The Institute of Medicine has stated a goal that 90% of practice be evidence-based by 2020. According to HealthyPeople.gov, the United States is currently at approximately 15%. Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which identified barriers may be addressed.
An Oral Glucose Tolerance Test (OGTT) should be performed in obese children with a family history of T2DM as per guidelines mentioned in above section and in grossly obese children. Although obesity is associated with insulin resistance, diagnosis of insulin resistance by measuring plasma insulin concentration is no longer recommended, since the insulin assay is unreliable. ALT level greater than 25 and 22 in males and females respectively warrants ultrasonography of the liver followed by biopsy in those with a suspicion of cirrhosis. TABLE 8 HISTORY Mental retardation Genetic etiology Short stature/ decreased height velocity Endocrine etiology Medication history, eg. antipsychotics Medication etiology Snoring, morning headaches Obstructive sleep apnea Knee or hip pain Orthopedic morbidity Polyuria, polydipsia Type 2 Diabetes Hirsutism, irregular menses PCOS PHYSICAL EXAMINATION Dysmorphism Genetic syndromes Acanthosis nigricans Insulin resistance BP ≥95th percentile Hypertension Hepatomegaly Hepatic steatosis Tanner staging Early puberty Papilledema Pseudotumor cerebri Hirsutism PCOS MANAGEMENT Comprehensive interventions combining diet, physical activity, education, and behavioral therapy are associated with improvement in terms of weight reduction and metabolic outcomes. The Expert Committee on Obesity Evaluation and Treatment recommends that the primary goal should be developing healthy eating and activity habits, not achieving ideal body weight. The environment that shapes behavior of the child should be modified and family influence is the most important factor in childhood obesity treatment. For weight loss, obese children must expend more energy than they consume, by decreasing caloric intake and increasing physical activity. Studies show interventions involving exercise alone did not cause weight loss but when exercise was combined with diet and education, reduction in body weight was noted. Consumption of fast food in children has increased over the past few years because of the easy availability and media marketing. Fast foods (eg. Pizza, burger, fries, somosa, pakora, potato chips, soft drinks, etc) have high level of fat and sugars that are unhealthy but addictive, making it hard for children to choose healthy food. Nutrition labeling might restrict the quantity and choice of food am>GET ANSWER