Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.
VIJAY VARA
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PICOT is an acronym for patient, intervention, comparison, outcome, and time, which are the constituents of clinical research questions. The PICOT procedure starts with a case study, and the question is formulated to elicit a response (Duquesne University School of Nursing Online, 2020). In evidence-based practice, nurses need to use a process and format to communicate a clinical question to clinicians. This process gives a clear understanding of the issue, which leads to an appropriate intervention and outcome. I work in skilled nursing facilities; our population is older adults. The average age group is 85 years old and above. In order for evidence-based practice (EBP) to gain momentum and flourish in the American healthcare system, nurses need to possess the following qualities: a strong conviction in the benefits of EBP, proficiency in EBP knowledge and skills, and a dedication to providing patients and their families with the best possible evidence-based care (Wolters Kluwer, n.d.).
An inability to focus and control impulsive behaviors (behaving without considering the consequences), or excessive activity are some of the characteristics of ADHD. While there is no known cure for ADHD, it can be effectively managed, and some symptoms may get better as the child gets older (CDC, 2022). My clinical issue of interest is to manage hypertension in children with attention deficit hyperactivity disorder (ADHD) using a dietary approach to stop hypertension (DASH) diet (Khoshbakht et al., 2021). P: children aged 6 to 12 years old with ADHD; I: using (DASH) diet; C: without DASH diet; O: improve the symptoms of ADHD.
First, I used Walden University library to do my search; under the library database, I used CINAHL Plus with Full Text. In the search box, I typed DASH diet, and it gave me 659 options; then, using Boolean/Phrase, I typed attention deficit hyperactivity disorder, which showed me 453 search results; then I checked the option of peer-reviewed scholarly journals, and the date range it showed me 42 results.
The secondary databased that I used was MEDLINE with Full Text to find my article, I used the Walden library database, I clicked on MEDLINE with full text, EBSCO host opened a search engine, I typed stop hypertension, it showed me 1,526 search results, using Boolean/Phrase I typed attention deficit hyperactivity disorder in the next box, checked only peer-reviewed scholarly journals and entered the date range starting the year 2023 and pressed the enter button, it showed me 3 peer-reviewed articles.
I was lost and confused when reading this week’s discussion description. Reviewing the weekly resources gave me an idea of how to use the search engine and the tabs to find the articles I am looking for. Walden Library has most of the resources that are needed, and a good search method will provide us with the relevant information.
NICOLE MIR
PICO(T) is a mnemonic used to guide the development of a well-built and focused clinical question for evidence-based practice (EBP). It stands for:
P- patient/problem: the characteristics of the patient or population being studied (e.g., age, gender, ethnicity)
I – intervention: the treatment or action being studied (e.g., medication, therapy, diet)
C – comparison: the alternative treatment or action that is being compared to the intervention (e.g., placebo, different dose of medication)
O – outcome: the result or impact of the intervention being studied (e.g., improved health, reduced symptoms)
T – time: the specific period in which the outcome is being measured (e.g. six months, one year)
PICO(T) questions are used to formulate concise, specific, and searchable clinical queries that can help healthcare providers make evidence-based decisions in patient care. By clearly defining the elements of the question, PICO(T) allows to focus the search for relevant and helpful evidence. Creating a PICO(T) question also ensures that all aspects of the clinical issue are carefully considered, leading to a more comprehensive and practical approach to patient care (Eriksen & Frandsen, 2018).
In 2018, I worked in a primary care clinic where I learned about my current clinical issue with interest. The clinic treated mostly geriatric patients suffering from multiple chronic conditions. Often, these patients had diagnoses of hypertension, diabetes, and some cardiovascular disease. Treating these chronic diseases requires constant maintenance through medication management, eating a healthy diet, and exercise. In some cases, geriatric patients harmfully overdose themselves by taking too many medications, not sticking to a healthy diet, and having difficulty walking, resulting in falls in their homes.
Types of Medications Used to Treat Hypertension Lifestyle interventions are considered the first options: exercise, dietary changes, weight reduction, and alcohol moderation. Antihypertensives are drugs prescribed in combination with those used to treat high blood pressure as well. In the pharmaceutical market, healthcare providers have many antihypertensive medications, so it is essential to understand what classes of antihypertensive drugs are for elderly patients and how they work (Khalil & Zeltser, 2023).
Research Studies on Antihypertensive Medications in Elderly Patients The medications prescribed to our senior population are known to worsen their physical and cognitive function. In the United States, CMS has implemented a star rating system for all Medicare Advantage plans. CMS uses a scale of one to five stars to measure the quality of the health care services provided and is dependent on specific scores. Star ratings are based on the plan’s HEDIS®/CMS performance measures.
Number of Articles Returned Using Different Search Terms Using PICO(T) I used different search terms, including primary issue, hypertension, antihypertensive medications, older adults, and CMS star ratings. I searched various electronic databases, including Medline and CINAHL. The search terms are essential not only because they guide the direction of my research but also because they help me become more efficient in my search. Initially, the investigation resulted in 127 articles. However, when I included more specific keywords related to elderly patients and CMS star ratings, the number of articles decreased, resulting in more manageable articles to explore more closely for my PICOT question.
Strategies to Increase the Rigor and Effectiveness of Database Searches on PICO(T) The following strategies can be used to increase the rigor and effectiveness of database searches on my PICO(T) question on antihypertensive medications in elderly patients:
1. Use citation chaining: This process involves reviewing the references used by the articles in the initial search to find additional relevant articles.
2. Utilize Boolean operators: By using AND, OR, and NOT operators, I can narrow down or broaden my searches to find the most relevant articles for my PICO(T) question.
3. Use database filters: Most allow users to filter results based on specific criteria such as study type, publication date, and language.
4. Utilize MeSH terms: MeSH stands for Medical Subject Headings, standardized terms used to index medical and healthcare literature articles. Using MeSH terms, I can ensure that I find the most relevant articles for my PICO(T) question.
