NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

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NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach – Step-by-Step Guide

The first step before starting to write the NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Example

Preventive nursing focuses on the early detection of an illness and implementing interventions to stop the illness from occurring or progressing. In a hypothetical case scenario, a nurse had a hard time diagnosing surgical site infection using the warning signs of infection. The patient only had erythema and swelling at the incision site without fever, discharge, or pain.

His desire to prevent surgical site infection from occurring in his patient led to his doubt that the signs were not adequate to say for sure that his patient started to have a surgical site infection (SSI). SSIs are a major cause of long patient hospital stays, mortality, morbidity, and increased cost of treatment (Iskandar et al., 2019). Annually, there are more than 100000 cases of surgical site infections (National Healthcare Safety Network, 2022).

SSIs surveillance and prevention have been some of the strategies used to intervene to prevent the outcome of SSIs. This paper aims to formulate a clinical question, identify potential sources, and explain their findings to answer the clinical question.

Definition of Practice Issue

The scenario above involves a situation where the nurses need clinical or scientific evidence to make informed decisions about the patient. To ensure proper patient surveillance, he will need to identify and prevent SSI early in this patient.

An alternative way to diagnose SSI is through laboratory investigations. Like other infections, SSIs can cause inflammation that can be detected through blood testing. C-reactive protein (CRP) assays have been a good marker for inflammation in the body.

Its assay can suggest inflammation in the body in the setting of SSIs. However, surgery is also an iatrogenic process that can cause inflammation (Chijioke, 2019). As such, the use of CRP in SSI surveillance requires clinical evidence. The benefits of using this protein marker in surgical site infection can be ascertained through evidence-based practice.

Clinical Question

Having defined the clinical issue, the second phase of the John Hopkins EBP model is to research for evidence. This started with the formulation of a practice question. The practice question was formulated in a PICOT format.

The PICO question stated: “In postoperative adult patients (P), is C-Reactive Protein assay (I) compared with the use of clinical signs (C) more accurate in early diagnosis of surgical site infections (O)? In this PICO question, the population includes adult patients who have had significant surgeries during their inpatient stay in the hospital. The intervention is laboratory testing that measures the serum amount of CRP during this period after the surgery.

The comparison intervention will use clinical signs of inflammation, such as tenderness, discharge, swelling, redness, and hotness. The time element will not be included in this clinical practice question.

PICO approach will benefit the exploration of the clinical issue by providing the search terms and phrases. Using the PICO question will improve the specificity of the literature search, thus improving its relevance and credibility (Eriksen & Frandsen, 2018).

The conceptual clarity before the search will also improve through PICO as all elements, including comparisons, are declared before literature acquisition. The population, problem, and interventions are defined, thus making the framework of the literature search clearer. Therefore, the returned search results will be high-quality, high-level evidence (Eldawlatly et al., 2018). Finally, using PICO questions will reduce the time required to complete the search.

Evidence-based Sources

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

A literature search was performed from the Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and PubMed databases. These sources are authoritative and contain peer-reviewed resources, including but not limited to journal articles and books.

After the literature search, articles were manually selected, and three sources were presented to attempt to answer the PICO question. The four resources selected were articles by Kim et al. (2021), Malheiro et al. (2020), Okui et al. (2022), and Shetty et al NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach. (2022). These resources were credible because they were current, relevant, authoritative, accurate, and objective research articles (Kurpiel, 2022).

Their credibility made them fit to be used to answer the PCIO question. The credibility assessment was performed using the criteria from the CRAAP test. This test assesses the currency, relevance, authority, accuracy, and purpose of an evidence-based source.

Findings from the Articles

The article by Shetty et al. (2022) was from a prospective cohort study involving 51 orthopedic patients. This study found that fifteen patients developed surgical site infections and that CRP rose in all patients after surgery. However, the rise levels differed in both groups after the third post-op day (POD). The rise was gradual, and the difference between the two groups was statistically significant. Therefore, CRP is a good marker of SSI but only after the second day of the postoperative period.

Kim et al. (2021) excluded patients with comorbidities from their study that involved post-operative patients who underwent posterior lumbar fusion or decompression. Their observational study found a rise in all patients who had these surgeries. However, by POD7, CRP levels had been decreasing in some patients, of which 43% did not develop SSIs, and increasing in some patients who eventually developed SSIs. The serial CRP level change rate had a sensitivity of 90.9% and a specificity of 68.1% in SSI detection. Therefore, additional clinical patient monitoring is also important.

Okui et al. (2022) found that, on average, patients were being diagnosed with SSI between POD5 and POD9. Patients with poorer outcomes, such as SSI diagnosis, longer hospital stays, and low survival rates, had higher CRP levels by the 14th postoperative day. Early diagnosis with SSI was associated with severe SSI and outcomes. Therefore, early SSI detection is essential for patient care outcomes, and CRP levels can be good markers

Malheiro et al. (2020) compared various factors that would be used to predict the risk of infection, such as post-surgical antibiotic use, positive culture test,  CRP values, body temperature, leukocyte count, surgical re-intervention, admission to the emergency room, and hospital readmission among patients who had undergone colorectal surgeries and cholecystectomies.

The study found that antibiotic use and CRP values had the highest sensitivities for SSI risk. These two factors are, therefore, sensitive to the prediction of SSIs and thus good SSI surveillance markers.

The sources by Malheiro et al. (2020) and Kim et al. (2021) were the most credible because they additionally addressed other confounders, thus suitable for inference making. Additionally, they had the highest sample sizes making their findings more powerful due to increased accuracy. The other sources were also credible, nevertheless.

Relevance of the Findings

The four sources presented more or less related findings and addressed one common intervention, the CRP value use. Each source addressed the various elements of the PICO but only partially. The most addressed element was population and intervention. Only one source (Kim et al., 2021) addressed the comparison intervention.

The findings presented by Kim et al. (2021), Okui et al. (2022), and Shetty et al. (2022) are useful in addressing the appropriateness of the intervention from the PICO. Their findings explain to the clinician when to do CRP values and which patients. The other source by Malheiro et al. (2020) is too general for the PICO question despite using the largest sample size in their study. The source by Kim et al. (20210 remains the most credible in solving the clinical practice issue.

Conclusion

The clinical issue involved a scenario where the use of clinical signs in the early detection of surgical site infection was unreliable. Therefore, using CRP values to screen for SSIs early in the postop period was a new intervention that would require evidence-based answers. This activity adopted the John Hopkins EBP model to seek evidence-based answers to the clinical issue.

A PICO question was used to improve search accuracy and provide conceptual clarity to the search. The four sources selected based on their credibility answered the PICO question in parts. Of the four sources, one source was outstanding because it was the most credible in that it additionally addressed the comparison intervention.

Therefore, the use of the PICO question is a valuable intervention in the EBP process as literature search and drawing a conceptual framework for literature acquisition depend on it.

References

Chijioke, A. C. (2019). Evaluation of Serial C-Reactive Protein as a Predictor of Surgical Site Infection Following Emergency Laparotomy in Children in Ile-Ife, Nigeria. World Journal of Surgery and Surgical Research, 2, 1138.

Eldawlatly, A., Alshehri, H., Alqahtani, A., Ahmad, A., Al-Dammas, F., & Marzouk, A. (2018). The appearance of Population, Intervention, Comparison, and Outcome as a research question in the title of articles of three different anesthesia journals: A pilot study. Saudi Journal of Anaesthesia, 12(2), 283. https://doi.org/10.4103/sja.sja_767_17

Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420–431. https://doi.org/10.5195/jmla.2018.345

Iskandar, K., Sartelli, M., Tabbal, M., Ansaloni, L., Baiocchi, G. L., Catena, F., Coccolini, F., Haque, M., Labricciosa, F. M., Moghabghab, A., Pagani, L., Hanna, P. A., Roques, C., Salameh, P., & Molinier, L. (2019). Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria. World Journal of Emergency Surgery, 14(1). https://doi.org/10.1186/s13017-019-0266-x

Kim, M. H., Park, J.-H., & Kim, J. T. (2021). A reliable diagnostic method of surgical site infection after posterior lumbar surgery based on serial C-reactive protein. International Journal of Surgery: Global Health, 4(5), e61–e61. https://doi.org/10.1097/gh9.0000000000000061

Kurpiel, S. (2022, April 13). Research guides: Evaluating sources: The CRAAP test. https://researchguides.ben.edu/c.php?g=261612&p=2441794

Malheiro, R., Rocha-Pereira, N., Duro, R., Pereira, C., Alves, C. L., & Correia, S. (2020). Validation of a semi-automated surveillance system for surgical site infections: Improving exhaustiveness, representativeness, and efficiency. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases, 99, 355–361. https://doi.org/10.1016/j.ijid.2020.07.035

National Healthcare Safety Network. (2022, January). Surgical Site Infection Event (SSI). Cdc.gov. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

Okui, J., Obara, H., Shimane, G., Sato, Y., Kawakubo, H., Kitago, M., Okabayashi, K., & Kitagawa, Y. (2022). The severity of early diagnosed organ/space surgical site infection in elective gastrointestinal and hepatopancreatobiliary surgery. Annals of Gastroenterological Surgery, 6(3), 445–453. https://doi.org/10.1002/ags3.12539

Shetty, S., Ethiraj, P., & Shanthappa, A. H. (2022). C-reactive protein is a diagnostic tool for postoperative infection in orthopedics. Cureus, 14(2), e22270. https://doi.org/10.7759/cureus.22270

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Instructions

Create a 3-5-page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question. PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation. It stands for:

  • P – Patient/population/problem.
  • I – Intervention.
  • C – Comparison (of potential interventions, typically).
  • O – Outcome(s).
  • T – Time frame (if 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. Have a look at NURS-FPX4030 Assessment 4 Remote Collaboration and Evidence-Based Care. 

You are encouraged to complete the Vila Health PCI(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.

DEMONSTRATION OF PROFICIENCY

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

  • Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
    • Explain the findings from articles or other sources of evidence.
  • Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
    • Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
    • Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
  • Competency 3: Apply an evidence-based practice model to address a practice issue.
    • Define a practice issue to be explored via a PICO(T) approach.
  • Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
    • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style. Assessment #3 Instructions: PICO(T) Questions and an Evidence- Based Approach.

Reference

Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Burlington, MA: 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 judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related 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.

SCENARIO

For this assessment, please use an issue of interest from your current or past nursing practice. If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

Instructions for Completing NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

For this assessment, select an issue of interest an apply the PICO(T) process to define the 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 issues, as well 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.
  • Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
  • Explain the findings from articles or other sources of evidence.
  • Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
  • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using 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 1 [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. A title page is not required but you must include a reference list.
  • 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 current APA style.
  • NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

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.

PICOT QUESTION PROCESS

Creating a question using the PICOT elements will provide a framework for the research you need to conduct an evidence-based study or to make an evidence-based decision.

PICOT Elements:

(P) – Population, Patients or Problem: The sample of subjects used in a study, or the problem being addressed.

(I) – Intervention:  The treatment that will be provided to subjects enrolled in your study.

(C) – Comparison or Control:  Identifies an alternative intervention or treatment to compare. Many study designs refer to this as the control group. If an existing treatment is considered the ‘gold standard’, then it should be the comparison group. A control group is not required for every type of study.

(O) – Outcome: The clinical outcome that measures the effectiveness of the intervention.

(T) – Time: Duration of the data collection.  Some versions don’t include this element, and time may not be specified in cases where the question is focused on prediction or diagnoses.

PICOT Question Formats:

  • Intervention: In _______ (P), how does _______ (I) compared to _______  (C) affect _______  (O) within _______ (T)?
  • Prognosis/Prediction:  In _______ (P), how does _______ (I) compared to _______ (C) influence/predict _______ (O) over _______ (T)?
  • Diagnosis or Diagnostic test:  In _______   (P) are/is _______   (I) compared to _______ (C) more accurate in diagnosing _______ (O)?
  • Etiology:  Are _______ (P), who have _______ (I) compared to those without _______ (C) at _______ risk for/of _______ (O) over _______ (T)?
  • Meaning:  How do_______ (P) with _______ (I) perceive _______ (O) during _______ (T)?

Example PICOT Questions:

  • In acute care hospitals (P), how does having a rapid response team (I) compared with not having a response team (C) affect the number of cardiac arrests (O) during a three-month period (T)?
  • In women with gestational diabetes (P), how does a monitored diet and exercise program over the course of pregnancy (I &T), compared to the use of metformin only (C) reduce the incidence of high birth weight babies(O)?
  • In patients admitted for acute myocardial infarction (P), how well does the hospital’s new data model created from EMR data (I) compared to current practices (C) predict readmission rates (O) within 30 days after initial discharge (T)?
  • For patients of a rural health clinic (P), does the use of text message reminders (I), compared with telephone calls (C) reduce the number of missed appointments (O) over a six month period (T)?

References:

  • Melnyk, B.M., Fineout-Overholt, E., Stillwell, S. & Williamson, K. M. (2010). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. AJN, American Journal of Nursing, 110, 51-53.
  • Posing the research question: Not so simple
  • To make your case, start with a PICOT question
  • What is your research question? An introduction to the PICOT format for clinicians.
  • Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. (Not in library)

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Example

PICO(T) Questions and an Evidence-Based Approach

PICOT Question and Search Strategy Template

  1. Define your question using PICOT (review the “Create PICOT Questions” page as needed):

Population:     Patients who have experienced an acute myocardial infarction (AMI)

Intervention:   Implementing an evidence-based cardiac rehabilitation program.

Comparison:   Compared to standard post-AMI care without cardiac rehabilitation

Outcome:        Reducing the risk of future cardiovascular events and mortality

Time (optional):  Over one year

  1. Write out your question:

For a patient who has had AMI, what is the effect of implementing an evidence-based cardiac rehabilitation program instead of standard care immediately after an AMI on the risk of future cardiovascular events and mortality over a year?

  1. Write down the most important words from your question in the gray boxes. For each top term, add synonyms or related terms in the boxes below it. All these are your search terms.
Acute myocardial infarction AMI heart attack cardiac rehabilitation
recurrent events cardiovascular risk secondary prevention exercise rehabilitation
mortality
  1. Review the “Best Bets” in the Nursing Databases list. Check the databases you will search:
  • Nursing & Allied Health
  • Public Health Database
  • PubMed Central
  1. Write in your first search below. Follow the instructions on the “Find EBP Articles…” page.

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

  1. Type of studies you want to include in your search:
  • Systematic Review or Meta-Analysis
  • Clinical Practice Guidelines
  • Individual Research Studies
  1. What information did you find to help answer your question?

Two highly relevant sources were identified that provide good evidence to help answer this PICO(T) question:

Source 1:

Dibben, G., Faulkner, J., Oldridge, N., Rees, K., Thompson, D. R., Zwisler, A.-D., & Taylor, R. S. (2021). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, 2021(11). https://doi.org/10.1002/14651858.cd001800.pub4

The present Cochrane systematic review was upgraded and included 85 randomized controlled trials with 23,430 participants with coronary heart disease, mostly having a myocardial infarction or revascularization procedure. The trials were designed to examine the effectiveness of exercise-based cardiac rehabilitation programs, including some that had psychosocial or educational components as further additions, against control groups that received no exercise intervention (Dibben et al., 2021).

At the 6-12 months short-term follow-up, exercise-based cardiac rehab is most likely associated with a significant reduction of all-cause mortality, a large decrease in MI risk, and a need for hospitalization in individuals compared to the controls. The same results were probably observed regarding cardiovascular mortality, the need for CABG and PCI revascularization procedures, or cardiovascular hospitalizations.

At longer-term follow-ups, which reach three years, benefits may include a significant reduction in mortality caused by cardiovascular diseases and MI risk. Still, the evidence for the effect of revascularization needs to be more specific (Dibben et al., 2021). Cardiac rehab that centers on exercise was likewise noted to improve health-related quality of life measures, with effects that lasted up to a year. Furthermore, this intervention may be cost-effective.

The review is reinforced by the evidence that exercise-based cardiac rehabilitation is essential in decreasing major adverse cardiovascular events and healthcare use for patients with coronary heart disease, especially during the first year, but over a more extended follow-up period (Dibben et al., 2021). For a more accurate picture of the effectiveness, the trials need to be of a higher standard, and the patients should be representative of real-world practice.

Source 2:

Bruneau, J. E. E. (2020, May 1). The development and evaluation of the cardiovascular assessment screening program. Research.library.mun.ca. https://research.library.mun.ca/14388/

This exploratory mixed-methods study of the CASP intervention for improving usage of CVD screening guidelines employed a Cardiovascular Assessment Screening Program (CASP) intervention. In the context of our research, the Knowledge-to-Action Framework came to be used as a guiding instrument. In the qualitative phase, interviews and focus group discussions with healthcare providers, managers, and the public were conducted to identify barriers, facilitators, and strategies for CVD screening, which provided the information needed for CASP’s planning (Bruneau, 2020). The Theoretical Domains Framework (TDF) was used to translate the findings for each intervention component.

In the quantitative phase, a randomized controlled trial (RCT) was conducted involving four nurse practitioners and 167 patients aged 40-74 with no clinical history of CVD. The intervention group provided CASP during the specified time, while the other group offered the usual care. Statistical and clinical significance was shown through the analysis, which favored the intervention group in the comprehensiveness of screening (RR=43.9, p<0.0001) (Bruneau, 2020). The identification of various risk factors, the determination of CVD risk levels, the priority action planning with patients, and the personalized goal setting for heart health can be achieved by Intervention nurse practitioners.

Combining the qualitative and quantitative pieces helped confirm and refine strategies for knowledge translation of CVD screening guidelines in practice (Chapman, 2021). Through a strategic approach, CASP successfully deployed the guidelines to assess risks and offer risk reduction strategies by both providers and patients (Bruneau, 2020). This research approach allows for the development of a model that can be used to implement dance-based CVD prevention in clinical practice.

These two sources deliver a high-level systematic review and implementation report, demonstrating the use of complete, evidence-based cardiac rehabilitation programs for AMI patients to reduce mortality, morbidity, and future cardiac events over usual care. Specific mechanisms to guarantee all qualified AMI patients finish cardiac rehab programs are recommended due to this evidence. Other research can explore longer-term outcomes, cost-effectiveness, and specific program components. Still, this evidence indicates that cardiac rehab should be standard AMI treatment to achieve better recovery and prevention of recurrent events.

Other relevant findings

New research demonstrates that cardiac rehabilitation (CR) programs, especially those targeting the reduction of cardiovascular death and rehospitalization, directly contribute to the improvement in patients’ quality of life and functional capacity after an acute myocardial infarction (AMI). The primary result shows the positive effect of early cardiac rehabilitation that begins in the acute phase after AMI and leads to improved cardiac function, particularly in left ventricular remodeling and ejection fraction.

Furthermore, it enhances the patient’s physical and mental condition by increasing exercise capacity and diminishing the symptoms of depression (Darvishzadehdaledari et al., 2023; Schon et al., 2024). Moreover, the effectiveness of comprehensive cardiac rehabilitation programs, including exercise training, risk factor management, and psychosocial touching on patient outcomes, has also been found to be very substantial.

However, although there are many advantages to those programs, the low number of program enrollment and completion is noticeable due to discrimination by race and socio-economic factors. Innovative modalities, such as home-based and hybrid cardiac rehabilitation, have been discovered to be as effective as physical in-person institutions, and their effect came to light during the COVID-19 pandemic as physical distancing was required (Basognano, 2023).

Relevance of the Other Findings

The results of the studies are highly relevant to clinicians’ and policymakers’ decision-making. They underscore the importance of incorporating cardiac rehabilitation into routine care for AMI patients to ensure optimal recovery and prevent second cardiovascular events. Healthcare facilities and policymakers should embrace this finding for a broader application of CR facilities and increased access. For example, facilities can significantly streamline the design and delivery process, focusing specifically on issues that could complicate access, such as long distances from medical institutions or physical limitations. On the one hand, shifting to home-based and hybrid delivery models has become a typical phenomenon among providers.

On the other hand, it gives a new dimension to reach a more significant number of people. Modifications of those approaches lead to the need for policymakers to rethink healthcare system plans, including insurance inclusion of remote rehabilitation services. Furthermore, the literature revealed that CR should begin early and patient-centered care. Therefore, such findings can become a crucial platform for the arrival of new guidelines and the improvement of the current protocols for cardiac rehabilitation (Basognano, 2023). Hence, such data provides a basis for future research and practice guideline changes. Ensuring better program outcomes and broader availability for AMI patients is necessary.

Conclusion

The exploration of PICO(T) questions using an evidence-based approach gives a great deal of evidence for the influence of cardiac rehabilitation programs after AMI. The effects of these treatments are undoubtedly beneficial, decreasing mortality and recurrent CV events, highlighting their importance in improving patient outcomes rather than standard post-AMI treatment. Integrating exercise-based interventions alongside psychosocial and educational ones improves patients’ lifestyle and physical capacity, which conventional care methods cannot compare. This finding is the basis for changes in clinical practices that advocate for including comprehensive cardiac rehabilitation as a mandatory part of routine post-AMI care.

These modifications could signify a significant shift in patient recovery patterns and the overall outcome of the healthcare system, demonstrating the potency of the evidence-based approach in clinical decision-making and policy formulation. The peer-evaluated data from scholarly sources, including Dibben et al. (2021) and Bruneau (2020), strengthens the approach and touches upon the skills needed to be developed or further enhanced in cardiac health services provision.

References

Basognano, J. B. (2023). A new era in cardiac rehabilitation delivery: Key points. American College of Cardiology. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2023/01/25/17/06/a-new-era-in-cardiac-rehabilitation

Bruneau, J. E. E. (2020, May 1). The development and evaluation of the cardiovascular assessment screening program. Research.library.mun.ca. https://research.library.mun.ca/14388/

Darvishzadehdaledari, S., Harrison, A., Gholami, F., & Arian Azadnia. (2023). Examining the effectiveness of home-based cardiac rehabilitation programs for heart failure patients with reduced ejection fraction: A critical review. BMC Cardiovascular Disorders, 23(1). https://doi.org/10.1186/s12872-023-03640-x

Dibben, G., Faulkner, J., Oldridge, N., Rees, K., Thompson, D. R., Zwisler, A.-D., & Taylor, R. S. (2021). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, 2021(11). https://doi.org/10.1002/14651858.cd001800.pub4

Schon, C., Felismino, A., de Sá, J., Corte, R., Ribeiro, T., & Bruno, S. (2024). Efficacy of early cardiac rehabilitation after acute myocardial infarction: Randomized clinical trial protocol. PloS One, 19(1), e0296345–e0296345. https://doi.org/10.1371/journal.pone.029634