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Analyze and evaluate

Synthesis Paper

February 20, 2022

Synthesis Paper

Diabetes is a significant ailment that affects many individuals globally. It is a chronic ailment that impairs the body’s physiological function by interfering with its ability to produce an essential hormone called insulin (Wang & Tao, 2019). As a result, the body fails to break down and absorb sugar adequately; hence its levels in the bloodstream become high, precipitating significant complications in the body of patients (Kim et al., 2018). Loss of eyesight is one of the critical complications caused by the condition in the patient’s body.

According to Kim et al. (2018), diabetic retinopathy is one of the complications that patients with diabetes present with. Subsequently, Wang and Tao (2019) comment that the condition causes maladaptive changes to the choroid and retina of the eye that aggravate as the disease becomes more severe. Further, Moudgil et al. (2021) posit that failing to treat the condition promptly can lead to blindness which is irreversible damage to the eyes of the patient. This essay scrutinizes diabetes, a national practice problem is prevalent in contemporary society. It analyzes, synthesizes, appraises and translates evidence that proves that in diabetic retinopathy, macro vascular changes in the choroid and retina in the eye correspond with progressive severity of the condition.

Analysis of the Practice Problem

Diabetes is a significant health problem because of its complexities in the human body. Studies show that it affects eyesight, an essential physiological function in humanity (Wang & Tao, 2019). Human vision plays significant roles, including allowing individuals to engage in their day-to-day activities such as working, reading, and playing. It also safeguards humanity by helping them to see and avoid dangerous objects. Therefore, impairment or loss of eyesight is a significant deterrent to functionality because it makes individuals from performing their day-to-day activities (Kim et al., 2018). As a result, they rely on others to perform different functions. Also, the condition escalates the financial implications of treating diabetic patients.

Diabetes retinopathy, a severe eye ailment, causes many diabetic patients to have impaired vision or lose their eyesight entirely. According to the National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation (n. d.), approximately one in every twenty diabetic adults aged over twenty-nine years has the condition in the U. S. Evidence from government databases shows that currently, over 890,000 diabetic patients grapple with different stages of the infection. Additionally, Vision Health Initiative (n.d.) indicates that white people were the most susceptible to the condition, while African Americans were least vulnerable to it. Further, women were more predisposed to the disease than men. The National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation (n. d.) provides statistical evidence that indicates that ten percent more females with diabetes contract the ailment than men.

Evidence Synthesis

Diabetic retinopathy is a significant health concern in diabetic patients that affects the quality of the life they lead. Kim et al. (2018) found that the severity of diabetic retinopathy corresponded with the extent of the damage in vital parts of the eyes, such as the choroid and retina. Similarly, Wang and Tao (2019) deduced that as diabetic retinopathy in diabetic patients became more advanced, the corresponding damage to the eyes intensified. The content compiled from the two articles brings to light a significant theme that patients with a mild form of diabetes had minor changes in their eye structure. In contrast, those with a severe form of the condition had aggravated damages.

Wang and Tao (2019) take a different approach in their study that unearths another significant theme that is vital in the care of diabetic patients. They deduced that maladaptive changes in the eye structure in patients who were yet to be diagnosed with diabetic retinopathy, such as changes in the density of the choroid’s capillaries, indicated that the affected patients could have a condition; hence they should be tested. Therefore, screening undiagnosed patients with mild changes in the choroidal structure showed that they had diabetic retinopathy. This perspective concurred with the conclusions made by Moudgil et al. (2021), who highlighted the significance of physicians examining the eyes of diabetic patients. It brings to light the importance of studying the eyes of diabetic patients to determine whether there are changes that suggest that they have diabetic retinopathy.

Conceptualizing that the changes in ocular structure in diabetes patients with diabetic retinopathy corresponded with the severity of the condition Kim et al. (2018), and that patients’ eyesight became more damaged when they stayed with the disease for prolonged periods Wang and Tao (2019) lead to the conclusion that physicians should develop a culture of examining diabetic patients eyes from time to time for timely detection of affectation with diabetic retinopathy Moudgil et al. (2021). It highlights that periodic monitoring of the eyes of patients with diabetes patients is an evidence-based practice that ensures that signs of diabetic retinopathy are detected on time and treatment initiated to prevent severe damage to their eyesight.

Appraisal of the Evidence

Kim et al. (2018) carried out a quantitative study that explores a medical challenge faced by diabetic patients. It utilizes single research to compile good quality, level II evidence. The quality of the evidence is classified as good because it uses effective procedures for undertaking a research study, such as manipulating an independent variable, including a control group to prove the validity of the compiled evidence, and using effective methods of selecting participants (Kin et al., 2018). Subsequently, it clearly explains the processes used while carrying out the study, such as the method used during the process, the strategies used to compile data, and how it was analyzed to make conclusive assertions about the research question. However, its main shortcoming is that it does not explain the limitations experienced during the study. Nevertheless, the evidence compiled from the survey is reliable and can be applied in the clinical setting to provide evidence-based care.

Wang and Tao (2019) also carried out a quantitative study that provides good quality level III evidence. The single research investigative study analyzed the choroidal changes in a group of selected participants to determine the changes that occurred in the structure of their eyes as the condition became more severe. The evidence compiled from the study was of good quality because effective strategies were used in the study, such as providing clear explanations of the objectives that the study aimed to fulfill and incorporating an adequate number of participants (Wang & Tao, 2019). The strategies used to collect and analyze data are also explained well. Therefore, it is possible to replicate the experiment to determine whether the evidence compiled from the study is accurate. Further, it also explains the limitations encountered during the research and the steps taken to overcome them. Therefore, the evidence gathered from the study is reliable and applicable in providing quality care to diabetic patients.

Moudgil et al. (2021) carried out a qualitative study that provides adequate evidence that answers the research question. It contains good quality, level II evidence applicable in the clinical setting. The evidence compiled from the study can be classified as good evidence because it clearly states what the investigative study aimed to achieve and the process it used to achieve it (Moudgil et al., 2021). Subsequently, it explains why it chooses the approaches to accomplish its purpose, outlines the outcomes unearthed from the study, and discusses their implications in the clinical settings. Further, the study is undertaken by experts in the medical field. However, the study’s primary shortcoming is that it does not document quotes from the respondents in the study to support its claims. Still, it contains significant evidence that can be applied in the clinical setting to provide quality, evidence-based care to the patients.

Selection of a Translation Theory or Model

After compiling evidence, it is necessary to restructure it into a format that can be applied in the clinical setting. To achieve this, it is essential to select a translation model that will be used to translate the evidence into practice. The proposed translation model that can effectively translate the compiled evidence into practice is the knowledge to action (KTA) translation framework. It is a conceptual framework comprising two significant steps that translate scientific evidence into a format that can be used clinically. The two steps inherent in the model include, firstly, the knowledge creation process, which involves summarizing the evidence objectively to form a knowledge tool. The second step is the action cycle, which consists of deducing the issue that evidence aims to change and factors that may promote or hinder its transformation. It also includes determining the approaches used to implement the knowledge and evaluating its outcomes. It also includes deducing how to sustain the achievements that will be made by implementing the strategies.

The stakeholders will be integrated into the model’s design by being incorporated in different steps of the translation process depending on the essentiality of their roles in the clinical setting. For example, stakeholders such as physicians and nurses are facilitators of the translation process. Therefore, they will play a significant role in the action cycle when implementing the necessary changes. On the other hand, stakeholders such as hospital administration can be barriers to implementing the change. They may oppose the change because of the financial implications that it may precipitate. Subsequently, stakeholders such as patients can be used to provide feedback on the effectiveness of the implemented changes.


Diabetes is a significant health issue that is prevalent in contemporary society. It is a chronic ailment that causes patients to develop a wide range of complications that lower their quality of life. Diabetic retinopathy is one of the typical complexities in diabetic patients. Diabetic retinopathy is an eye ailment that causes maladaptive changes in the retina and choroid of patients. Evidence compiled from the literature shows that the structural changes in the eyes of the patients intensified as the ailment became more severe. The evidence gathered from the articles is excellent, which further confirms the compiled findings’ reliability. Therefore, it highlights the need for early detection of the condition to avoid impairment of the sight diabetic patients. Additionally, it provides evidence that helps healthcare professionals conceptualize the approach they can use to detect the ailment promptly. It also brings to light the need for regular screening of patients for early detection of the condition and prompt initialization of the treatment process.


Vision Health Initiative. (n. d.). Economic Studies. Retrieved from

Kim, M., Choi, S. Y., & Park, Y. H. (2018). Quantitative analysis of retinal and choroidal microvascular changes in patients with diabetes. Scientific Reports8(1), 1-8.

Moudgil, T., Bains, B. K., Bandhu, S., & Kanda, N. (2021). Preferred practice pattern of physicians regarding diabetic retinopathy in diabetes mellitus patients. Indian journal of ophthalmology69(11), 3139.

National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation (n. d.). Diabetic Retinopathy. Retrieved from

Wang, H., & Tao, Y. (2019). Choroidal structural changes correlate with severity of diabetic retinopathy in diabetes mellitus. BMC ophthalmology19(1), 1-9.


Appendix A

Article Number

Author and Date

Evidence Type

Sample, Sample Size, Setting

Findings That Help Answer the EBP Question

Observable Measures


Evidence Level, Quality


Wang and Tao, 2019

Quantitative study that uses an experimental research design

104 eyes in Beijing Chaoyang Hospital in Korea

The investigate study shows that there is a significant change in the structure of the choroid of the human eye that corresponds with the severity of a condition known as diabetic retinopathy in patients ailing from T2D

Manipulating independent variables and using control groups

Failure to include some populations in the study

High quality level II evidence


Kim et al., 2018

Quantitative study that uses an observational cross section design

174 eyes in Seoul St. Mary’s Hospital in Korea

The study findings show that an increment in DR levels in the body of patients precipitates transformations in the vascular features of the retina and choroid.

Use of independent and control groups

Failure to identify the limitations of the studies.

Good quality, level II evidence

Volume 69, issue 11

Moudgil et al., 2021

Qualitative study that uses a qualitative descriptive research design

100 physicians practicing in India who had access to electronic media

As primary caregivers physicians taking care of diabetic patients should have the skills needed to notice changes in parts of the eye of diabetic patients, and send them to ophthalmologists for screening for diabetic retinopathy. The changes that the medical professionals look out for include changes in the physiological structure of the retina and choroid.

Use of online questionnaires

Lack of quotes in the narratives

Good quality level III evidence


Project Change in Healthcare


Institutional Affiliation



The stakeholders in a health care setting include patients, policymakers, patient providers, and pharmacists’ ancillary service providers and medicine. The team of interprofessional primary stakeholders that must be anticipated during a project change must include the team of professionals in any health care setting to ensure that quality is offered to patients and that institutions get profit to enable them to expand their service provision. Therefore, patients are the major key stakeholders that must be incorporated whenever a change is anticipated in a healthcare setting. The role of patients is to help in regard of learning the healthcare system and such that donors of personal clinical data among other beneficiaries acknowledge the importance of patience since they are the key responsibility of any health care unit (Wu et al,2019) The other stakeholder in a healthcare set up is of patient providers who play a major role in the direction of healthcare towards support in funding activities and offering of solutions in cases where projects emerge and others have to be changed to meet the current role of healthcare and ensure the quality of care.

The other stakeholders in a healthcare setting who can easily be associated with project change plans are physicians, employers, insurance companies, and the rest of pharmaceutical firms. Therefore, while implementing future change in projects, then these stakeholders act as professional teams who will ensure that expectations are met in a timely and concise manner while ensuring quality is topnotch in the event of meeting patient needs and boosting the reputation of the organization. However, challenges exist in the execution of a project change while interacting with the primary stakeholders. This is because steps must be followed in anticipating project change such as impacting healthcare providers to use newer and better forms of care based on recent extensive research in that the entire organization must be prepared for change, a vision, and a plan must be crafted to reflect the change, changes then executed while embedding the culture of the health care setting.

The common challenges faced in a healthcare setting include the type of systems to be used, complex science base, technological advancements, and workforce shortages. Therefore, in the vent of meeting quality standards and preparing the nursing team for changes such as that of new drugs introduced by the U.S Food and Administration which has recently approved the use of Farxiga for heart disease to treat adults and a reduced ejection to mitigate cardiovascular deaths and hospitalizations among adults (Taylor et al,2019). Therefore, the common barriers that can be experienced among stakeholders in healthcare such as dealing with patients and informing them on the new methods of treatment they should opt for are tasking. This is because patients might be rigid in decisions that concern their health; therefore, much effort is needed to convince them otherwise which limits the project change and scope within the organization.

Additionally, the other issue that might arise from pharmacists’ ancillary service providers is the changes that might come with different changes in medication. This might result in different delivery of medications, counseling, and offer to patients such that ineffective communication between hospitals and their service providers might impact in failure in project change towards incorporating better health services and care. Policymakers can still make the process of project change in healthcare difficult by complicating the processes and documents is needed to acquire certification to offer certain health services (Mazlan et al,2020). Typically, evidence has shown the lack of healthcare professionals in familiarizing with the latest research evidence, however, incentives might help in motivating them towards ensuring effective healthcare approaches. The other challenges that might impact change negatively in healthcare through health professionals are poor training, communication among themselves, impact from external environments and regulations. Physicians, employers, insurance companies, and the rest of pharmaceutical firms can also negatively influence change in the offering of care for the case of heart failure patients in that their participation, motivation and focus towards the same is key. If insurance companies fail t support new and developed treatments strategies and those physicians do not find extensive research concerning the same, chances are high the project will fail, otherwise.



Mazlan, A. A., Daud, S. M., Sam, S. M., Abas, H., Rasid, S. Z. A., & Yusof, M. F. (2020). Scalability challenges in healthcare blockchain system—a systematic review. IEEE Access8, 23663-23673.

Taylor, C. J., Ordóñez-Mena, J. M., Roalfe, A. K., Lay-Flurrie, S., Jones, N. R., Marshall, T., & Hobbs, F. R. (2019). Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population-based cohort study. bmj364.

Wu, J., Wang, Y., Tao, L., & Peng, J. (2019). Stakeholders in the healthcare service ecosystem. Procedia CIRP83, 375-379.

Running head: ROLE OF DNP NURSES 2


Role of DNP Nurses

In my opinion, the characteristics of a DNP nurse are based on the roles they are expected to play in the nursing field. DNP nurses are designated to seek a degree in the nursing practice and to also offer alternatives to research-based doctoral programs. They are well equipped to help in the implementation of science that had been improvised by other nurse researchers in Ph.D., Doctorates, and even DNS. Through the contributions of a DNP-educated nurse, with a unique skill set, then clinical practice, evidence-based research implementation, and evaluation and advocacy in health are guaranteed (Trautman et al,2018). Generally, they aim at positively impacting healthcare delivery through transforming and improving methodologies, evidence, and practices although a times DNP nurses face challenges such as competition from the rest of the team (Labardee et al,2020).

The Global Burden of Disease is a tool that is used in the provision and the quantification of health loss caused by a variety of diseases, injuries among other risk factors. The aim of studying this is to impact the improvement of health systems to handle disparities and eliminate them also. Among the National Practice problems in nursing, a category is an Alcohol-related harm which is rated the most top 10 challenges in public health. In my opinion, extensive research on alcohol-related issues is paramount since most of the cases have reached an alarming level. Additionally, alcohol use presents a wide range of diseases and triggers the occurrence of others, and even causes death. Health conditions, mental disorders, liver diseases, and high-risk behaviors result from alcoholic abuse. Alcohol also causes long-term risks that can lead to the development of chronic diseases among other serious health problems. Most of the recently published research studies give solutions to solve alcohol-related issues to help reduce the alarming rate especially in youths and create awareness on the range of possible diseases to be infected if one takes part in the consumption of alcohol.

DNP nurses are required to lead population-based health care programs that help in promoting health among specific populations such as alcohol abuse. These healthcare initiatives should however correspond to the federal state’s policies. Through the use of the Global Burden of Disease tools, DNP nurses can predict and quantify health loss across specific populations based on evidenced-based findings and find ways to mitigate risks of the same national problems. Through taking part in the reduction of National Practice problems, DNP nurses can therefore help in boosting the quality of life as well as a health care setting responsibilities. The existence of two graduate-level programs in healthcare has come along with challenges where confusion exists between the two DNP and Ph.D. which is brought about by the similar positions, they take part in the nursing space, what differentiates DNP and Ph.D. is the complementary skills each of them possesses (Falkenberg-Olson,2019). The building of collaborations between the two groups of nurses reflects the general health care system positively. However, Doctoral nurses’ role can be a bit challenging, integrating them with DNP nurses is a bit crucial but ensures collaboration and created a perfect working environment (Cowan, Hartjes & Munro,2019).

The unique contributions of DNP nurses to the healthcare setting and in the fight against National Practice programs with the help of tools such as Global Burden of Disease have improved health among people. Research-based and evidence-based pieces of articles have been worked to boost the same as well as offer support to the DNP nurses to put into practice in their respective places of work.


Cowan, L., Hartjes, T., & Munro, S. (2019). A model of successful DNP and Ph.D. collaboration. Journal of the American Association of Nurse Practitioners31(2), 116-123.

Falkenberg-Olson, A. C. (2019). Research translation and the evolving Ph.D. and DNP practice roles: A collaborative call for nurse practitioners. Journal of the American Association of Nurse Practitioners31(8), 447-453.

Labardee, R., Buck, J., Coffey, R., Dhakal, K., Francis, D., Seeling, D., & Chipps, E. (2020). Describing the challenges faced by newly prepared DNP graduates in the acute care setting. Nurse Leader18(5), 451-454.

Trautman, D. E., Idzik, S., Hammersla, M., & Rosseter, R. (2018). Advancing scholarship through translational research: The role of Ph.D. and DNP prepared nurses. Online Journal of Issues in Nursing23(2).



Theory of Interpersonal Relations

Nursing theories are used in nursing research as well to understand the use of theories in the provision of patient care in different nursing fields. The theory of Interpersonal relations was developed by Hildegard Peplau who was focusing on the benefits of creating a strong relationship between nurses and patients to foster interpersonal relations which comprise of four major elements; person, environment, health, and nursing. The basics of the theory are that nurses’ interactions play a major role in influencing patients’ well-being and experience through interactions and communication habits (Dias et al,2019). For the development of the theory, the four concepts work best. The person represents the patient and the surrounding immediate family and friends who ensure the physical, spiritual, emotional, and social needs of the person are met. The environment is the surrounding that affects the patient through internal and external influences. Health reflects the quality and general well-being of the patient and the access the patient has towards healthcare. The fourth paradigm, nursing is the application of knowledge and skills by the nurse in caring for the patient.

The nursing research study on the effect of support groups interventions used by caregivers to patients with heart failure to discover the outcomes when used with a nursing theory fully influences the purpose of the research. The case study uses support groups such as caregivers to determine the impact of the health of the patients. The experimental research with 69 support group team with 35 under control and 35 of them under intervention. The interceding group took part in meetings and data was collected from both the intervention and the control team periodically. Findings had it that caregivers in the intervention team had same scores in terms of depression levels while the intervention team had lower burden scores than the control group except that of objective personal care. The burden of the caregivers that offer support to patients with heart failure reduced significantly as the time progressed from 3 months to 6 months. Therefore, conclusions were made that extended support of patients with heart failure requires more time to ensure depression and burden among the caregivers minimizes while personalized are is perfected (Barutcu & Mert,2016).

According to research, heart failure incidence rate increases annually as well as its mortality and morbidity rate. More than 5.8 million patients have heart failure in the U.S with some percentage of older people affected. To ensure personalized care for patients nursing theories are applied that meet the nursing paradigm. Among the concepts of the paradigm is patients who are heart failure patients, nursing is the practice applied by caregivers with the help of other health providers to meet quality care and ensure the quality of life of the patients. The research conducted identified that the environment influenced the level of care. This is because some of the caregiver’s occupational practices led to a reduced level of care, burden, and depression rates are high among the support group teams. This reflects the environment in which the patients are exposed to with caregivers whose mental status is affected is high to affect the quality of care and hence slow recoveries.

Additionally, time affected the quality of care of the patients as well as the interaction between the support group caregivers and the patients. According to the theory of interpersonal relations, a good relationship between nurses and patients fosters the recovery process through a better understanding of personalized care with enough time to monitor the impact on the recovery process. This explains the impact of nursing theories on the health of the patient which covers the nursing paradigm concepts also.


Barutcu, C. D., & Mert, H. (2016). Effect of support group intervention applied to the caregivers of individuals with heart failure on caregiver outcomes. Holistic nursing practice30(5), 272-282.

Dias, J. S., Rocha, L. P., Carvalho, D. P. D., Tomaschewski-Barlem, J. G., Barlem, E. L. D., & Dalmolin, G. D. L. (2019). Construction and validation of a tool to assess nursing interpersonal relations. Revista brasileira de enfermagem72, 408-413.


Summary of a Qualitative Article

Student’s Name

Institutional Affiliation

Course Name and Number

Instructor’s Name


Summary of a Qualitative Article

The article named Outer retina dysfunction and choriocapillaris impairment in type 1 diabetes discusses the changes in the retina and choroid in a diabetic patient with diabetic retinopathy. The authors undertake qualitative research to determine the type of changes that occurs in parts of the eyes of patients ailing from the condition. Parravano et al. (2021) aimed to deduce the difference in the morphological features in the eyes of diabetic patients with diabetic retinopathy and those in diabetic patients without eye impairment.

The method that Parravano et al. (2021) used to determine the changes in the choroid and retinal structure in the eyes of individuals ailing from diabetes is observing and comparing the morphological features of a group of forty-three diabetic patients, some of who had diabetic retinopathy while others did not. The participants consisted of both male and female patients to ensure that the outcomes compiled from the study were not biased; hence they can apply to the entire population. The approaches used to detect the changes in the eye structures include evaluating the factual data compiled from MfERG and OCTA after a comprehensive examination of the participants’ eyes (Parravano et al., 2021). The results showed significant changes in the morphological features of the eyes in diabetic patients with diabetic retinopathy, including the density of the capillaries in the choroid and retina and their blood flow capacity.

The data compiled from the study led the authors to conclude that affectation with diabetic retinopathy triggers changes in the morphological structure of parts of the eye, such as the retina and the choroid. The changes include a maladaptive transformation of some features of the capillaries found in the region, such as their density, structure and reflective values (Parravano et al., 2021). Therefore, the authors recommended that the research findings should be incorporated in the clinical setting as a technique of deducing whether patients have developed diabetic retinopathy.


Parravano, M., Ziccardi, L., Borrelli, E., Costanzo, E., Frontoni, S., Picconi, F., … & Querques, G. (2021). Outer retina dysfunction and choriocapillaris impairment in type 1 diabetes. Scientific Reports11(1), 1-9.


Synthesis vs. Summary

Student’s Name

Institutional Affiliation

Course Name and Number

Instructor’s Name


Synthesis vs. Summary

A synthesis and a summary of articles are two forms of writing that differ distinctly in various ways. The first factor that separates a true synthesis from a summary is that a true synthesis evaluates articles to find any connections or patterns present in them. While writing a true synthesis, one has to comprehensively read information from write-ups to find distinctive aspects about them, such as their differences or similarities (van Ockenburg et al., 2019). After that, this information can be used to discuss them analytically by describing the similarities that connect them and the differences that distinguish one author’s viewpoints from that of another. On the other hand, a summary does not address the patterns inherent in articles.

Another distinctive aspect that separates a true synthesis from a summary is that writing a true synthesis of articles usually involves researching and extracting information from different articles and using them to interpret the topic under discussion in a new light (Jaakkola, 2020). In this way, a synthesis helps an individual add a unique perspective to the information shared in the articles. It differs significantly from a summary in that a summary merely documents an overview of articles without analyzing them further. Another dynamic aspect that separates a true synthesis from a summary of articles is that when writing a true synthesis, it is necessary to integrate parts of the information shared by different authors to create a detailed entry (van Ockenburg et al., 2019). It differs from a summary that shares and evaluates the information presented by one author at a time without taking any step to deduce how they interrelate.

In conclusion, a synthesis and a summary are both effective forms of documenting the information shared by authors. However, writing a true synthesis is separate from writing a summary in the comprehensive way it evaluates, interprets, and communicates the information present in the write-ups.


Jaakkola, E. (2020). Designing conceptual articles: four approaches. AMS review, 10(1), 18-26.

van Ockenburg, L., van Weijen, D., & Rijlaarsdam, G. (2019). Learning to write synthesis texts: A review of intervention studies. Journal of Writing Research, 10(3), 401-428.


Quantitative research

Quantitative Research

Diabetes is a significant national practice problem prevalent in society characterized by excessive sugar levels in patients’ blood. Diabetes causes numerous maladaptive changes in the body of patients (Forouhi and Wareham, 2019). One of these changes is contracting diabetic retinopathy (DR), a condition marked by the destruction of the retina that may lead to blindness. Studies indicate that over 40% of the adults aged forty years or more in the U. S develop the condition. The prevalence of the ailment in society necessitates research to scrutinize the disease further. Quantitative analysis of retinal and choroidal microvascular changes in patients with diabetes is a write-up that scrutinizes the changes that take place in a patient with DR. The article, which is written by Kim et al. (2018), examines the relationship between the increased severity of the condition and the corresponding aggravation of the clinical manifestations.

Literature Search Strategy

A comprehensive literature search was conducted to find an article containing quantitative research on diabetes patients. Only academic databases were scrutinized to ensure that the selected article was a scholarly write-up (Lefebvre et al., 2019). The keywords and phrases used during the search included “diabetes,” “quantitative research,” and “diabetic patients.” The search yielded numerous articles with varying information about the condition. The criteria used to identify the chosen article included one published recently to ensure that it had updated content on the topic, was written in the English language, and its full body text was available.

Critique of the Article Using the John Hopkins Appraisal Tool

Evaluation of the article using the appraisal tools designed by John Hopkins shows that it is a quantitative study based on a single investigative research. The methodology used in the study is the manipulation of an independent variable, which was patients with diabetes. The approach is significant because it helps prove that the changes noted during the experiment are reliable (Lefebvre et al., 2019). It encapsulated a group of diabetic patients who had varying stages of DR and a group of individuals without the condition who were to act as the control group. The study was a level II investigation that provided good evidence applied in a clinical setting. The authors achieved this goal by clearly identifying the gaps in knowledge that the article filled, stating its purpose, and providing clear details of the method used during the study and the process used to analyze it. However, the sample used in the study was fairly small, a factor that negatively impacted its reliability.

Summary of the Article

The write-up is an investigative study that seeks to compare the changes in the clinical manifestations that patients with diabetes who have DR present with the severity of their condition. The study encapsulated a total of one seventy diabetic patients who had varying phases of DR and a group of diabetes-free individuals (Kim et al., 2018). The patients were clustered into six groups depending on the severity of the conditions and examined progressively to determine the changes in patients’ eyes, such as the FAZ, SCP and DCP, such as the length and density of blood vessels (Kim et al., 2018). The study results showed significant changes in the severity of clinical manifestations that the patients presented with were more extensive in patients with severe DR than that in patients with a mild form of the condition.


The study provides important information on diabetes, a significant national practice problem prevalent in contemporary society. The evidence compiled from the investigative research provides crucial evidence that can be applied in the clinical setting to determine the treatment processes that can be applied in different stages of the ailment to elicit positive outcomes.


Forouhi, N. G., & Wareham, N. J. (2019). Epidemiology of diabetes. Medicine47(1), 22-27.

Kim, M., Choi, S. Y., & Park, Y. H. (2018). Quantitative analysis of retinal and choroidal microvascular changes in patients with diabetes. Scientific reports8(1), 1-8.

Lefebvre, C., Glanville, J., Briscoe, S., Littlewood, A., Marshall, C., Metzendorf, M. I., … & Cochrane Information Retrieval Methods Group. (2019). Searching for and selecting studies. Cochrane Handbook for systematic reviews of interventions, 67-107.

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