Assessment 3: PICO (T) Questions and Evidence-Based Approach
Name
Capella University
Hypo NURS-FPX4030
Professor Name
February, 2024
PICO (T) Questions and Evidence-Based Approach
Incorporating evidence-based practice (EBP) is essential for enhancing clinical reasoning and judgment skills, especially for baccalaureate-prepared nurses. The PICOT framework is an essential tool that guides the formulation of clear, specific research questions. Using this approach, nurses can design studies, search for relevant literature, and evaluate the effectiveness of interventions or treatments. The PICOT framework emphasizes the improvement of healthcare outcomes and quality. Therefore, integrating EBP competencies into nursing curricula, particularly formulating PICOT questions, is crucial for developing these skills. Utilizing a PICOT template can help write healthcare-specific PICOTs, guide nurses in their search for quality evidence, and address community healthcare needs through evidence-based quality improvement. The PICOT process can be applied to develop a research question fundamental to evidence-based healthcare research. It ensures that the practice is informed by the most current and relevant findings, ultimately benefiting patients, healthcare systems, and nursing practice outcomes (Costanzo et al., 2023).
Use of the PICO (T) Approach for Analyzing Possible Treatment of Cholecystitis Disease
Defining a practice issue through a PICO(T) approach is a structured and systematic method of exploring and analyzing potential treatments for diseases such as cholecystitis. The PICO(T) framework helps to form a specific research question, which guides the study design and literature search for effective interventions or treatments. For instance, when considering the treatment of cholecystitis, a PICO(T)-formatted question may focus on the patient population with cholecystitis, a specific intervention or treatment that is being considered, a comparison to another treatment or no treatment, and the expected outcomes. The time frame is also critical, particularly when considering the progression and response to treating an acute condition such as cholecystitis.
Applying the PICO(T) approach to explore treatment options for cholecystitis helps frame a researchable question and ensures that the investigation is focused and relevant. PICO(T) facilitates a more targeted and effective exploration of clinical issues by breaking down the research question into specific components, leading to better-informed healthcare practices (Frandsen et al., 2020).
A possible PICOT question related to the treatment of cholecystitis could be structured as follows: “In adult patients with acute cholecystitis (P), how does early laparoscopic cholecystectomy (I) compare to delayed laparoscopic cholecystectomy (C) in reducing postoperative complications and hospital stay length (O) within the first 30 days post-surgery (T)?”. The question aims to clarify whether early intervention is more beneficial than a delayed approach in treating acute cholecystitis.
Benefit from a PICO (T) Approach
Using the PICOT approach, researchers can develop a well-structured research question to identify relevant studies, gather evidence, and conclude the impact. Studies suggest that early laparoscopic cholecystectomy (ELC) may result in shorter hospital stays and fewer postoperative complications in comparison to delayed laparoscopic cholecystectomy (DLC) for adult patients with acute cholecystitis. The PICO(T) approach can be used to structure research questions that compare ELC and DLC for treating cholecystitis (Kivivuori et al., 2023).
Using this framework, nurses can focus on specific aspects of patient care, promoting evidence-based practice. By clearly defining the intervention and the comparison, the PICO(T) approach allows for a direct comparison between two different methods of treating cholecystitis. The PICO(T) approach helps improve patient outcomes by identifying the most effective treatment method through rigorous research. Findings from studies that use this approach can inform and update clinical guidelines, ensuring that healthcare professionals follow the latest and most reliable evidence. It aids in efficient literature searches and clear comparisons between different treatments and ultimately contributes to improved patient outcomes and clinical guidelines (Shunmuga Sundaram et al., 2022).
Sources of Evidence
To effectively answer a PICO(T) question, nurses should use high-quality evidence that addresses the question. Moreover, PubMed and Medline journal articles are some sources that could effectively define evidence-based PICOT questions. Systematic Reviews and meta-analysis studies synthesize findings from multiple RCTs and provide a comprehensive overview of the existing evidence. They are particularly useful for summarizing data and determining the overall effectiveness of an intervention. Clinical guidelines provide evidence-based recommendations for current clinical practice. Cohort studies with large sample sizes and low bias can provide valuable insights. Relevance to the PICO(T) question is important when choosing sources (Dusin et al., 2023). Randomized controlled trials (RCTs) and systematic reviews are considered more reliable due to their strict methodological criteria. In this case, a meta-analysis and randomized trials have been examined to compare early and delayed laparoscopic cholecystectomy for acute cholecystitis. The findings indicate that patients who undergo early laparoscopic cholecystectomy may experience shorter hospital stays and lower morbidity.
Criteria or Rationale
The CRAAP test is a tool for assessing source reliability and validity in medical research. Applying the test to selected sources on early vs. delayed laparoscopic cholecystectomy shows that currency, relevance, accuracy, and authoritative background are critical. All selected sources are current and relevant to the research question, with accurate data and credible authors. The CRAAP test ensures reliable conclusions in medical studies that impact patient care and treatment protocols. Each source compares early and delayed laparoscopic cholecystectomy, examining postoperative complications and hospital stays within 30 days. This alignment with the research question enhances the pertinence of the findings and discussions presented in the sources. This rigorous evaluation is essential in medical studies where outcomes can directly impact patient care and treatment protocols (Giles et al., 2020).
Findings from Articles
Studies have found significant findings in assessing whether performing early laparoscopic cholecystectomy (ELC) yields better outcomes compared to delaying the procedure (DLC) for adult patients with acute cholecystitis in reducing postoperative complications and hospital stay length. This suggests that ELC might be more beneficial in terms of reducing the length of hospital stays, which is a crucial factor in patient recovery and healthcare resource management (Janjic et al., 2020).
In 2023, Wu et al. conducted a study to compare the effectiveness of early and delayed laparoscopic cholecystectomy for acute cholecystitis. The study revealed that early surgery is as safe as delayed surgery, with no rise in patient risks or intraoperative complications. The duration of hospitalization was critical in evaluating the efficacy of early versus delayed surgery. Patients undergoing early laparoscopic cholecystectomy experienced shorter hospital stays than those undergoing delayed intervention. This finding underscores the potential benefits of timely surgical management in reducing the length of hospitalization, which is beneficial for patients’ physical recovery and healthcare resource utilization and cost-effectiveness. By minimizing the duration of hospitalization, early laparoscopic cholecystectomy may contribute to alleviating the burden on healthcare facilities and improving patient flow within the healthcare system.
Consistent with the meta-analysis results, early laparoscopic cholecystectomy was associated with shorter hospital stays than delayed intervention. Moreover, the study highlighted a lower rate of complications and readmissions among patients undergoing early laparoscopic cholecystectomy, suggesting potential advantages regarding postoperative outcomes and healthcare resource utilization. A study recommends immediate laparoscopic cholecystectomy for acute cholecystitis. Earlier intervention leads to better patient outcomes and cost-effective care.
The evidence synthesized from both Wu et al. (2023) and Janjic et al. (2020) suggest that early laparoscopic cholecystectomy for acute cholecystitis may offer several benefits, including comparable safety profiles, shorter hospitalization durations, and potentially lower rates of complications and readmissions. These findings collectively suggest that early laparoscopic cholecystectomy may be more beneficial for patients with acute cholecystitis, mainly due to the potential for reduced hospital stays and lower morbidity. However, it’s important to note that the decision to opt for early vs. delayed cholecystectomy should be made considering the individual patient’s condition and the healthcare provider’s judgment. These studies provide valuable evidence that can guide clinical decision-making and may influence future guidelines in the management of acute cholecystitis (Gallaher et al., 2022).
Most Credible Source
The most credible systematic review and meta-analysis source is the reputable, peer-reviewed medical journal “Frontiers in Medicine.” Being published in such a journal indicates that the study underwent a rigorous peer-review process, ensuring the validity and reliability of the findings. It includes multiple authors who are likely experts in gastrointestinal surgery or related specialties, contributing to the trustworthiness of their findings.
Relevance of these Findings
The PICO(T) framework is useful for investigating the optimal timing of laparoscopic cholecystectomy for adult patients with acute cholecystitis. To answer this question, it is important to rely on credible sources of evidence, such as peer-reviewed medical journals and databases like PubMed. Two significant studies that provide relevant evidence for this question are as follows: One study found that the group that received early laparoscopic cholecystectomy had significantly lower morbidity rates and shorter hospital stays. This suggests that performing the surgery within the first day of being admitted to the hospital is superior in terms of reducing complications and costs.
Evidence suggests that early laparoscopic cholecystectomy is better than delayed laparoscopic cholecystectomy for acute cholecystitis. Early laparoscopic cholecystectomy is associated with shorter hospital stays and comparable safety profiles to delayed laparoscopic cholecystectomy. This information helps determine the optimal time for laparoscopic cholecystectomy in cases of acute cholecystitis. Early laparoscopic cholecystectomy can reduce postoperative complications and hospital stay lengths within the first 30 days post-surgery. Patients should receive early intervention for better outcomes and efficient use of healthcare resources (Kloda et al., 2020).
The presented evidence directly addresses the outcomes outlined in the provided PICOT question. It helps determine the best time for laparoscopic cholecystectomy in cases of acute cholecystitis. These studies demonstrate that an early laparoscopic cholecystectomy can reduce postoperative complications and hospital stay lengths within the first 30 days after the surgery. This supports evidence-based practice in managing acute cholecystitis. They are performing laparoscopic cholecystectomy early on after diagnosis, which is more effective in reducing post-surgery complications and shortening hospitalization time within the first 30 days after surgery, compared to delaying the surgery. This information is crucial for healthcare providers when making treatment decisions for acute cholecystitis patients. It indicates that early intervention can lead to better outcomes and more efficient use of healthcare resources for operable patients (Kloda et al., 2020).
Relevant Findings Lead to Positive Outcomes
After analyzing evidence comparing ELC and DLC for acute cholecystitis; positive results can assist in clinical decision-making and enhance patient care. The study related to systematic review and meta-analysis revealed that early laparoscopic cholecystectomy is as safe as delayed laparoscopic cholecystectomy. This finding assures clinicians considering early intervention that starting surgery promptly does not increase the risk of adverse events. This outcome is especially beneficial for patients, as shorter hospital stays lead to reduced healthcare costs, a decreased likelihood of hospital-acquired infections, and quicker recovery and return to normal activities. Single-center experience study also supports the positive outcomes linked to early laparoscopic cholecystectomy. Their findings indicate shorter hospital stays and a lower rate of complications and readmissions among patients who undergo early intervention.
Hypo NURS FPX 4030 Assessment 3 PICO (T) Questions and Evidence-Based Approach Conclusion :
As a baccalaureate-prepared nurse, finding credible and scholarly resources is crucial to incorporating evidence-based findings that improve clinical reasoning and judgment skills. The PICO(T) framework is a useful tool to identify relevant evidence and research studies for effective clinical decision-making. Engaging with scholarly evidence and applying evidence-based practice models is foundational to nursing practice and contributes to advancing nursing knowledge and practice (Wu et al., 2023).
Hypo NURS FPX 4030 Assessment 3 PICO (T) Questions and Evidence-Based Approach References :
Costanzo, M. L., D’Andrea, V., Lauro, A., & Bellini, M. I. (2023). Acute cholecystitis from biliary lithiasis: Diagnosis, management and treatment. Antibiotics, 12(3), 482. https://doi.org/10.3390/antibiotics12030482
Dusin, J., Melanson, A., & Mische-Lawson, L. (2023). Evidence-based practice models and frameworks in the healthcare setting: a scoping review. BMJ Open, 13(5), e071188. https://doi.org/10.1136/bmjopen-2022-071188
Frandsen, T. F., Bruun Nielsen, M. F., Lindhardt, C. L., & Eriksen, M. B. (2020). Using the full PICO model as a search tool for systematic reviews resulted in lower recall for some PICO elements. Journal of Clinical Epidemiology, 127, 69–75. https://doi.org/10.1016/j.jclinepi.2020.07.005
Gallaher, J. R., & Charles, A. (2022). Acute cholecystitis: A review. JAMA, 327(10), 965–975. https://doi.org/10.1001/jama.2022.2350
Giles, A. E., Godzisz, S., Nenshi, R., Forbes, S., Farrokhyar, F., Lee, J., & Eskicioglu, C. (2020). Diagnosis and management of acute cholecystitis: a single-center audit of guideline adherence and patient outcomes. Canadian Journal of Surgery, 63(3), E241–E249. https://doi.org/10.1503/cjs.002719
Janjic, G., Simatovic, M., Skrbic, V., Karabeg, R., & Radulj, D. (2020). Early vs. delayed laparoscopic cholecystectomy for acute Cholecystitis – Single Center Experience. Medical Archives, 74(1), 34–38. https://doi.org/10.5455/medarh.2020.74.34-37
Kivivuori, A., Salminen, P., Ukkonen, M., Ilves, I., Vihervaara, H., Zalevskaja, K., Pajari, J., Paajanen, H., & Rantanen, T. (2023). Laparoscopic cholecystectomy versus antibiotic therapy for acute cholecystitis in patients over 75 years: Randomized clinical trial and retrospective cohort study. Scandinavian Journal of Surgery, 112(4), 219–226. https://doi.org/10.1177/14574969231178650
Kloda, L. A., Boruff, J. T., & Soares Cavalcante, A. (2020). A comparison of patient, intervention, comparison, outcome (PICO) to a new, alternative clinical question framework for search skills, search results, and self-efficacy: A randomized controlled trial. Journal of the Medical Library Association, 108(2). https://doi.org/10.5195/jmla.2020.739
Shunmuga Sundaram, C., Campbell, R., Ju, A., King, M. T., & Rutherford, C. (2022). Patient and healthcare provider perceptions on using patient-reported experience measures (PREMs) in routine clinical care: A systematic review of qualitative studies. Journal of Patient-Reported Outcomes, 6(1). https://doi.org/10.1186/s41687-022-00524-0
Wu, H., Liao, B., Cao, T., Ji, T., Huang, J., Luo, Y., & Ma, K. (2023). Comparison of the safety profile, conversion rate, and hospitalization duration between early and delayed laparoscopic cholecystectomy for acute cholecystitis: a systematic review and meta-analysis. Frontiers in Medicine, 10, 1185482. https://doi.org/10.3389/fmed.2023.1185482
