Does the barbaric adolescent patient undergoing gastric bypass have better continuity of care when the nurse is a primary member of the multi professional team versus when the nurse is a secondary member whose only role is in providing preoperative care and has no specialized training?

Women`s Health Evidence based Practice question using “PICO”

1) As for the Clinical question I had in mind. In women who are diagnosed with Breast Cancer, what are the best treatment options? Medical treatment versus surgical treatments, which one is better, and why?
2) What are the best screenings for women who have a family history of breast cancer and why.

The Instructions for this assignment are on pages 2-3, and pg 4- 6 has some information on the definition of ?PICO?.

Assignment 1: Asking the Clinical Question: Developing the Evidence Matrix
The focus of this assignment will be asking the clinical question from a specific issue/problem within the student’s focus area and/or potential professional practice. The student is expected to: Construct a PICO with a corresponding question; identify key search terms related to the question; describe EBP models that may be useful in framing the question for searching. You are asked to use your focus area as you are searching to complete this assignment.
While this assignment does have a due date, you will continue to build your foundational base from the evidence for your question(s). This is an evolutionary process. When selecting the best evidence, it is important to know where to look and refine your searching as you progress in your reading and synthesis of the evidence. You will continue to refine your question as you dig deeper into the evidence.

According to Craig (2007), “knowing which type of study design would best answer the question enables rapid sorting of the retrieved studies such that studies with the most appropriate study design take precedence” (p. 31). For example, questions about effectiveness of an intervention would lend themselves to systematic reviews of randomized controlled trials. Questions about causation would be more likely to be found in case-control or cohort studies. Qualitative research would be a more appropriate search for questions about perceptions, attitudes and beliefs.

Using the tools below (you can expand and make more useful for your needs), begin your search of databases. You are also asked to begin your evidence review matrix from your database search. Identify at least four (4) sources of evidence from your database search. As you review your research evidence, grade the recommendations. Guided by DiCenso, Guyatt, and Ciliska’s Chapter 35, use Assessing Health Care Recommendations (Table 35-1: Users’ Guide for the Validity of Health Care Recommendations) to complete this discussion.

Consider a variety of tools available to you in formulating your questions, identifying search terms, and optimal study designs according to the question. There are multiple tools attached to this assignment.
The total length of this assignment should not be more than 6 pages and no less than 4 pages (excluding title page and references). Please submit your paper and turnitin reports as an attachment to the Assignment Section of the course by the due dates listed in the syllabus.


1/1: “Burning question” identified, using PICO to guide question.

3/3: Description of at least 2 EBP model(s) appropriate for focus area and/or potential practice burning question; critique similarities and differences of models.

2/2: Identifies clinical question that prompts evidence search; Identifies key search terms; Describes how key search terms and clinical question were determined.

2/2: Identifies and describes number of articles obtained from searching and possible need for further refinement of question.

4/4: Identifies at least four (4) levels of evidence, beginning the Evidence Review Matrix. (Attach Evidence Review Matrix). Critically evaluates recommendations from Users’ Guide in Dicenso, Guyatt, and Ciliska; Describes the relationship between levels of evidence and grades of recommendations

6/6: Summarize work (i.e., how you will build on this beginning search.)

2/2: APA; Scholarly writing; professional style; referenced work.

Additional resources for assignment
? EBPRevMatrix07.doc ( 32 KB; Aug 11, 2013 9:59 pm )
? DatabaseDevelopment.doc ( 31 KB; Aug 11, 2013 9:59 pm )
? GradingRecommendations.docx ( 15 KB; Aug 11, 2013 9:59 pm )

This is some information on ?PICO? questions
The PICOT question format is a consistent “formula” for developing answerable, researchable questions. Writing these questions is deceptively simple! When you write a good one though it makes the rest of the process of finding and evaluating evidence much more straightforward. As strange as it sounds deciding what you are looking for related to your outcome can be one of the hardest parts! When you determine the outcome it helps you hone the process of searching for evidence. Remember evidence is not just what you want the outcome to be.. it is evaluating the evidence supporting or refuting what influences the outcome. If you are interested in getting to the heart of the effect of testing foley balloons on the rates of UTIs then you need to find evidence on the pros and cons of testing the balloon!
Question Templates for Asking PICO Questions:
P: Population/disease ( i.e. age, gender, ethnicity, with a certain disorder)
I: Intervention or Variable of Interest (exposure to a disease, risk behavior, prognostic factor)
C: Comparison: (could be a placebo or “business as usual” as in no disease, absence of risk factor, Prognostic factor B )
O: Outcome: (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome)
T: Time:
For an Intervention:
In _______(P), how does_______(I) compared to _______(C) affect _______ (O) within ______ (T)?
For etiology:
Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C)?
Diagnosis or diagnostic test:
Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O) over ____ (T)?
For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?
Does __________ (I) influence ________ (O) in patients who have _______ (P)?
How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?
Based on Melnyk B. & Fineout-Overholt E. (2005). Evidence-based practice in nursing & healthcare. New York: Lippincott Williams & Wilkins.
Examples of Evidence-Based PICO Questions
1. Population: Bariatric adolescents undergoing gastric bypass surgery.
Intervention: The nurse?s role as a primary member of the multiprofessional team regarding perioperative care of the bariatric adolescent patient.
Comparison: The nurse’s role as a secondary member of the multiprofessional team without any specialized training and is only involved in perioperative care of the bariatric adolescent patient.
Outcome: When the nurse is involved as one of the primary members in the multiprofessional team approach, the bariatric adolescent patient has better continuity of care.
Time: During perioperative hospitalization
PICOT Question: Does the barbaric adolescent patient undergoing gastric bypass have better continuity of care when the nurse is a primary member of the multi professional team versus when the nurse is a secondary member whose only role is in providing preoperative care and has no specialized training?
2. Therapy PICOT Question: An Intervention example: In adult patients with total hip replacements (Patient population) how effective is PCA pain medication (Intervention of interest) compared to prn IM pain medication (Comparison intervention) in controlling post operative pain (Outcome) within the first 24 hours after surgery? Note: The IM pain medication would be called the control group. It would be unethical to have a control group that received NO pain medication. Many times the control group means they get “business as usual!” or the current standard of care.
3. Therapy PICO Question: A non-intervention example: What is the duration of recovery (O) for patients with total hip replacement (P) who developed a post-operative infection (I) as opposed to those who did not (C)?
4. Etiology PICO Question: Are kids (P) who have obese adoptive parents (I) at Increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C)?
5. Diagnostic PICOT Question: Is a PKU test (I) done on two week old infants (P and T) more accurate in diagnosis inborn errors in metabolism (O) compared with PKU tests done at 24 hours of age (C and T)?
6. Prevention PICO Question: 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)?
7. Prognosis PICOT question: Does telelmonitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O) during the first month of treatment (T)?
8. Meaning PICO Question: How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels (O) to their healthcare providers?

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