Evidence-Based Practice using PICO
The question posed for this search activity will be, "Does early referral of terminally ill patients into a hospice program results in better patient outcomes, in particular, with regard to pain management?" The patient group in this question is terminally ill patients. The intervention is terminally ill disease. The comparison is time entered into hospice care. The outcome is reduced pain. The primary search terms for this search are hospice and pain management. Synonyms for the search are in-home care, bereavement care, critical condition, deathbed, palliative, and anesthesia. The MeSh terms are Hospices, Terminal Care, Pain management and Chronic Disease.
Based on the located synonyms, the better phrasing of the question may be, "Do early admitted hospice patience have a better outcome regarding pain management?" The reason for shaving the question slightly is that only terminally ill patients can be admitted into hospices. So, the term does not necessarily need to be part of the actual question.
The first search that I ran was using CINAHL. I initially tried using the primary research terms placed separately in quotations. This brought up very vague searches with no helpful articles. The total amount of papers was 2,330. I next removed the term "terminally ill" and left the other two and the search titles became very useful articles but the total amount of articles increased. In total, there were 14,200 articles that came up with the search. This search brought up the following helpful articles on the first search page:
Berry, Patricia...
A study conducted by Leep Hunderfund et al. tested the effectiveness of a follow-up assessment and risk factor specific intervention measures in reducing falls in an inpatient setting (2011). The study suggested that the Hendrich Risk Fall Model works as an effective primary screening tool and, when used in combination with further physician assessment, reduces the number of patient falls dramatically. Ang, Mordiffi and Wong corroborated these results in
Mobility Evidence-based Practice Progressive Mobility Protocol This paper is a project based on PICO. The clinical question that serves as the foundation for this data-based design is; for immobile critical care patients, does the use of a nurse driven progressive mobility protocol reduce ICU LOS compared to every hour of repositioning? In this paper, the adult patients admitted to an ICU represent the population (P) of interest. The nurse driven progressive mobility
Still, the concept of guided imagery tends to stray far from traditional methods of pain management. Pharmaceuticals have long been a major method of treatment for pain, but have resulted in major backlashes in regards to patients becoming addicted, especially in long-term and chronic cases of pain. If guided imagery could be a successful method, it may reduce pain or increase pain tolerance, without the threat of chemical dependence. There
Qualitative, meetings and seminars, then questions to ascertain efficacy. Smallish, 65 in one hospital. Survey and qualitative observation. Clear and effective communication goals were met using positive educational interventions. Longitudinal and sample size. Good basic, lacks lengthy literature review. Data may be extrapolated, but further work needs to be done using larger, more diverse sample. Melnyk, B., et.al. Evidence-based Practice: Step-by-Step Igniting a Spirit of Inquiry. 2009 What is the effectiveness of an evidence-based practice format on collaborative inquiry. Meta-Analysis
Meta- Analysis and Evidence-Based Research on Children Feeding Disorders The eating disorders are among pediatric clinical problems in the United States that can cause distress to clinicians and parents. Typically, eating disorders are affecting more than 40% of children of pre-school and school ages, and the associated psychology and health problems of the eating disorders include a mental retardation, behavioral problems, growth retardation, and poor academic records in schools. This study
Evidence-Based Medicine Working Group. (1992). Evidence-Based medicine: A new approach to teaching the practice of medicine. JAMA, 268 (17), 2420-2425. Evidence-based medicine is a new paradigm that places emphasis on new skills for physicians that include: performing efficient in performing literature searches and applying formal rules of evidence in examining clinical literature (critical appraisal exercise, which applies when authority is not trusted, the answer unknown, or there are divergent opinions). This
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