone Project. PICOT Statement Literature Evaluation Table Assignment Paper

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For this assignment, the student will provide a synopsis of 15 peer-reviewed articles from nursing journals using an evaluation table that determines the level and strength of evidence for each of the 15 articles. The articles should be current within the last 5 years and closely relate to the PICOT statement you developed earlier in this topic. Appropriate resources to include involve quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed Capstone Project. PICOT Statement Literature Evaluation Table Assignment Paper

PICOT Statement Literature Evaluation Table

While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

Portfolio Practice Hours

Students will track their practice hours throughout the course via the Practice Hours Completion Statement provided in this assignment. PICOT Statement Literature Evaluation Table Assignment Paper

Complete the following statement in a Word document and submit it to the instructor via the individual forum in LoudCloud.

Practice Hours Completion Statement NRS-490

I, (INSERT NAME), verify that I have completed (NUMBER OF) practice hours in association with the goals and objectives for this course. I also verify that all required course approvals are in place from my faculty and practice mentor. PICOT Statement Literature Evaluation Table Assignment Paper

PICOT Statement Literature Evaluation Table Practice Issue

Heart failure is a cardiovascular disease that occurs when the heart is unable to inject enough blood to meet the body’s demand (American Heart Association, 2015). The mortality rate for cardiovascular diseases in the United States is on the rise as cardiovascular diseases accounts for about 610,000 deaths annually (Centers for Disease Control and Prevention, 2017). According to the American Heart Association’s 2017 Heart Disease and Stroke Statistics Update, the prevalence of heart failure among adults in the United States has increased from 5.7 million in 2009-2012 to 6.5 million in 2011-2014. Based on this statistics, the number of adults diagnosed with heart failure is estimated to rise by 46 percent in 2030 (Benjamin et al., 2017). Furthermore, the Centers for Disease Control and Prevention (CDC) reports that about 50% of adults who develop heart failure die within 5 years after their diagnosis and in 2009, heart failure contributed to the cause of one in nine deaths in the United States (CDC, 2016). The incidence of heart failure is equally recurrent in both men and women with, African-Americans being 1.5 times more likely to develop heart failure than Caucasians (Centers for Disease Control and Prevention, 2017). Causes of deaths in heart failure include; cardiovascular causes such as decompensated or treatment resistant heart failure, acute myocardial infarction, stroke, and aneurysm rupture. Deaths from non-cardiovascular sourced include infections, decline syndrome, and malignancies (Pons et al., 2010). PICOT Statement Literature Evaluation Table Assignment Paper Some of the of the risk factors for heart failure include; high blood pressure, coronary artery disease, diabetes, smoking tobacco, obesity, and sedentary lifestyle (Centers for Disease Control and Prevention, 2016). In addition, common signs and symptoms of heart failure are difficulty breathing during physical activities and when lying down, fatigue, weight gain, cool skin, poor mentation, anorexia, tachycardia, hepatomegaly, ascites, and peripheral edema (Centers for Disease Control and Prevention, 2016). PICOT Statement Literature Evaluation Table Assignment Paper

The American Heart Association/ American college of Cardiology categorizes heart failure into classes based on disease progression (American Heart Association, 2017). Class A-Patients at risk for heart failure but without any symptoms, Class B- Patients with a known damage to their cardiovascular system but without any present or past symptoms, Class C-Patients with heart failure symptoms during physical activity due to cardiovascular diseases, and Class D-Patients with severe heart failure symptoms while at rest due to cardiovascular diseases. In addition, the New York Heart Association (NYHA) also classifies heart failure based on symptoms presented. Class I- No restriction of daily physical activities, Class II- Mild restriction of daily physical activity i.e. ordinary activities results in fatigue. Class III- Severe restriction of physical activity and comfortable at rest. Class IV- Severe symptoms of heart failure at rest and distress with any activity (American Heart Association, 2017). The AHA classification is based on the progression of the heart failure while the NYHA classification is based on symptoms of the heart failure. PICOT Statement Literature Evaluation Table Assignment Paper

Telemonitoring is the utilization of communication technology to remotely monitor patients’ clinical status to improve the care of patients with chronic disease (Chaudhry et al., 2007). Since telemonitoring interventions helps to swiftly determine deteriorating symptoms in patients with chronic diseases, it is imperative that telemonitoring should be tailored to target the needs of patients with heart failure via constant monitoring of patients parameters such as body weight, blood pressure, and heart rate for signs of worsening conditions with the purpose of providing immediate medical care. While some studies have shown the effectiveness of telemonitoring in decreasing mortality rate and heart failure related hospitalizations (Kitsiou, Paré & Jaana, 2015), it is important to evaluate the efficacy of telemonitoring interventions in improving quality of life among patients diagnosed with heart failure. PICOT Statement Literature Evaluation Table Assignment Paper

PICO (T) Question and Components

The following PICO (T) question is proposed for evidence review to make a practice change recommendation: Does daily telemonitoring intervention improve quality of life among adult patients diagnosed with heart failure? The specific PICO (T) component are identified as follows:

Population (P): Patients diagnosed with Heart failure (age >18yrs)

Intervention (I): Daily telemonitoring (24 hours monitoring system) of bodyweight, blood pressure, heart rate, and onset of new symptoms related to heart failure.

Comparison (C): standard care (post discharge education) PICOT Statement Literature Evaluation Table Assignment Paper

Outcomes (O): Quality of life (e.g. Minnesota Living with Heart Failure Questionnaire Scale (physical, emotional, social, and mental dimensions), Kansas City Cardiomyopathy Questionnaire (daily activities-dressing, bathing, etc.)

T: 1month- 12 months follow up

Description of the Search

PICOT Statement Literature Evaluation Table Assignment Paper

The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed database was used to search using the key words “heart failure” AND “remote monitoring OR telemonitoring ” AND “quality of life”. Using these initial keywords, the PubMed database yielded 125 results while the CINAHL database yielded 29 results. Results in PubMed were further limited with inclusion criteria of: 1) articles published within 5 years, 2) clinical trials, 3) articles published in English language, and 4) full text articles generating 24 articles. Results in CINAHL were further limited with inclusion criteria of: 1) peer reviewed articles, 2) articles published between 2012-2017, and 3) articles published in English language generating 10 articles. Out of a total of 34 articles generated from PubMed and CINAHL (after inclusion criteria was applied), 5 articles were duplicates, leaving 29 articles to be screened. Through abstract reviews, 21 articles were excluded for several reasons, mainly because the interventions utilized were not relevant to the PICO (T) question or the outcomes measured in these articles were different from the intended outcomes (quality of life) in the PICO (T) question. Other reasons for exclusion include; telemonitoring of cardiac implants and pilot tests to determine the efficacy of telemonitoring. For further details, see the PRISMA Flow Diagram in Appendix A. The remaining eight full text articles were assessed for eligibility. One article was eliminated because the methods of outcome measures were not understood. Two other articles were eliminated because the population in the study included participants with other chronic illnesses and not heart failure. PICOT Statement Literature Evaluation Table Assignment Paper

PICOT Statement Literature Evaluation Table References

American Heart Association (2015). What is heart failure? Retrieved from http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300315.pdf

American Heart Association (2017). Classes of heart failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure_UCM_306328_Article.jsp#.WcZEikyZO9Y PICOT Statement Literature Evaluation Table Assignment Paper

Bekelman, D. B., Plomondon, M. E., Carey, E. P., Sullivan, M. D., Nelson, K. M., Hattler, B., & … Rumsfeld, J. S. (2015). Primary Results of the Patient-Centered Disease Management (PCDM) for Heart Failure Study: A Randomized Clinical Trial. JAMA Internal Medicine, 175(5), 725-732. doi:10.1001/jamainternmed.2015.0315

Blum, K., & Gottlieb, S. S. (2014). The effect of a randomized trial of home telemonitoring on medical costs, 30-day readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients. Journal Of Cardiac Failure, 20(7), 513-521. doi:10.1016/j.cardfail.2014.04.016 PICOT Statement Literature Evaluation Table Assignment Paper

Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., & … Mackey, R. H. (2017). Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation, 135(10), e146-e603. doi:10.1161/CIR.0000000000000485

Chaudhry, S. I., Phillips, C. O., Stewart, S. S., Riegel, B., Mattera, J. A., Jerant, A. F., & Krumholz, H. M. (2007). Telemonitoring for patients with chronic heart failure: a systematic review. Journal Of Cardiac Failure, 13(1), 56-62 PICOT Statement Literature Evaluation Table Assignment Paper

Center for Disease Control and Prevention. (2016). Heart failure fact sheet. Retrieved from https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm

Center for Disease Control and Prevention. (2017). Heart disease fact sheet. Retrieved from https://www.cdc.gov/heartdisease/facts.htm

Delaney, C., Apostolidis, B., Bartos, S., Morrison, H., Smith, L., & Fortinsky, R. (2013). A Randomized Trial of Telemonitoring and Self-Care Education in Heart Failure Patients Following Home Care Discharge. Home Health Care Management & Practice, 25(5), 187-195. doi:10.1177/1084822312475137 PICOT Statement Literature Evaluation Table Assignment Paper

Evangelista, L. S., Lee, J., Moore, A. A., Motie, M., Ghasemzadeh, H., Sarrafzadeh, M., & Mangione, C. M. (2015). Examining the effects of remote monitoring systems on activation, self-care, and quality of life in older patients with chronic heart failure. Journal Of Cardiovascular Nursing, 30(1), 51-57. doi:10.1097/JCN.0000000000000110

Kitsiou, S., Paré, G., & Jaana, M. (2015). Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews. Journal Of Medical Internet Research, 17(3), e63. doi:10.2196/jmir.4174 PICOT Statement Literature Evaluation Table Assignment Paper

Ong, M. K., Romano, P. S., Edgington, S., Aronow, H. U., Auerbach, A. D., Black, J. T., & … Sadeghi, B. (2016). Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition — Heart Failure (BEAT-HF) Randomized Clinical Trial. JAMA Internal Medicine, 176(3), 310-318. doi:10.1001/jamainternmed.2015.7712 PICOT Statement Literature Evaluation Table Assignment Paper

Pons, F., Lupón, J., Urrutia, A., González, B., Crespo, E., Díez, C., & … Valle, V. (2010). Mortality and cause of death in patients with heart failure: findings at a specialist multidisciplinary heart failure unit. Revista Espanola De Cardiologia, 63(3), 303-314.

U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. (2015). How is heart failure treated? Retrieved from https://www.nhlbi.nih.gov/health/health PICOT Statement Literature Evaluation Table Assignment Paper

Appendix B

Evidence Review Table

PICO (T) Question: In patients diagnosed with heart failure (age=18-90yrs), how does daily telemonitoring in addition to standard medical therapy compared to standard medical therapy without telemonitoring affect quality of life?
Author(s), Year	Objective/Intervention, or Exposure Compared	Design	Sample (n)	Intervention	Outcomes Studied (How Measured)	Results	Level of Evidence Rating (1-7)
Bekelman, D.PICOT Statement Literature Evaluation Table Assignment Paper B., Plomondon, M. E., Carey, E. P., Sullivan, M. D., Nelson, K. M., Hattler, B., & … Rumsfeld, J. S. (2015).	Evaluate the effectiveness of the integration of multidisciplinary collaborative care and telemonitoring in improving the health status (quality of life) of patients with heart failure.	Randomized controlled trial	Total n= 392 PICOT Statement Literature Evaluation Table Assignment PaperGroup 1 (intervention) = 193 and usual care Group 2 (control) =199 Baseline characteristics: Group 1(male -95.2%, Caucasian-79.7%) Group 2 (male-98.0%, Caucasian -83.8%). Duration: 12 months. Setting: Four Veteran Affairs medical centers in Colorado, California, Virginia, Washington. Criteria Inclusion- – Diagnosed with heart failure (with/ without preserved left ventricular systolic function). – KCCQ score < 60 (indicating poor quality of life) Exclusion- -Cognitive or psychiatric impairment PICOT Statement Literature Evaluation Table Assignment Paper -Nursing home resident -Irrevocable, non-cardiac medical condition -Prior heart transplant -Alcohol abuse (indicated by the a score at least 7 on the Alcohol Use Disorders Identification Test	Daily telemonitoring of blood pressure, weight, heart rate and self reported symptoms like dyspnea and edema by registered nurse in addition to collaborative care provided by a team of cardiologists, primary care provider, nurse coordinator, and psychiatrist. Frequency of daily telemonitoring was unspecified. Usual care: -Regular healthcare providers without any care from the collaborative team. Self-care information sheet and weighing scale if the patients needed weighing scales.	Primary: self-reported heart failure- health status (KCCQ)Total score (min=0, max=100). -Score of 60= poor quality of life, significant HF symptoms, and limited functional status. Secondary: – Depression (PHQ-9) Score of 10= positive for depression. –Mortality and Hospitalization(VA databases, supplemented by patient self-report). 4. Vital status(VA Vital Status File) database	There was no difference in the mean KCCQ scores for both groups at 12 months follow-up. The mean KCCQ overall scores at baseline were 37.9 in-group 1 and 36.9 in-group 2. At 12-month follow-up, the mean KCCQ score increased by 13.5 points for both groups (P= 0.97). Therefore, the intervention did not necessarily improve health status or quality of life. Also, at 12-months follow up, there were significantly lower deaths in the intervention group i.e. 8/187 (4.3%) than the control group i.e. 19/197(9.6%) (P= 0.04). There was no difference at 12-months follow-up in hospitalization rates between both groups (intervention 29.4% vs. usual care 29.9%) (P= 0.87). Amongst the patients positively screened for depression, there was greater improvement in the PHQ-9 score of those in the intervention group than patients in the usual care group at 12-months follow-up (P= 0.01).	2
Blum, K., & Gottlieb, S. S. (2014).	Assess the efficiency of home remote monitoring on mortality, health related quality of life, and 30-day readmission rates in patients with heart failure. PICOT Statement Literature Evaluation Table Assignment Paper ORDER PLAGIARISM -FREE PAPER HERE	Randomized controlled trial	Total n= 206Group 1(monitored group) = 104 and Group 2 (control group)=102 Baseline characteristics: Group 1(male -70%, female-30%, Caucasian- 54%, African American- 46%). Group 1(male -72%, female-28%, Caucasian- 57%, African American- 44%). PICOT Statement Literature Evaluation Table Assignment Paper Duration: 4 years Setting: University of Maryland Medical Center, VA Medical center Baltimore and some private cardiology practices in Baltimore-Washington area. Criteria Inclusion- -Systolic or diastolic heart failure, enrolled in Part A and B as well as had hospital admission within one year prior to the study. Has a telephone and capable of giving informed consent. Exclusion – Dementia, cancer, HIV/AIDS, active drug use, weight of greater than 300 lbs, and residence of skilled nursing homes.	Group 1(monitored group):In addition to routine heart failure care, remote monitoring of daily blood pressure, 15-second EKG strip, weights, and heart rate with the use of Phillips Electronics wireless system. Data transmitted to a nurse practitioner was compared with individually assigned parameters for each participant. When biometric readings went out of patient’s assigned parameters, the nurse practitioner would be alerted by the system and would immediately contact the patient for immediate assessment. If necessary, doses of diuretics medication were adjusted. Control group: -Access to routine heart failure care and outpatient visits.	1. Health-related quality of life (MLHF and SF-36) – MLHF: 21-item. Total score (min=0, max=105). Lower score indicates better QOL. 2. Mortality and Readmissions(Medicare Medpar and Denominator files and MCCD data files).	Descriptive results:A total of 203 thirty-day readmissions occurred in the entire trial. Group 2 had 114 (43%) thirty-day readmissions while Group 1 had 89 (35%) thirty-day readmissions those readmissions (p < 0.05). No significant difference occurred in the mortality rate between Group 1 and 2 throughout the course of study. The number of days participants in Group 1 and Group 2 were alive and away from the hospital were 799 + 429 and 734 + 433 days respectively (p= 0.207). Quality of life assessment was conducted at 6 months and 1 year after randomization. Over the 1-year follow-up, SF-36 (physical and mental) and MLHF (physical and emotional) scores significantly improved r (p < 0.001). However, overall, there was no difference between both groups in terms of QOL.	2
Delaney, C., Apostolidis, B., Bartos, S., Morrison, H., Smith, L., & Fortinsky, R. (2013).	Evaluate the effective of telemonitoring intervention in addition to self –care education in reducing hospital readmissions, improving quality of life and patient knowledge about HF.	Randomized controlled trial PICOT Statement Literature Evaluation Table Assignment Paper	Total n=93Group 1(Telemonitoring group) =46 and Group 2(control group) =47 Baseline characteristics: Significant difference In age and living arrangement between both groups (p=0.02 and p=0.01 respectively). No significant difference in gender (p=0.82) and educational level (p=0.68). Duration: 90 days Setting: A home care agency in Connecticut with several branches. Criteria: Inclusion- – >21 years of age with diagnosis of HF with recent discharge from home. care -Resides in the community and not nursing home. -Home phone line access. Exclusion- Not specified. PICOT Statement Literature Evaluation Table Assignment Paper	Intervention group: Patients continued (after discharge from home care) with the use of telemonitoring devices that recorded and transmitted their daily weight, BP, HR, and oxygen saturation. Upon receipt & review of these information every morning, the manager Program coordinator may contact the patients if parameters were above predetermined levels. Telemonitoring was not 24/7 and patients were instructed to visit the ED if symptoms worsened. Also, HF self-care education on symptoms, diet, weigh and fluid, exercise, and medications. Control group: discharged from home care and were taught to record their medications and symptoms daily for 90 days. Self-care education described above was also provided	Primary: 90-day all cause hospitalization after discharge from home care assistance.Secondary: 2) Quality of Life (MLHF)-to evaluate mental distress, functional limitations and symptom effects. –Heart failure knowledge(Dutch HF knowledge scale).	At 90 days follow-up, there was a decreased amount of all-cause readmissions in the Group 1 than in Group 2 (control). This difference remained even after controlling for the differences in age and living arrangement (p=0.011). At 90 days follow-up, there was a significant improvement in MLHF scores post-home care discharge in Group 1 when compared to Group 2. Group 1 pre-intervention mean score-45.5; post intervention mean-32.1 (p=0.004). In Group 2, no changes occurred; pre-intervention mean score-42.9; post intervention mean-42.4. This effect remained after living arrangement and age were controlled for (p=0.008). Although, both group had an increase knowledge about HF, HF knowledge was higher in Group 1 than Group 2 at 90 days follow-up (p=0.019).	2
Evangelista, L. S., Lee, J., Moore, A. A., Motie, M., Ghasemzadeh, H., Sarrafzadeh, M., & Mangione, C. M. (2015). PICOT Statement Literature Evaluation Table Assignment Paper	To assess the impact of remote monitoring intervention in addition to standard heart failure care on quality of life and self-care of patients recently discharged for heart failure exacerbation.	Quasi-experimental	Total n= 42 Group 1(remote monitoring group) = 21 and Group 2 (control group)=21 Baseline characteristics: Mean age of participants was 72.7 ± 8.9 years. Participants were mostly women (52.4%). Married participants (61.9%) and NYHA class II F (69%), Duration: 3 months Setting: A single tertiary care center in South Carolina. PICOT Statement Literature Evaluation Table Assignment Paper Criteria Inclusion- -18 years and above -Ability to read and write. -Willingness to be trained on the use the remote monitoring system platform Exclusion – – Dementia, malignant cancer, inability to use the remote monitoring platform due to visual impairment or lack of 3G mobile network, residence of an long-term care facility or homeless.	Group 1: Pre-discharge education on how to use the remote monitoring system (RMS) platforms by the research nurse. Participants were instructed to take their heart rate, weight, and blood pressure everyday for 3 months. In addition, the research nurse contacted participants 24 to 48 hours after discharge to clarify questions about the use of the remote monitoring device. Participants were contacted through teleconferencing upon receiving alerts that biometric data was out of predetermined limits. With the collaboration with the care provider, the research nurse intervened by; providing medical advise, resetting thresholds, scheduling a timely outpatient visit, or contacting the emergency department. Control group: Primary care outpatient office visits, home healthcare, and a telephone call from a nurse within a day after discharge to evaluate patient’s status.	1) Self-care (Self-care of HF index) -Score of 0 to 100-higher score indicate better self-care. 2)Self-care confidence(Self-care of HF index) 3) Quality of life (MLHF) -21-item. Total score (min=0, max=105). Lower score indicates better QOL	At 3 months, there was significant improvement in self-care management and self-confidence Group 1 but a decrease occurred in Group 2(p < 0.001). Also, at 3 months follow-up, patients in Group 1 had higher improvements in their emotional (p= 0.003) and overall QOL (p < 0.001) than those in Group 2. However, there was no significance difference between both groups in physical QOL (p= 0.035).	3
Ong, M. K., Romano, P. S., Edgington, S., Aronow, H. U., Auerbach, A. D., Black, J. T., & … Sadeghi, B. (2016).	Evaluate the effectiveness of transitional care remote telemonitoring in decreasing readmissions, mortality and improving quality of life among older adults with heart failure (HF). PICOT Statement Literature Evaluation Table Assignment Paper	Randomized controlled trial	Total n= 1437 Group 1(Telemonitoring group) =715 and Group 2 (control group)=722 PICOT Statement Literature Evaluation Table Assignment Paper Baseline characteristics: No substantial differences in characteristics. Participants median age of 73 year, 22.0% African American, 46.2% female and 61% with NYHA III or IV. Duration: 30-180days Setting: six university medical centers in California PICOT Statement Literature Evaluation Table Assignment Paper Inclusion Criteria: -50 years or older receiving active treatment for decompensated HF -Expected to be discharged home – Capable of providing written informed consent in English, Spanish, Farsi, or Russian. -Being actively treated for HF as well as those having a principal diagnosis of Heart failure Exclusion: -Cognitive or physical disability (dementia, overweight >204 kg) or no telephone resources – Residing in a skilled nursing facility, receiving chronic hemodialysis, awaiting or received an organ transplant).	Telemonitoring group:-1)Pre-discharge training by registered nurse on medication adherence, fluid monitoring, total salt avoidance, exercise, daily checks of weigh.2) dailytelemonitoring transmission of body weight, heart rate, and blood pressure via electronic wireless system which was assessed daily by registered nurses for 6 months. Frequency of daily telemonitoring was unspecified. The assigned registered nurse received alerts for biometrics readings that exceeded predetermined thresholds and immediately contacted the patients for assessments. If the symptoms were very concerning, the nurse would advise the patient to report to the nearest emergency department or call 911. The healthcare provider would also be notified immediately. 3) Nine telephone coaching calls (to reinforce the pre-discharge instructions over a period of 6 months. Usual care group: Pre-discharge training (same as above) and one follow-up call post discharge. No additional telemonitoring surveillance.

PICOT Statement Literature Evaluation Table Assignment Paper