Mastering PICO: Crafting Clinical Questions Effectively
School
Egerton University**We aren't endorsed by this school
Course
PHYSICS PHYC 226
Subject
Nursing
Date
Dec 11, 2024
Pages
5
Uploaded by DeaconSummerHerring47
Developing Clinical and Research QuestionsApplying PICO to ScenariosTask:Choose 2 scenariosfrom the scenario list below the chartsUse PICO to break them down and then develop a clinical questionDetermine and select the most appropriate study type(s) for your scenarioScenario I Lucille Murphy and the Mediterranean dietQuestion ComponentsBuilding Your QuestionP- Patient or PopulationA 47-year-old overweight woman with a family history of diabetesWith a family history of diabetesI- Intervention; Prognostic Factor; ExposureMediterranean dietDietC- Comparison (if appropriate)No specific diet or standard dietary adviceNonO- OutcomeDecreasing the risk of metabolic syndromeMetabolic syndrome reducingThe well-built clinical question:In a 47-year-old overweight woman with a family history of diabetes, does following a Mediterranean diet decrease the risk of developing metabolic syndrome compared to not following a specific diet?Ideal Type of Study: Cohort Study or Randomized Controlled Trial (RCT)PICO activity adapted from Supporting Clinical Care: An Institute in Evidence-Based Practice for Medical LibrariansDartmouth College1 of 5
Developing Clinical and Research QuestionsScenario II Robert Murphy and PSA TestingQuestion ComponentsBuilding Your QuestionP- Patient or PopulationA 48-year-old African American male with no history of prostate cancer.African American, no historyI- Intervention; Prognostic Factor; ExposureUndergoing PSA (Prostate-Specific Antigen) testing.Under PSA testingC- Comparison (if appropriate)Not undergoing PSA testing or following current standard screening recommendations.O- OutcomeEarly detection of prostate cancer and reduction in prostate cancer-specific mortality.The well-built clinical question: In a 48-year-old African American male with no history of prostate cancer, is PSA testing effective in early detection and reducing prostate cancer-specific mortality compared to not undergoing PSA testing?Ideal Type of Study: Cohort Study or Randomized Controlled Trial (RCT).PICO activity adapted from Supporting Clinical Care: An Institute in Evidence-Based Practice for Medical LibrariansDartmouth College2 of 5
Developing Clinical and Research QuestionsIdeal Study Types Based on Type of QuestionScenarios to select from1.Jimmy is a five year old with a large wart on his hand. His previous warts have been “burned off” using cryotherapy, a treatment he found painful. His mother read on the internet about using duct tape to remove warts and wants to know if it will work.2.A 2-year-old child was roughhousing with his brother at home, fell, and cut his head on the coffee table. His mother brought him into the ER, where a resident examines him. He has a 2-cm horizontal laceration on his forehead. It's deep, but not bleeding. His mother is concerned about the discomfort associated with closing the laceration, healing time, and also cosmetic outcome. The resident wonders if Dermabond skin adhesive might be better than stitches in this situation.3.A physician in a busy primary care clinic is seeing the last patient for the day,a 70-year-old male patient who is complaining of cough and mild shortness ofbreath. After a complete physical examination, he suspects pneumonia. He is unable to get chest x-rays at his clinic and wonders about the accuracy of clinical assessment vs. a chest x-ray in diagnosing pneumonia.4.Lucille Murphy, a 47-year-old mother of three, is concerned that she is at risk for metabolic syndrome. She’s overweight, doesn’t exercise, and has a history of diabetes in her immediate family. She’s been hearing about the Mediterranean diet and wonders if this might be something that you would recommend to help her decrease her risk for metabolic syndrome.5.Robert Murphy, a 48-year-old African American with no history of prostate cancer, has recently heard a lot about the PSA test. He asks you what the current medical thinking on PSA testing is and wonders if it is worth having done.6.A nurse in the PACU is interested in ways to decrease the use of pain medication in post-op patients. She’s wondering if classical music might be efficacious.PICO activity adapted from Supporting Clinical Care: An Institute in Evidence-Based Practice for Medical LibrariansDartmouth College3 of 5
Developing Clinical and Research Questions7.Venous ulcers often occur in older patients. Wound specialists often recommend compression stockings or wraps with some form of dressing. You heard recently that a honey dressing might be beneficial. You wonder if there’s evidence to support the use of this alternative therapy.8.A hearing test is an important component of the physical exam of elderly patients. Dr. Smith knows that some clinicians simply ask patients about theirhearing ability and others use a tuning fork to test it, but he thinks that a simple whispered voice test is very accurate. Challenged to back this up with evidence at morning report tomorrow, he has come to you to help do a literature search.9.In browsing one of the medical weeklies, Dr. Chen read about the use of imiquimod cream for treatment of basal cell carcinomas (BCC). The idea of a cream for BCCs surprised her; she emailed you inquiring about the long-term effectiveness of imiquimod cream.10.You are on a hospital committee exploring best practices in inpatient oncology nursing. The first question to come before the committee is, “how can we improve patients’ sleep quality and quantity without resorting to sleep medication?” The committee decides to explore relaxation techniques (e.g., massage; music), noise reduction, bed/pillow comfort, and ambient temperature changes. Your assignment is to find the best practices to reduce noise levels on the unit.11.A nurse in the ICU asks about the care of patients with head injuries. She’s wondering if elevating the head of the bed 30 degrees will reduce intracranialpressure.12.A 17-year-old African American woman, just diagnosed with hepatitis B, has been taking acetaminophen for headaches. Her mother has heard that acetaminophen can cause liver problems, and she asks you if her daughter should continue taking the drug for her headaches, considering her hep-b diagnosis.13.Julie is pregnant for the second time. She had her first baby when she was 33and had amniocentesis to find out if the baby had Down syndrome. The test was negative but it was not a good experience, as she did not get the result until she was 18 weeks pregnant. She is now 35, one month pregnant, and asks if she can have a test that would give her an earlier result. The local hospital offers nuchal translucency screening as a first trimester test for Down syndrome. Is this test as accurate as amniocentesis?14.John is 3 years old, has an ear infection, and hates taking medicine. He’s already taken the antibiotic for 6 days and is feeling better. His parents want to know if they can stop. Is the short course (< 7 days) as effective as the long course (14 days) in treating otitis media in children?15.An administrator from a local nursing home is considering banning the use of atypical antipsychotics as she has heard that they are associated with a PICO activity adapted from Supporting Clinical Care: An Institute in Evidence-Based Practice for Medical LibrariansDartmouth College4 of 5
Developing Clinical and Research Questionssignificant rate of cerebrovascular accidents and may be no more effective than behavioral interventions. Is this true?16.A 53-year-old woman with rheumatoid arthritis wants to possibly change her medication to short-term low-dose corticosteroids instead of NSAIDS, which are upsetting her stomach. Will the corticosteroids be as effective?PICO activity adapted from Supporting Clinical Care: An Institute in Evidence-Based Practice for Medical LibrariansDartmouth College5 of 5