pico question for stroke patientspico question for stroke patients

Telerehabilitation avails the services closer to the patient without much hustle of movement. The Iowa Model of Evidence-Based Practice to Promote Quality Care. Running head: STROKE REHABILITATION 1. Your email address will not be published. The National Stroke Association estimates stroke costs the U.S. about $43 billion a year. The tool is now part of our electronic charting system, and we continue to track compliance and monitor patient outcomes. (2013) explore the extent to which technology can be used in the prevention of stroke symptoms. During a stroke, one side of the face can become numb or droop. PICOT is used by nursing students to generate answers to seemingly vague questions. You may find this article Nursing Pico/Picot Questions Writing Service useful. The PICO process is a technique used in evidence-based practice to frame and answer a clinical question in terms of the specific patient's problem that helps clinically relevant for . Topic 2 regards stroke and rehabilitation. (1) What are the most important elements of the Affordable Care Act in relation to community and public health (1) What is Clinic skill? Nursing Pico/Picot Questions Writing Service, Heart Failure and Clinic Care Plan: A Discharge Education Plan. The process can be lengthy but humane and considerate, not compounding the pain on patients bodies. The results showed high reliability with sensitivity and specificity 100%. We found a systematic review of literature that addressed three questions: The goal of this review was to seek current best evidence for dysphagia screening for acute stroke patients. This has a dampening effect on ones self-esteem and level of confidence. The students parent is going to seek an evaluation referral from their primary care physician, and the school team is going to start an evaluation. PICO Question #2. PICO allows you to develop focused relevant questions. 2. PICO Question Template Examples. 11 Patient with acute ischemic stroke Statins Placebo Recurrent stroke, all cause mortality 12 Patient undergoing neurosurgery for malignant disease Early It is a mnemonic for the important parts of a well-built clinical question. The mean NIHSS score on admittance was 6.9 among the patients on warfarin and 5.2 among those without warfarin (p = 0.10). During my evidence-based practice (EBP) class, I was able to make a change on my own unit by developing and implementing a Nursing Bedside Swallow Screen for acute stroke patients by using the Iowa Model of Evidence-Based Practice to Promote Quality Care. All patients, except those with a known history of dysphagia, should have a dysphagia screen before any oral intake. I feel very satisfied with the reply to the discussion topic. PICO is a way to help structure a research question and then take that question and translate it into search phrases. Or with some very specific motor-based prompts?). Because its informal testing, youre able to use any visuals and prompting you might need, which is also a great indicator of what type of supports the child might need in the classroom and with your intervention. Professional Custom Essay Writing Service. Lactate. The question needs to identify the key problem of the patient, what treatment to consider, alternative treatment considered (if any), what is the outcome you want to avoid or promote, and the timeframe (if any). PICO questions require a considerable time of effort and time that students mostly dont have due to stringent deadlines, emergencies, and other life commitments. Stroke. A clinical question needs to be directly relevant to the patient or problem at hand and phrased in such a way as to facilitate the search for an answer. The data generated hereupon is useful in evaluating the output of every management options adoptable under the various circumstances. A good PICO will investigate something new in terms of diagnosis, etiology, therapy, harm, etc. Answerable PICO Question: In middle-aged adult females with hypertension, are beta blockers more effective than ACE inhibiters in controlling . I have an intact gag reflex, but cannot always swallow. Running head: STROKE REHABILITATION 2. Unnecessary days in the hospital may lead to patient complications (e.g., healthcare-associated infections, falls) and increased costs. In particular, the research conducted by Rangel-Castilla et al. Reducing morbidity from aspiration pneumonia is an initiative shared by national stroke quality improvement programs such as those from the Joint Commission, Centers for Disease Control and Prevention, and the American Heart Association. Article 2: The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity, CMAJ 2008; 178:1141-1152 ANSWER KEY. We often come across the problem of not being able to identify strengths with formalized assessment, so well explore other ways to gain information. Accessed June 14, 2012. They hold advanced degrees in nursing and other related fields. The model starts with triggers that nurses must identify as knowledge-based or problem-focused. (1) What is the impact of obesity? With the language sample, you could ask the child to describe their favorite foods or movie and get baseline data in describing. We anticipated some resistance to change but surprisingly received very little. Using evidence-based practice to develop a swallow screen for stroke patients. http://www.ncbi.nlm.nih.gov/pubmed/11778337. Using PICO to Formulate Clinical Questions . You need to decide whether to prescribe her a beta-blocker or an ACE inhibiter. It was extensive, and in my opinion, excellent. 2000;81(8):1030-1033. I'm Marisha. The best way is to ensure that the rehabilitators are of different profiles, experience, and diverse knowledge to ensure that the patient has more individualized experience of the process. What is PICO. Describe the population\'s demographics and health concerns, and explain how nursing science, health determinants, and epidemiologic, genomic, and genetic data may impact population health management for the selected population. Step 4: Make your Clinical Decision. The acronym translates to: P =Patient/population I =Intervention C =Comparison O =Outcome T =Time Initially only four . It stands for: P--Patient/Problem I--Intervention C--Comparison O--Outcome. The first step in the evidence-based practice (EBP) process is to identify the clinical problem or question for which you are seeking evidence. We asked: Where did each item fit on the hierarchy of evidence? For middle-aged women is the ingestion of zinc pills more effective than Vitamin C for preventing cold during winter? Narrative Intervention for Children With Autism Spectrum Disorder (ASD). What time periods should be considered? What effect has screening swallow function on patient outcomes. Well-composed PICO (T) questions generally contain up to four components each represented in the acronym "PICO (T)" P=Patient or Population and Problem; I=Intervention or Indicator; C=Comparison or Control (not part of all . PICO (alternately known as PICOT) is a mnemonic used to describe the four elements of a good clinical question. J Neurosci Nurs. They are all native English speakers and understand your needs as a nursing student. We scheduled weekly meetings with our professor and CNS, and meetings with the NP and SLP were scheduled as needed. The research question is looking to find clinical information related to a specific patient, intervention or therapy. (O). McHale J, Phipps M, Horvath K, Schmelz J. Here is my experience, which I hope will help others who wish to implement change. These were useful to dissect each study and screen for its applicability for our use. Among school-going children is medical intervention a proper way of dealing with childhood obesity? The details, including your email address/mobile number, may be used to keep you informed about future products and services. The form included knowing the signs and symptoms of aspiration, how to use the swallow screen tool effectively, and when its appropriate to refer cases to the SLP. In kindergarteners (patient), is individual pull-out treatment (intervention) more effective than group pull-out treatment (comparison) for improving . Overwhelmingly, they said they needed a swallow screen that they could use at the bedside. The diversity of specialty of rehabilitators is helpful in ensuring that different approaches are used. Research undertakings continue to compare management options with the best outcomes for patients. Are the findings applicable in my setting? RESULTS: In total, 42 patients (8.1%) used warfarin at the time of stroke onset. Check back in with teachers and caregivers, if needed. 2. There are so many things to accomplish with an evaluation: addressing teacher and parent concerns . The teacher has concerns about social skills and language. Population. We do not resell any papers. Medical rehabilitation has been highlighted as the move to alleviate any pathological process that can lead to a persistent or just a temporal state of physical disability. PICO makes this process easier. Anne, That is a goal of mine, to have other ICUs and ER use the screen. PICOT: Some models add Time: the time it takes to demonstrate an outcome (e.g. 3) Comparison intervention (if relevant) 4) Clinical Outcomes. The statistical test used to answer your PICOT question. In low-birth-weight/pre-term neonates in health facilities (P), are plastic wraps or caps used immediately after birth (I) more effective than conventional care (C) in preventing hypothermia (O)? What are the most important elements of the Affordable Care Act in relation to community and public health. In African American female adolescents with hepatitis B (P), how does acetaminophen (I) compared to ibuprofen (C) affect liver function (O)? Could also be the result NOT desired. In this case, I would do extensive interviews with the teacher/school staff/caregivers and observations. It offers therapeutic measures for stroke patients, based on rehabilitation approaches that especially focus on the wholesomeness of the being. Amongst patients who are suffering from chronic diseases does psychological intervention help increase self-confidence? IN Emergency Department, does the Application of over-crowding indices, compared to Raw ED volumes, lead to prognostic accuracy for over-crowding-related outcomes (increased error rates, ED length of stay, staff burnout), reliability, physician/patient acceptability, external validity in 3 months? By formatting your research question in a PICO (T) format you can gather evidence relevant to your patient's problem. My classmate and I developed a poster for staff nurses that outlined the practice change and the supporting evidence. P Student in kindergarten, areas of concern: language, social skills (suspected autism). It was a two-phase study to establish inter-rater reliability and content validity. She expressed the need for a swallow screening tool for nurses to identify patients at risk for dysphagia. What Population is this question referring to? We presented the tool to our neurology physicians and explained their role in ordering the screen. Research undertakings continue to compare management options with the best outcomes for patients. A: Arm weakness. It is, therefore, only ethically right to almost immediately place the patient on a rehabilitation regimen almost immediately. When the patient is in a state of unconsciousness or unable to productively consider the matters at hand, aid must be consulted. A stroke will cause weakness in one arm or a feeling of numbness. A blog created for SLPs--by SLPs! This is a guest blog post by Monica, a school-based SLP, on how to streamline your speech and language evaluations by using the PICO question as an evidence-based strategy. There are so many things to accomplish with an evaluation: addressing teacher and parent concerns, seeing where the student is developmentally, finding patterns of strengths, finding areas of needs, planning for new goals, thinking about what EBP interventions were going to use with the student, and considering influences like other languages and cultures (at the very least!). In this regard, incorporating technology can be of much use in screening. What is the alternate intervention, if any? In _______ (P), how does ________ (I) compared to ________ (C) influence _________ (O) over _________ (T)? In kindergarteners(patient), is individual pull-out treatment (intervention) more effective than group pull-out treatment (comparison) for improving articulation disorders (outcome)? Expand your horizons - "The Forest.". I am glad you had support to follow through on this project. Int J Lang Commun Disord. What is the national incidence of dysphagia among stroke patients? Click "Next" below to start your research. The Leaders Project has a great explanation of the test-teach-retest model of dynamic assessment here. PICO is a tool that can help you deal with clinical scenarios where you don't know the answer to a patient's question, or know the answer but need evidence to support you. The T usually stands for time and can be helpful in making sure you're thinking of the appropriate time frame for your intervention and/or outcomes. Labor & Delivery . (n.d.). I created the SLP Now Membership and love sharing tips and tricks to help you save time so you can focus on what matters most--your students AND yourself. It provides empirical information on the outcome for approaches that patients underwent and the effect they had on them. Wood P, Emic-Herring B. Dysphagia: a screening tool for stroke patients. 3. It would not include any food or thickened liquids. P - Patient / problem : Identify the problem of the patient / Ask how could you describe a group of patients similar to your patient's case. The natural history of dysphagia following a stroke. Step 3: Assess the Evidence. 1998;30(2):137-141. If you ask a person who is having a stroke to raise both of their arms, one will drift downward. I Formal and informal testing in all areas of concern. We've all faced the same problem of wanting to get a lot done with our evaluations, but not having enough hours in the day. http://www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelinesHFStroke/Get-With-The-Guidelines-Stroke-Home-Page_UCM_306098_SubHomePage.jsp. See below for definitions, PICO templates, and example questions from the primary clinical domains: intervention, diagnosis, etiology, prevention, prognosis/prediction, quality of life/meaning, and therapy. I am a school-based SLP who is all about working smarter, not harder. For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)? Develop PICO questions. For the autistic population, I know that Ill need a good picture of how they are functioning in real life, not just what a standardized test can give me, and that Ill need to do extensive interviewing with the teacher and caregivers. Amongst patients awaiting cardiac operation do the roles of a pre-surgery cardiac nurse prevent depression? Does telelmonitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O) within the six months of initiation of the medication (T)? Clinical predictors of dysphagia and aspiration risk: outcome measures in acute stroke patients. One type of intervention I will most likely want to use is to work on them having a foundation of perspective-taking skills to improve their comprehension and ability to interact with peers in a way that is comfortable for them. BUT, I will often think about what type of intervention I know to be evidence-based practice for that population and what information I will need to drive goals. For adults over the age of 50 years, is fentanyl more effective than morphine in dealing with the pain? Starting with identifying what strengths to build on, and what interventions might be appropriate, has really streamlined my assessments. (2014). The stroke patient needs socialization and activation of cognitive abilities, as a method of rehabilitation. PICO Question; Search this Guide Search. PICO (T) stands for Population, Intervention, Comparison (comparison can be with placebo or with no treatment), Outcome and Time frame (which is optional). Among other things, the focus of the rehabilitation approaches, include the motor activity of patients, helping them to adapt to the new neurological deficiencies, correction of functional disorders, increased tolerance to physical loads, improving the quality of life, increasing social activity, as well as slowing down the pathological process. The average cost per patient for the first 90 days after a stroke is $15,000 although 10 percent of those cases exceed $35,000. What are the patient-relevant consequences of the intervention? PICO is a popular mnemonic in nursing. Population: Adult ED patients with suspected sepsis Intervention: Sepsis bundled care Comparison: Routine clinical care Outcome: Short-term mortality, ICU admission rates, ED & ICU length-of-stay Search Strategy #3:You conduct a PUBMED Clinical Query using a narrow search strategy for therapy combining the search terms "shock" yielding 2278 original research publications. O = improved balance "In recent stroke patients, how does using virtual reality affect or improve balance?" Example 3. Further, to depict the wide research areas to be exploited in the management of stroke incidents, the researcher in the cited work concludes that management of Tandem Occlusion cases requires more pragmatic improvements to tie loose ends. The PICOT process begins with a case scenario, and the question is phrased to elicit an answer. What is the difference between pathophysiology and pathology? The framework is actually divided into four major elements. 1997;29(5):325-329. PICO (alternately known as PICOT) is a mnemonic used to describe the four elements of a good clinical question. Our commitment to customer satisfaction has consistently made us the best site to buy a research paper. A question root (who, what, when, etc.) PICO stands for patient/population, intervention, comparison and outcomes. Treatment, cause, prognostic factor, etc. Do type 2 diabetics (P) get better glycemic control (O) with exercise as the primary treatment (I) than those who get drug therapy as a primary treatment (C)? Furthermore, the input of Rice et al. Example Nursing Picot Questions. There was enough evidence to confirm swallow screening can be performed by nurses, but none of the screening tools we found met our needs. An answerable question has a format that follows the PICO concept. (1) What are the importance of clinical skills? I think especially when we have a lot of evaluations going on at the same time, posing each evaluation as a PICO question could help to hone in on what you want to get out of the evaluation. Does the use of pain relief medication throughout the process of the surgery reduce the pain more effectively when compared to the intake of the same medicine given post-surgery? Questions addressing the causes or origin of disease, the factors that produce or predispose toward a certain disease or disorder. In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)? In patients with type 2 diabetes and obesity (P), is bariatric surgery (I) more effective than standard medical therapy (C) at increasing the probability of remission of diabetes (O)? This is also a great time to test out some speech sound interventions and different levels of prompting. Your email address will not be published. We often come across the problem of not being able to identify strengths with formalized assessment, so well explore other ways to gain information. We began our literature search with two objectives in mindinvestigate if there is evidence that a dysphagia screening tool is effective, and search for current dysphagia tools that other institutions have implemented. Her rheumatologist suggested she start on Plaquenil for her joint pain, but she is interested in alternative therapies because she heard about success a neighbor had with turmeric tea. Further, the condition can also be caused by bursting or leakage of a blood vessel (causing a hemorrhagic stroke) or by blockage of vessels or arteries (causing an ischemic stroke). I did not submit it yet but I can see that it is well-written, structured, and formatted. Is a PKU test (I) done on two week old infants (P) more accurate in diagnosis inborn errors in metabolism (O) compared with PKU tests done at 24 hours of age (C)? Smithard DG, ONeill PA, England RE, et al. O.2. What triggers affected our need for a nursing bedside swallow screen? (2017) demonstrate these fundamentals by explaining that the role of family and close associates of a patient is critical in this socialization endeavor. Here is an article that helps to explain a bit more about PICOT: Marik P, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Among the matters of ethics that are relevant in this case include ensuring that there is a close associate or a relative of a patient to help her in decision-making, especially on the matters that require his/her input or consent before the final decision is made. We searched for research and theoretical articles that included systematic reviews, articles on dysphagia and pneumonia, and swallow assessment tools. 3. I use my favorite materials during this portion of the informal assessment, and can get a lot of information that I might have missed with just a standardized assessment. EBP Process Step 1: Frame Your Clinical Question. Top Geriatr Rehabil. I: Intervention. The patient complains of abdominal pain and nausea. In OR nurses doing a five minute scrub (P) what are the differences in the presence and types of microbes (O) found on natural polished nails and nail beds (I) and artificial nails (C) at the time of surgery (T)? Evidence: We also offer free revisions once you hire someone to write a research paper from us. What clinical domain does your question fall under. The Iowa Model of Evidence-Based Practice to Promote Quality Care. Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)? We are a cheap essay writing service online. Intervention: Describe what it is youre trying to do or what has happened to the patient.

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