mezzinapatricia_85654_28381866_Evidence Synthesis and Tables - Mar. 27 @ 9_50 pm

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1 Evidence Synthesis and Tables Patricia Mezzina Chamberlain University NR-711 Dr. Karen Myers March 31, 2024

2 Evidence Synthesis and Tables Th e purpose of this paper i is paper aim s to provide an overview of the practice problem identified at the Multiple Sclerosis (MS) Center practicum site, along with the greater significance at the population and national level, and a synthesis of the evidence to support the proposed practice change. There needs to be 3 sentences for paragraph and intro is simply 3 to 5 sentences that introduces the topic. The information needs to be combined together and made a little bit more concise. Results of a chart review and needs assessment at the practicum site revealed a high incidence of comorbid conditions that negatively impact overall quality of life (QOL). As much as 80 % of patients living with MS suffer from fatigue, 40-70% experience anxiety-inducing cognitive dysfunction, and 24% are diagnosed with depression which synergistically impacts overall mortality (Kern & Cepeda, 2020). Finally, obesity has been tied to the evolution and progression of MS (Schreiner & Genes, 2021). The practice gap identified was a lack of an organized process to address these comorbidities and modifiable risk factor reduction. The evidence-based intervention is a wellness program that addresses the three priority focuses identified by the National MS Society including diet, exercise, and emotional well-being (Hart et al., 2011). Significance of the practice problem According to the Global Burden of Disease study, in the United States, there was a 23.9% increase in the incidence of MS, a 60.4 % increase in prevalence, a 75 % increase in disability- adjusted life years (DALYs), and as high as an 89.4% increase in mortality from 1990 to 2017 (Feigin et al., 2021).

3 With approximately one million people living with MS in the United States today, the total economic burden has been reported to be 85.4 billion dollars annually. With annual direct excess medical expenses being approximately 65,612 dollars and indirect costs of 22, 875 dollars per patient, the biggest expenses are related to disease-modifying therapy and lost wages/productivity related to comorbidities and disability (Bebo et al., 2022). A focus on secondary and tertiary prevention though a focus on wellness may impact the economic burden, DALYs, and mortality. All of these sentences need to be cited. Especially all the numbers because that specific information is pulled from a specific source. Add a little bit more information by explaining what the numbers mean. The significance of an issue answers the question why do we care? So you have great numbers and data now explain to the reader what that data means. One extra sentence would work Evidence Synthesis The Evidence-based intervention to be implemented is an 8-week wellness program that acknowledges the bio-psycho-neuro-immunological challenges experienced by patients living with MS. In a structured format, it provides education and enrichment activities that address the priorities identified by the National MS Society, modifiable risk factors and support patients to live their most authentic experience of wellness possible at every stage of the disease course and ultimately improve overall quality of life (National MS Society, n.d.-a). Meeting in a group format once per week for the course of the program, the content will also be presented in alignment with the six dimensions of wellness identified by the National MS Society, including physical, cognitive, emotional, social, occupational, and spiritual wellness (National MS Society, n.d.-b).

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4 Main themes are you don’t want one. This is main themes because you already have evidence synthesis and the other headings need to be left justified for the synthesis Qualitative data obtained from separate studies involving both healthcare providers and current MS patients reveal main themes, including that the MS population was underserved, and across the board, there was a strong recommendation for a pathway to link patients with a “living well” type of program where patients can have access to expert education on lifestyle and behavior strategies to address modifiable risk factors. A very long sentence that also needs to be cited. For evidence synthesis. All the sentences will be cited in a need to be cited with at least 2 sets of authors. To show synthesis you want to use all of your research articles and have them support each other so you will want to use at least 2 research articles are more for each paragraph. Also learn how to cite sentences with more than one set of authors.. Both groups also identified a need for interventions addressing diet, exercise, and stress management as a perceived need to improve their QOL with a high value on mental and emotional health at the same level as physical symptoms (Donkers et al., 2019, & Faraclas et al., 2022). Contrasting main points left justify A key contrasting main point is that studies on wellness programs addressing various key comorbidities, from interventions aimed at reducing obesity and increasing physical activity to interventions such as mindfulness training to address emotional dysregulation, to behavioral programs to address symptoms such as pain, depression, and fatigue, all the interventions resulted in positive changes in the intervention groups and improvement in the quality of life domains tested (Cozart et al., 2023, Schirda et sl., 2020, Hart et al., 2011 & Weinstein et al., 2022). This is one sentence. This is not a paragraph and is not synthesizing information. There needs to be additional information /sentences that help support th e 1 st sentence. A dd in 2 more

5 sentences from various authors already cited at the beginning sentence to help bring in extra information supporting what the first sentence says . Its’ a good start! A second key contrasting point is that both virtual and in-person formats of wellness- focused programs yielded positive improvements in the overall quality of life measured metrics (Cozart et al., 2023, Hart et al., 2011 & Weinstein et al., 2022). Need 3 sentences for paragraph Overarching Synthesis In considering all the evidence presented here, it is clear that key stakeholders have identified a need for a process for addressing interventions to improve the quality of life for patients with MS and, a formal behavioral wellness program, virtual or in-person, that addresses one or more modifiable risk factors for comorbidities can have a positive impact to improve the lives of those suffering with this disease (Cozart et al., 2023, Donkers et al., 2019, Faraclas et al., 2022, Hart et al., 2011, Schirda et al., 2020 & Weinstein et al. 2022). same error Conclusion Patients with MS have a significantly higher incidence of comorbid conditions including obesity, anxiety, depression, fatigue, and cognitive dysfunction, which negatively impacts the overall quality of life, morbidity, and mortality (Kern et al., 2020, & Schreiner et al., 2021). The consensus among key stakeholders is that this population is underserved in the community and there is a strong interest in access to opportunities for interventions that address priority focuses identified by the National MS Society, including increasing physical activity, nutrition, and emotional wellness (Donkers et al., 2019, & Faraclas et al., 2022). Evidence in the literature supports that the evidence-based intervention of a behavioral wellness program can improve the overall quality of life for patients living with MS (Cozart et al., 2023, Donkers et al., 2019,

6 Faraclas et al., 2022, Hart et al., 2011, Schirda et al., 2020 & Weinstein et al. 2022). , generally there’s no cited material in summaries

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7 References Bebo, B., Cintina, I., LaRocca, N., Ritter, L., Talente, B., Hartung, D., Ngorsuraches, S., Wallin, M., & Yang, G. (2022). The economic burden of multiple sclerosis in the United States. Neurology , 98 (18). https://doi.org/10.1212/wnl.0000000000200150 Cozart, J. S., Bruce, A. S., Befort, C., Siengsukon, C., Lynch, S. G., Punt, S., Simon, S., Shook, R. P., Huebner, J., Bradish, T., Robichaud, J., & Bruce, J. M. (2023). A pilot study evaluating the prefeasibility of a behavioral weight loss program in people with multiple sclerosis. Preventive Medicine Reports , 36 , 102437. https://doi.org/10.1016/j.pmedr.2023.102437 Donkers, S. J., Oosman, S., Milosavljevic, S., & Musselman, K. E. (2019). Addressing physical activity behavior in multiple sclerosis management. International Journal of MS Care , 22 (4), 178–186. https://doi.org/10.7224/1537-2073.2019-029 Faraclas, E., Merlo, A., Lynn, J., & Lau, J. D. (2022). Perceived facilitators, needs, and barriers to health-related quality of life in people with multiple sclerosis: A qualitative investigation. Journal of Patient-Reported Outcomes , 6 (1). https://doi.org/10.1186/s41687-022-00496-1 Feigin, V. L., Vos, T., Alahdab, F., Amit, A. L., Bärnighausen, T., Beghi, E., Beheshti, M., Chavan, P. P., Criqui, M. H., Desai, R., Dhamminda Dharmaratne, S., Dorsey, E., Wilder Eagan, A., Elgendy, I. Y., Filip, I., Giampaoli, S., Giussani, G., Hafezi-Nejad, N., Hole, M. K.,...Murray, C. L. (2021). Burden of neurological disorders across the us from 1990- 2017. JAMA Neurology , 78 (2), 165. https://doi.org/10.1001/jamaneurol.2020.4152

8 Hart, D. L., Memoli, R. I., Mason, B., & Werneke, M. W. (2011). Developing a wellness program for people with multiple sclerosis. International Journal of MS Care , 13 (4), 154–162. https://doi.org/10.7224/1537-2073-13.4.154 Kern, D. M., & Cepeda, M. (2020). Treatment patterns and comorbid burden of patients newly diagnosed with multiple sclerosis in the United States. BMC Neurology , 20 (1). https://doi.org/10.1186/s12883-020-01882-2 National MS Society. (n.d.-a). Living Well with MS . Retrieved November 28, 2023, from https://www.nationalmssociety.org/Living-Well-With-MS National MS Society. (n.d.-b). Pathways to wellness in MS . Retrieved March 21, 2024, from https://www.nationalmssociety.org/Resources-Support/Library-Education-Programs/ PathwaystoWellness Reece, J. C., Yu, M., Bevens, W., Simpson-Yap, S., Jelinek, G., Jelinek, P., Davenport, R., Nag, N., Gray, K., & Neate, S. (2023). Study protocol for an online lifestyle modification education course for people living with multiple sclerosis: The multiple sclerosis online course (msoc). BMC Neurology , 23 (1). https://doi.org/10.1186/s12883-023-03298-0 Schirda, B., Duraney, E., Lee, H., Manglani, H. R., Andridge, R. R., Plate, A., Nicholas, J. A., & Prakash, R. (2020). Mindfulness training for emotion dysregulation in multiple sclerosis: A pilot randomized controlled trial. Rehabilitation Psychology , 65 (3), 206–218. https://doi.org/10.1037/rep0000324 Schreiner, T.-G., & Genes, T.-M. (2021). Obesity and multiple sclerosis—a multifaceted association. Journal of Clinical Medicine , 10 (12), 2689. https://doi.org/10.3390/jcm10122689

9 Weinstein, S. M., Reilly, E., Garland, N., Zimmerman, V., & Jacobs, D. (2022). Impact of a virtual wellness program on quality of life measures for patients living with multiple sclerosis during the COVID-19 pandemic. International Journal of MS Care , 24 (6), 282– 286. https://doi.org/10.7224/1537-2073.2021-134 good job on the references

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