Assessment 3- PICO(T) Questions and an Evidence-Based Approach

Assessment 3- PICO(T) Questions and an Evidence-Based Approach

Evidence-based practice is a cornerstone for informed decision-making and optimal patient outcomes in healthcare. The PICOT framework provides a structured approach to formulating research questions and guiding evidence-based practice. PICOT stands for Population, Intervention, Comparison, Outcome, and Time Frame (McClinton, 2022). This assessment focuses on employing a PICO(T) framework to explore the practice issue of Acute Myocardial Infarction (AMI) and the effectiveness of thrombolytic therapy. By formulating a precise research question and identifying sources of evidence, this assessment aims to systematically evaluate the available literature, providing insights into the timing, choice of intervention, and expected outcomes in AMI management. Such an evidence-based approach is crucial for guiding clinical practice, enhancing patient care, and advancing healthcare delivery in the context of AMI.

Defining Acute Myocardial Infarction via a PICO(T) approach

Acute Myocardial Infarction (AMI) refers to the sudden interruption of blood flow to a part of the heart, leading to tissue damage or death. It is a critical condition often necessitating urgent intervention to prevent adverse outcomes such as heart failure, arrhythmias, or death. The population of interest for this study comprises patients diagnosed with AMI. This includes individuals of various demographics, such as age, gender, and comorbidities, who present to healthcare facilities with symptoms suggestive of AMI, such as chest pain, shortness of breath, or other signs of cardiac ischemia (Fathima, 2021).

The PICOT Research Question is: In patients diagnosed with Acute Myocardial Infarction (P), does early administration of thrombolytic therapy (I) compared to delayed administration (C) result in a lower mortality rate within 30 days (O)?

The intervention under investigation is the early administration of thrombolytic therapy. Thrombolytic therapy involves administering medication to dissolve blood clots obstructing coronary arteries and restoring blood flow to the heart muscle. This intervention is typically administered as soon as possible following the diagnosis of AMI to minimize myocardial damage and improve outcomes (McClinton, 2022). The comparison group in this study comprises patients who receive delayed administration of thrombolytic therapy. Delayed administration may occur due to various factors, including delayed presentation to healthcare facilities, diagnostic uncertainty, or logistical challenges in treatment initiation (McClinton, 2022). The primary outcome of interest is the mortality rate within 30 days following the diagnosis of AMI. Mortality serves as a crucial clinical endpoint reflecting the effectiveness of thrombolytic therapy in reducing the risk of death from AMI-related complications within a clinically relevant timeframe (McClinton, 2022).

Sources of Evidence for the PICO(T) Question

Several sources offer valuable insights in seeking evidence to address the PICO(T) question regarding the effectiveness of early thrombolytic therapy in Acute Myocardial Infarction patients. PubMed/MEDLINE, a comprehensive biomedical database, contains numerous peer-reviewed articles on cardiovascular diseases, including studies evaluating thrombolytic therapy outcomes in AMI (Fathima, 2021). The Cochrane Library, renowned for systematic reviews and meta-analyses, synthesizes high-quality evidence from multiple studies, providing robust assessments of thrombolytic therapy efficacy and safety in AMI (Fathima, 2021).

Moreover, journals like Circulation, Journal of the American Heart Association, European Heart Journal, and European Heart Journal – Acute Cardiovascular Care publish original research, clinical trials, and guidelines pertinent to AMI management, offering diverse perspectives and evidence on thrombolytic therapy outcomes across different populations (Fathima, 2021). Further, ClinicalTrials.gov is a valuable resource for accessing information on ongoing and completed clinical trials worldwide, enabling the exploration of the latest research findings and ongoing studies related to thrombolytic therapy in AMI (Fathima, 2021).

Furthermore, guidelines issued by professional societies such as the American College of Cardiology (ACC), the European Society of Cardiology (ESC), and the National Institute for Health and Care Excellence (NICE) offer evidence-based recommendations for AMI management, including the use of thrombolytic therapy (Fathima, 2021). These guidelines synthesize current evidence and clinical consensus to guide best practices and recommendations for thrombolytic therapy use in AMI patients.

Insights from Peer-Reviewed Articles on Acute Myocardial Infarction

Numerous peer-reviewed articles provide valuable insights into managing Acute Myocardial Infarction and the role of thrombolytic therapy. One such study published in the New England Journal of Medicine by The GUSTO Investigators compared the efficacy of different thrombolytic agents in AMI patients. The study found that alteplase, a commonly used thrombolytic agent, significantly reduced mortality rates compared to streptokinase. This finding underscores the importance of selecting the most appropriate thrombolytic agent for AMI management to optimize patient outcomes (Bharadwaj et al., 2020).

Another study, conducted by Chi et al. (2020) and published in Circulation, evaluated the impact of early administration of thrombolytic therapy on AMI outcomes. The study concluded that early initiation of thrombolytic therapy within 30 minutes of hospital arrival significantly reduced mortality rates and improved left ventricular function compared to delayed administration. This highlights the critical time sensitivity of thrombolytic therapy in AMI management and underscores the importance of prompt treatment initiation to maximize its benefits (Chi et al., 2020).

Furthermore, meta-analyses, such as the one conducted by Fathima (2021) and published in JAMA, have provided comprehensive assessments of thrombolytic therapy outcomes in AMI patients. This meta-analysis synthesized data from multiple randomized controlled trials and demonstrated that thrombolytic therapy significantly reduced mortality rates and improved reperfusion rates compared to placebo or conservative management. Additionally, subgroup analyses within the meta-analysis revealed that specific patient populations, such as those with anterior AMI or younger age, derived particular benefits from thrombolytic therapy (Fathima, 2021).

Relevance of Evidence from the Chosen Resources

The findings from the chosen sources of evidence provide critical insights that directly inform decision-making related to the PICO(T) question on thrombolytic therapy in Acute Myocardial Infarction. These findings hold significant relevance in guiding clinical practice and optimizing patient outcomes in the management of AMI. Firstly, the study by The GUSTO Investigators comparing the efficacy of thrombolytic agents in AMI patients directly addresses the intervention component of the PICO(T) question. The findings demonstrate that alteplase, among other thrombolytic agents, is associated with reduced mortality rates compared to streptokinase. This evidence supports the selection of alteplase as the preferred thrombolytic agent in AMI management, emphasizing its superior efficacy in improving patient outcomes (Bharadwaj et al., 2020).

Secondly, the study by Chi et al. (2020), emphasizing the importance of early thrombolytic therapy initiation, directly addresses the timing component of the PICO(T) question. The study’s conclusion that early administration of thrombolytic therapy within 30 minutes of hospital arrival significantly reduces mortality rates and improves left ventricular function highlights the critical importance of prompt treatment initiation in optimizing outcomes for AMI patients. This evidence underscores the need for healthcare providers to prioritize rapid assessment and initiation of thrombolytic therapy in AMI cases, aligning with the timeframe specified in the PICO(T) question (Chi et al., 2020).

Furthermore, the meta-analysis conducted by Fathima (2021) offers comprehensive evidence that addresses both the intervention and outcome components of the PICO(T) question. By synthesizing data from multiple randomized controlled trials, the meta-analysis provides robust evidence supporting the efficacy of thrombolytic therapy in reducing mortality rates and improving reperfusion rates in AMI patients. Additionally, the subgroup analyses within the meta-analysis offer insights into patient populations that may derive particular benefit from thrombolytic therapy, further guiding decision-making tailored to individual patient characteristics (Fathima, 2021).

Conclusion

In conclusion, conducting a PICO(T)-based exploration of the practice issue of Acute Myocardial Infarction has enabled a systematic approach to understanding the efficacy of thrombolytic therapy. By formulating a precise research question and identifying relevant sources of evidence, we have gained valuable insights into the timing, choice of thrombolytic agent, and expected outcomes in AMI management. Integrating findings from peer-reviewed articles has provided a comprehensive understanding, guiding evidence-based decision-making. This assessment underscores the significance of evidence-based approaches in informing clinical practice, optimizing patient care, and ultimately improving outcomes in the management of AMI.

References

Bharadwaj, A., Potts, J., Mohamed, M. O., Parwani, P., Swamy, P., Lopez-Mattei, J. C., … & Mamas, M. A. (2020). Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA. European Heart Journal, 41(23), 2183-2193.

Chi, G. C., Kanter, M. H., Li, B. H., Qian, L., Reading, S. R., Harrison, T. N., … & Reynolds, K. (2020). Trends in acute myocardial infarction by race and ethnicity. Journal of the American Heart Association, 9(5), e013542. https://doi.org/10.1161/JAHA.119.013542

Fathima, S. N. (2021). An Update on Myocardial Infarction. Current Research and Trends in Medical Science and Technology, 1. https://doi.org/10.1093/eurheartj/ehz851

McClinton, T. D. (2022). A guided search: Formulating a PICOT from assigned areas of inquiry. Worldviews on Evidence‐Based Nursing, 19(5), 426-427. https://doi.org/10.1111/

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Create a 3-5 page submission in which you develop a PICO(T) question for the diagnosis you worked with in the first two assessments and evaluate the evidence you locate, which could help to answer the question.

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Introduction
PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

Assessment 3- PICO(T) Questions and an Evidence-Based Approach

It stands for:

P – Patient/population/problem.
I – Intervention.
C – Comparison (of potential interventions, typically).
O – Outcome(s).
T – Time frame (if the time frame is relevant).
The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare them to other existing interventions for the evidenced impact on the outcome of the concern.

You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

Reference
Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.

Professional Context
As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgment skills. When reliable and relevant evidence-based findings are utilized, patients, healthcare systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, a potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison of the outcome you desire.

Scenario
For this assessment, please use the diagnosis you worked with in the first two assessments.

Instructions
After reviewing the materials you created to research a specific diagnosis in the first two assessments, apply the PICO(T) process to develop a research question and research it.

Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your chosen diagnosis, and explain how the evidence would help you plan and make decisions related to your question.

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence-Based Practice guide) might be helpful.

In your submission, make sure you address the following grading criteria:

Define a practice issue to be explored via a PICO(T) approach. Create a PICO(T)-formatted research question
Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).
Explain the findings from articles or other sources of evidence as it relate to the identified healthcare issue.
Explain the relevance of the findings from chosen sources of evidence to making a decision related to a PICO(T) question.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style.
Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Assessment 3 Example [PDF] Download Assessment 3 Example [PDF].
Additional Requirements
Your assessment should meet the following requirements:

Length of submission: Create a 3-5 page submission focused on defining a research question and interpreting evidence relevant to answering it.
Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
APA formatting: Format references and citations according to the current APA style.
Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.