Richardson suggests that PICO statement provides a general frame work in projects. The first step in developing a well-built question is by identifying patient problem or a population whereby the researcher identifies patients’ condition to a larger population. Asking a question is a very difficult skill based on the decision making process which begins with a patient question and problem. Secondly, intervention follows by identifying patients’ plan which includes specific diagnostic test and treatment according to procedure of medication. Comparison is the third phase in PICO statement which is the main step to be considered in patients.
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The well-built questions are specific and limited to the alternative choices in order to facilitate an effective and efficient work to the patient. Outcome is the forth step in PICO question. It comprises of the revealed specific symptoms and functions in patients. In projects, what is planned to be accomplished specifies the results in outcome. Outcome also allows better research results in the findings and focuses on the intervention process of the problem.
PICO components are very vital in identifying the type of question the researcher is asking for in relation to the research method, for example, prevention methods, diagnosis, and etiology. PICO strategy worksheet provides the frame work for developing steps in guiding researchers to compile each of the components in PICO question. This helps the clinicians to develop a clinical outcome and evidence of the research project.
Defining a Problem Using a PICO
PICO is an acronym for the elements of clinical questions which stands for P- Patient, I-intervention, C-comparison, O- outcome. Most of the questions arise during the patient care in healthcare system whereby some of the questions about diseases are developed. Evidence-Based Practice is followed step by step in asking the patients questions. The following components of PICO help in developing some of the general questions about the clinical problem in relation to the UII in patients.
Step I of the EBP Process
The first step of the Evidence-Based Practice (EBP) is to develop a question from a practice problem. Background question is the type of clinical question used in finding evidence to improve patient outcomes and support a practice. The purpose of developing a background question is to provide a general knowledge of UTI reduction in patients, especially female adults. UTI infection in patients is developed by normal micturition elimination bacteria from the urethral orifice whereby a patient undergoes the process of catheterization. During the process, it develops an increase of perineal pathogen which enters in the urethra and rises up hence causing infection of urine.
Example of PICO Question
Females with recurrent infection of UTIs associated with long term renal dysfunction. Evidence-based practice begins and ends with the patients. The patient population is the adult women with uncomplicated UTI infection. The main objective in EBP question problem is to implement the recurrent infection of UTIs in female adults and cost effective plan for uncomplicated urinary tract infection associated with long term renal dysfunction. UTI infection in patients is developed by normal micturition elimination bacteria from the urethral orifice whereby a patient undergoes the process of catheterization.
A Question of Diagnostic Test of UTI infection
|
PATIENT/PROBLEM |
INTERVENTION |
COMPARISON |
OUTCOME |
METHODOLOGY |
|
Recurrent infection of UTIs |
Laboratory tests and investigations |
3 days trimethoprim, 7days nitrofurantoin, 3 to 7 days of fluoroquinolone |
Cost effective and good strategy use of appropriate clinical care. |
Prospective study of UTI infection in female adults |
Diagnosis
The history of diagnosis comprises of 80% of women with dysuria and frequency in absence of vaginitis. UTI infection in adult females that affects part of urinary tract, especially the lower and upper urinary tract, is known as cystitis (bladder infection) and pyelonephritis (kidney infection), respectively. UTIs are common in females and lead to serious outcomes, especially in kidney damage and renal failure. It can be discovered easily by understanding a general pathogenic factor which contributes to the development of UTI infection.
Treatment consists of two lines. First line takes three days of trimethoprim and seven days of nitrofurantoin. Second line takes from three to seven days of fluoroquinolone, especially in expectant mothers, and seven days of amoxicillin.
Clinical Problem Management Issues
Incidence of UTIs outlines that 40% of women develop urinary tract infection during their life time thus implying a number of women with recurrent UTI infection. The cost effective strategy for the diagnosis and treatment of UTI is very important because of the high risk infection, investigations done and results from the laboratory which show the outcome of patient care. Recurrent infection of UTIs can be managed by prophylaxis and personal initiated therapy. This process provides a good strategy of uncomplicated UTI results in clinical outcome and appropriate clinical care of the resources.
The recurrent UTI should be treated in an acute urinary tract infection by giving the patient trimethoprim for 3 days and nitrofurantoin, 100 mg BID for 5-7 days. The second line's preferred order, when a patient should be given ciprofloxacin 200-500 mg for 3 days and Amoxillia 500 mg for 7 days. The patient should be educated by being counseled about risk factors by consideration of vaginal estrogen in postmenopausal women. Prophylaxis and self initiated therapy should be done continuous.
Recommendations
Immediate action taken in patients depends on the level of symptoms which may lead to admission in the hospital and immediate intravenous antibiotics in proper sample of urine sensitivity. In this case women, which presents high symptoms of lower UTI pyuria, may be treated without empirical culture, though it may assist in the patients who do not respond to therapy history of recent UTI risk infection due to resistance.
