literary review of 4 article for PICO
Pic0: Does The Use of Alternative Therapies Reduce The Need and Use of Narcotics in The Elderly.
The model of evidence based medicine requires physicians to formulate clinical questions base on the PICO analysis which stands for population, intervention, comparison as well as outcome .Together, these elements make up a PICO frame. This framework is developed to speed up the formulation process of clinical queries. Although PICO framework capabilities to represent the information required by physicians at the time has not been represented empirically, it presents a standard framework that can be utilized for evaluation of a clinical practice question. The paper herein will utilize PICO to answer the clinical practice question: “Does the use of alternative therapies reduce the need and use of narcotics in the elderly?” Some of the forms of alternative therapies that were utilized include acupuncture, orthodox medicine and homeopathy. The clinical practice question will be evaluated based on the PICO framework. The research reveals popular patterns in the structure for four frameworks in the clinical question namely diagnosis, etiology, therapy and prognosis. It was revealed that the PICO framework for representation is entirely on therapy.
Clinicians questions for each patient they care for range from 1 to 12. Nonetheless, the solutions to about two-thirds of these questions are never found. Subsequent analysis shows that most of these questions that have been left unanswered could be answered on the condition that there exists a better structure for query formulation as well as better search. Therefore, in order to assist physicians to properly convey the clinical questions they need answered, well thought of and focused questions need to be delivered to the patients. The PICO framework meets all this specifications as it encompasses four vital parts of anatomic nature.
The following literature review focuses on evaluating the viability of the research question based on PICO framework and literature. The study will evaluate the pliability and adequacy of this question as well as evaluate its completeness.
The research assembled about 60 of the real world medical questions from a total of two on-line offices for sourcing purposes. The Family Practice Inquiries Network, as well as the pankrust exchange. During the whole process of collecting questions from the field, the typical sampling process offered more guidance than the random sampling process. The main goal of these actions was not to acquire a full representation, but more of a typical sample of the field of research. The secondary data sources revealed that almost 33% of the questions asked to the patients suffering from chronic low back pains were asked about their treatments. 25% of the questions concerned with the diagnosis process while 15% had to do with the pharmaceutical therapies involved in treating acupuncture of lower back pains in the patients. In therapy, the diagnosis, prognosis and etiology, the questions gathered in the activity were respectively, 25, 15, 7, and 12.
Coding Clinical Questions with PICO
A collection of the questions that were collected underwent a coding process to feed them into a PICO framework.
Analysis of the Results
The collection of about 60 questions discussed earlier in this article evaluated the structural completion of the research. The prior researches had revealed that the clinical question were less likely to undergo representation due to lack of answers in the cases where the questions comprised of the proposed interventions and the targeted outcome in the patients with the non-specific chronic low back pains. Therefore the usage of the components provided indicators of how much the whole structure was complete (Lam, Curry & Galvin, 2015).a follow up of the research process involved an analysis of the prevalence of each one of the elements.it was found that the structures which were meant to analyze the categories named above showed patterns in the framework. The semantic classes of concepts that were present in the 60 questions underwent further identification. This action enabled the research to achieve a tabular relationship in the elements of the PICO framework. In the end, the challenges that were faced during the coding process had to be organized in distinct themes.
Structural completeness of clinical questions.
A: Rate of proof from the literature.
B: Rate elements covered in the framework in the question.
C: Rate interventions and different outcomes.
A B C
Therapy 25 1 (4.0% 16 (64.0%)
diagnosis 15 1 (6.7% 5 (33.3%)
Etiology 12 0 (0%) 0 (0%)
Prognosis 8 0 (0%) 2 (3.4%)
Total results 60 2 (3.4%) 22 (37.3%)
The table reveals that only an estimate of 20-60 questions of the study contains both of the interventions and the elements of outcome. The results not only confirm the findings of the prior researches who had found out about the clinical questions to patient with chronic low back pains that met the structural requirements used to facilitate numerous searches in the corpus the therapeutic questions of the patients with chronic low back pains which was 64% had a structure that dealt with intervention and outcomes. The diagnosis questions were 33.3% while the etiology as well the prognosis were least structured with a respective of 14% and 0%. Challenges in Structuring Clinical Questions
The research study showed that some of these challenges that were faced in the application of the PICO framework of analysis of the clinical questions to patients with low back pains.
Firstly, a challenge in the inabilities to construct genuine questions was found in the framework. This problem was due to the fact that clinical work was imperative of the elements in the PICO system during representation.
Another challenge was that there existed an inability to perform encoding and blending of relationships amongst the frame components (Benardini, Cracolici, Ferreri, Rinaldi & Pulcri, 2015).
The research considered the following question for say:
Does the Use of Alternative Therapies Reduce the Need and Use of Narcotics in the Elderly?
Therefore, it is very difficult formulate and incorporate such a question into PICO framework without losing some meaningful elements of semantic concepts. For instance in the clinical practice question, “does the use of alternative therapies reduce the need and use of narcotics in the elderly?” the relation between problems and interventions is presumed to be causal in nature. Accordingly, it lacks in addressing this concept of the question. Overloaded slots are another challenge. To questions challenging implicit relations, this framework lacks in this aspect. There some other types of the questions that never fit into the PICO framework completely (Meng, 2003). Also, in the clinical practice question, it is unfit in representing anatomical relations. The latter is a must have for any clinical question. There are many common questions involving human anatomy, and this was not be well captured in the clinical practice question based on PICO framework.
The research that was conducted on the clinical practice question showed that this question excelled in covering the aspects of intervention and outcome since the acupuncture therapy produced positive outcomes to the patients in the study. The paper also appreciated the difficulty encountered in coding the categories of the question without doing some form of modification to the structure of the PICO framework or introducing other components of the counterintuitive nature. Nonetheless, the PICO framework showed some limitations that were covered in the paper above especially in the formulation of the clinical query (Hopton, Thomas & Macpherson, 2013).
In conclusion, the study deduced that the clinical research question outlined above excelled in covering intervention and outcomes aspects, but lacked in population and comparison aspects on the PICO framework. Moreover, acupuncture proved to be a suitable alternative therapy that substantially reduced the need of narcotic use for the elderly.
Bernardini, S., Cracolici, F., Ferreri, R., Rinaldi, M., & Pulcri, R. (n.d.). Integration between orthodox medicine, homeopathy and acupuncture for inpatients: Three years’ experience in the first hospital for Integrated Medicine in Italy. Journal of Traditional and Complementary Medicine, 234-240.
Hopton, A., Thomas, K., & Macpherson, H. (2013). The Acceptability of Acupuncture for Low Back Pain: A Qualitative Study of Patient’s Experiences Nested within a Randomised Controlled Trial. PLoS ONE.
Lam, M., Curry, P., & Galvin, R. (n.d.). The Effectiveness of Acupuncture for Non-Specific Chronic Low Back Pain. Spine, 1-1.
Meng, C. (2003). Acupuncture for chronic low back pain in older patients: A randomized, controlled trial. Rheumatology, 1508-1517.