Ultimate List of Nursing PICO Question and Sample Statements

The PICO Questions: Overview with Examples

PICO questions generally have 4 parts or ideas and are utilized for clinical basic leadership. PICO questions are a sort of frontal area question, however unquestionably increasingly intricate. Most PICO questions address treatment and determination. These inquiries analyze the mediations, or activities, of human services experts when thinking about patients to decide which intercession is generally helpful.

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Instances of PICO Questions

  1. In non-mobile patients, (P) does turning the patient (I) contrasted with weight beddings (C) diminish the danger of weight ulcers? (O).
  2. In ventilated patients (P), the head-of-bed height of 45 degrees (I) contrasted with 20 degrees (C) decrease the frequency of ventilated related pneumonia (O).
  3. In hospitalized children,(P) does the Wong-Baker Pain FACES Rating Scale (I) contrasted with the Child Medical Fear Scale (C) all the more adequately assess the kid’s dimension of torment (O)?

The purpose of developing these questions is to identify the present health condition of a patient by going through their previous health records. Secondly, getting the precise facts about the diagnosed disease and their remedies is also the purpose of composing these questions. It really takes a lot of time to write such questions. However, you’ll end up in getting fruitful results after working hard on creating those questions. The best way is to study the prior record of the patient in detail. Then, you can be able to develop a feasible set of questions with no doubt. Another noteworthy point is to focus on the 4 elements included in the PICO. otherwise, the personal additions won’t work in your favor for sure. Asking some questions personally from the patient would be more helpful. This is how you would be able to accomplish the goal without facing a lot of trouble.

Notice the request of the inquiry and the segments, or ideas, in the perplexing inquiries.

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PICO Questions for Emergency Nursing

  1. Electronic medical record (EMR) system is an organized method of collecting, encoding, and storing patient and hospital information digitally. Evidence shows that EMR can improve patient outcomes by increased staff productivity, improved communication, improved quality of care, and reduced medical errors.

P: Staff nurses in the emergency department (ED) of a tertiary academic hospital in District A
I: electronic medical record system
C: Staff nurses in the ED of a tertiary academic hospital in District B
O: Patient admission time

Question: Does the use of an electronic medical record system in a tertiary academic hospital have an effect on patient waiting time?

  1. Intussusception is a medical emergency among pediatric patients where the intestines telescope into a distal portion causing bowel obstructions. If left undiagnosed and untreated, this condition can be fatal within five days. Surgical intervention is a conservative way of treating intussusception, however, improved patient recovery is observed among pediatric patients who are treated with surgery and water enema.

P: Pediatric patients who were admitted in the ED because of intussusception
I: Surgical intervention alone
C: Pediatric patients who were admitted in the ED because of intussusception and who received both ultrasound-guided water enema reduction and surgical intervention
O: Recovery time

Question: In pediatric patients who were admitted in the ED because of intussusception, how effective is surgical intervention alone compared to ultrasound-guided water enema reduction and surgical intervention in the patient’s recovery (time)?

  1. Triage process is very important in emergency practice particularly in hospitals posed with patient overcrowding challenges such as the increasing number of emergency patient visits and decreasing number of in-patient beds. Strong scientific evidence shows that effective patient triage process can lead to better patient outcomes and improved patient satisfaction.

P: Staff nurses in the emergency department (ED) of one medium-sized municipal hospital
I: Use of Emergency Severity Index (ESI) as a triage system
C: Staff nurses in the ED of another one medium-sized municipal hospital
O: Better patient recovery outcomes and improved patient satisfaction

Question: Does the adoption of the ESI triage system in one medium-sized municipal hospital lead to better patient recovery outcomes and improved patient satisfaction?

  1. Mild traumatic brain injury is one of the leading causes of emergency visits. One of the emerging approaches in emergency care is the use of a checklist/ questionnaire in identifying the concussion subtypes. The early identification of concussion subtype can help deliver treated in a timely manner.

P: Concussed athletes aged 18 years and older who visited the emergency department (ED) in one multi-sports health facility
I: Use of the Rivermead Post-concussion Symptoms Questionnaire (RPQ)
C: Concussed athletes aged 18 years and older who visited the ED in one multi-sports health facility who were not assessed using the RPQ checklist
O: Lower incidence of memory or thinking problems

Question: Among patients who complained of mild head concussion during their ED visits, does the use of the Rivermead Post-concussion Symptoms Questionnaire (RPQ) prevent the incidence of memory or thinking problems when they are discharged?

  1. The use of Glasgow Coma Scale (GCS) scoring has been used as a critical tool for nurses in assessing the level of patients’ consciousness and detecting early deterioration in patients’ neurological function. The elderly patients respond differently to head trauma and may benefit from a modified GCS scoring and prevent mortality.

P: Elderly patients aged 65 years and older who were admitted in the ED of an academic tertiary hospital because of a mild head trauma
I: Modified GCS scoring triage cutoff from GCS 13 to 14
C: Elderly patients aged 65 years and older who were admitted in the ED of the same academic tertiary hospital because of mild head trauma who were assessed by the traditional GCS scoring
O: Hospitalization time

Question: Is changing the GCS scoring triage cutoff from 13 to 14 can reduce the hospitalization time among elderly patients aged 65 years and older who were admitted in the ED of one academic tertiary hospital?

  1. Patient satisfaction is considered as one of the most sensitive indicators of healthcare. In emergency nursing, patient satisfaction has been linked to nursing care and effective patient triage. Evidence shows that nursing communication is associated with patient satisfaction.

P: Patients who presented in the emergency department of a district hospital
I: Communicating with patients their waiting time and informing them about situations that might cause a delay
C: (none)
O: Patient satisfaction as measured by the Consumer Emergency Care Satisfaction Scale (CECSS)

Question: Does nurses’ communication to patients in regards to their waiting time and emerging situations that might cause delay to improve patient satisfaction as measured by the Consumer Emergency Care Satisfaction Scale (CECSS)?

  1. Quality emergency care is dependent on an appropriately-trained team of medical practitioners. Providing regular and up-to-date training on emerging nursing practice guidelines are often a neglected priority. When emergency front-line nurses are adequately trained, there is a lower incidence of job dissatisfaction and burnout.

P: Emergency department (ED) staff nurses in rural state facility A
I: Regular quarterly clinical professional training updates for nurses
C: ED staff nurses in rural state facility B
O: Job dissatisfaction and burnout

Question: Are regular quarterly clinical professional training updates for ED nurses in rural state facility A help lower job dissatisfaction and burnout?

  1. Indwelling urinary catheters (IUC) are often required in older patients aged 65 years and older in the emergency department (ED). Care of elderly patients with IUC including proper placement, reassessment, and removal is required to prevent catheter-associated urinary tract infections.

P: Elderly patients aged 65 years and older admitted in the ED of a tertiary referral hospital with an IUC
I: Catheter irrigation with antimicrobials
C: Elderly patients aged 65 years and older admitted in the ED of a tertiary referral hospital with an IUC who do not receive catheter irrigation with antimicrobials
O: Catheter-associated urinary tract infections

Question: In elderly patients aged 65 years and older admitted in the ED of a tertiary hospital with an IUC, does catheter irrigation with antimicrobials prevent catheter-associated urinary tract infections?

  1. Emergency tracheostomy is a surgical treatment given to patients with acute respiratory distress syndrome. Tracheostomy may prolong patient survival, however, studies show that ICU and hospital stay is found longer among patients who underwent a tracheostomy.

P: Adult patients, aged 18 years and above, diagnosed with acute respiratory distress syndrome in one private hospital
I: Emergency tracheostomy
C: Adult patients, aged 18 years and above, diagnosed with acute respiratory distress syndrome in one private hospital who had endotracheal intubation
O: Hospital stay (in days)

Question: Does emergency tracheostomy among adult patients aged 18 years and above, who were diagnosed with acute respiratory distress syndrome in one private hospital reduce the hospital stay (in days) compared to adult patients from the same hospital who had endotracheal intubation?

  1. The use of ultrasonography in the acute care setting is not a common practice. However, scientific evidence demonstrates that the use of an airway ultrasound as a treatment adjunct to determine treatment can lead to better patient outcomes.

P: Patients with complaints of stridor and breathing difficulties in the emergency department of one medium-sized hospital
I: Use of airway ultrasonography
C: (none)
O: Detection of cause and treatment of respiratory difficulties

Question: In patients with complaints of stridor and breathing difficulties in the emergency department of one medium-sized hospital, does the use of airway ultrasonography detect the cause of stridor on a timely basis and eventually treat the respiratory difficulties?

List of Pediatric PICO Questions

  1. Croup treatment among pediatric patients usually includes the use of dexamethasone combined with nebulized epinephrine for the relief of airway constriction relief. The conventional dose of nebulized epinephrine is 0.5mg/kg of 1:1000 in patients to treat moderate to severe croup. However, research shows that the use of 0.1 mg/kg nebulized epinephrine also relieves airway constriction.

P: Pediatric patients aged 6 months to 5 years old diagnosed with severe croup admitted in three pediatric emergency departments
I: Use of 0.1 mg/kg dose of nebulized epinephrine as an adjunct to dexamethasone
C: Pediatric patients aged 6 months to 5 years old admitted in three pediatric emergency departments who were nebulized with 0.5 mg/kg conventional epinephrine dose
O: Relief of severe airway constriction

Question: In pediatric patients aged 6 months to 5 years old diagnosed with severe croup admitted in three pediatric emergency departments, how does the use of 0.1 mg/kg dose of nebulized epinephrine in combination with dexamethasone relieve severe airway constriction compared to the 0.5 mg/kg conventional epinephrine dose?

  1. Stress ulcer prophylaxis is considered standard care among critically ill patients in the intensive care unit. Scientific evidence demonstrates that the use of proton pump inhibitors as prophylaxis help prevent the development of stress ulcers among ICU pediatric patients.

P: Pediatric patients admitted in the critical care unit of one medium-sized public hospital
I: Use of proton pump inhibitors as prophylaxis to stress ulcers
C: Pediatric patients admitted in the critical care unit of one medium-sized public hospital receiving histamine-2-receptor antagonists as prophylaxis to stress ulcers
O: Shorter ICU stay

Question: Does the use of proton pump inhibitors as prophylaxis to stress ulcers compared to those who are receiving histamine-2-receptor antagonists shorten the ICU stay of pediatric patients admitted in the critical care unit of one medium-sized public hospital?

  1. Delaying the first bathing time of newborn infants to 48 hours after birth is effective in preserving the body temperature of the infant. It can also improve skin moisture and skin integrity.

P: Newborns born within 24 hours and admitted in a medical hospital
I: Delaying the first bathing time to 48 hours after birth
C: Newborns born within 24 hours and admitted in a medical hospital who were bathed immediately after birth
O: Higher body temperature at the 10th minute of life

Question: In newborn infants who were born within 24 hours and admitted in a medical hospital, how does delaying the first bathing time to 48 hours after birth increase the body temperature at the 10th minute of life?

  1. Early screening of type 2 diabetes in adolescents is important as it helps prevent the development of metabolic and cardiovascular complications. The use of glycosylated hemoglobin A1c as a screening method is a standard practice among adults.

P: Obese adolescents who are seen in a school clinic in the past six months
I: Use of glycosylated hemoglobin A1c as a screening method
C: Obese adolescents who are seen in a school clinic in the past six months and was screened using fasting plasma glucose test
O: Early diagnosis of diabetes (in days)

Question: In obese adolescents who are seen in a school clinic in the past six months, what are the differences of the use of glycosylated hemoglobin A1c and fasting plasma glucose test in the diagnosis time (in days)?

  1. Children suffering from pediatric asthma are noted to have low self-efficacy or self-confidence. A study by Kocaaslan and Kostak (2019) has observed that the use of a disease management education help in improving the quality of life and self-efficacy levels of the asthmatic children after two months.

P: Children with asthma aged 10-18 years old
I: Individual asthma education intervention
C: (none)
O: Higher self-efficacy scores using the standardized tool, “Self-Efficacy Scale for Children and Adolescents with Asthma”

Question: In children with asthma aged 10-18 years old, what are the effects of individual asthma education intervention on their self-efficacy scores?

  1. The conventional antimicrobial therapy for children with cellulitis, bone, and joint infections, and infective endocarditis is the continuation of intravenous antibiotics at home or after hospital discharge. This intervention is called outpatient parenteral antimicrobial therapy or OPAT and usually has a negative impact on the caregivers’ work or the child’s school attendance.

P: Children diagnosed with bone infections
I: Outpatient oral antibiotic therapy
C: Children diagnosed with bone infections who are in oral antibiotic therapy upon discharge
O: Missed school (in days)

Question: In children diagnosed with bone infections, how does OPAT affect the school attendance compared to those who are in oral antibiotic therapy upon discharge?

  1. Massage interventions are found to aid in the growth of preterm infants in the ICU, particularly on the improvement of weight, prevention of nosocomial infections, and reduction of incidence of respiratory illness.

P: Preterm infants born at a gestational age between 32 and 34 weeks who are admitted in the ICU
I: 15-minute massage intervention given by their parents or caregivers
C: Preterm infants born at a gestational age between 32 and 34 weeks who are in the NICU and do not receive massage intervention
O: Weight gain (in kilograms)

Question: Does a 15-minute massage intervention given by parents or caregivers have an effect on the weight gain of preterm infants born at a gestational age between 32 and 34 weeks who are admitted in the NICU?

  1. Evidence shows that the use of skin-to-skin care for infants help improve physiologic development, pain perception, brain development, and parental bonding. This low-cost and effective intervention is also being used for infants who underwent a surgical procedure.

P: Infants admitted in the ICU who underwent a surgical procedure
I: Skin-to-skin care intervention with their parents or caregivers
C: (none)
O: Wound healing time (in days)

Question: Does the skin-to-skin care intervention with parents or caregivers shorten the surgical wound healing time of infants admitted in the ICU who underwent the surgical procedure?

  1. Measuring the temperature of pediatric patients requires accurate measurement. Thermometry in pediatric care can help identify and diagnose serious illnesses that might be caused by infections. Similarly, accurate temperature measurement also helps prevent febrile seizures which are quite common among children less than 5 years old. The rectal thermometer is still the gold standard in measuring the temperature of children compared to measuring through the axilla, oral, or tympanic membrane.

P: Pediatric patients aged 3 years to 5 years old and admitted in one private pediatric ward
I: Use of rectal thermometer to detect fever
C: Pediatric patients aged 3 years to 5 years old and admitted in one private pediatric ward who are measured with an axillary thermometer
O: Prevention of fever >38 C or 100 F.

Question: In pediatric patients aged 3 years to 5 years old and admitted in one private pediatric ward, does the use of rectal thermometer help prevent the occurrence of fever >38 C or 100 F compared to the use of axillary thermometer?

  1. Chlorhexidine solution is among the many effective solutions being used in cleaning the umbilical cord which aid in the falling of the stump and drying of the umbilical area. Similarly, the use of chlorhexidine also helps in preventing bacterial colonization in the umbilical area.

P: Newborns who were delivered in one maternity clinic
I: Use of 4% chlorhexidine solution
C: Newborns who were delivered in one maternity clinic and cleansed with saline solution
O: Falling off of umbilical cord stump (in days)

Question: Does the use of 4% chlorhexidine solution in newborns who were delivered in one maternity clinic help in the faster falling off of umbilical cord stump?

PICO Questions for Oncology Patients

  1. Omega-3 rich foods are scientifically linked to improving the efficacy of cancer management and suppressing the progression of certain types of cancer cells. Foods that are high in Omega-3 are mackerel, salmon, herring, oysters, sardines, and cod liver oil.

P: Patients diagnosed with colon or colorectal cancer at the early stages
I: Consumption of a diet rich in Omega 3 twice a week for at least a year
C: (none)
O: Cancer survival rate

Question: What is the cancer survival rate among patients diagnosed with colon or colorectal cancer at the early stages who consumed a diet rich in Omega 3 twice a week for at least a year as opposed to patients who were not required to have an Omega-3 rich diet?

  1. Infections are one of the most common complications of patients diagnosed with a hematological or oncological illness. Recent trends on the management of febrile neutropenia involve a less aggressive initiation of antifungal treatment and instead be guided first by imaging or other screening tests prior to the initiation.

P: Patients aged 18 to 34 years old admitted in the cancer unit of a tertiary hospital and diagnosed with any hematological cancer or cancer type
I: Screening through imaging or other tests prior to the initiation of antifungal treatment for febrile neutropenia
C: Patients aged 18 to 34 years old admitted in the cancer unit of a tertiary hospital, diagnosed with any hematological cancer or cancer type, and initiated with antifungal treatment for febrile neutropenia without any imaging or screening tests
O: Shorter hospitalization stay

Question: In patients aged 18 to 34 years old admitted in the cancer unit of a tertiary hospital and diagnosed with any hematological cancer or cancer type, what is the effect of prior imaging or screening tests before being initiated on antifungal treatment for febrile neutropenia.

  1. High-intensity exercises during chemotherapy have positive effects on the survival of breast cancer patients. Moreover, other benefits of high-intensity exercises include reduction of cancer-related fatigue and improvement of the quality of life, muscle strength, cardiovascular health, among others.

P: Breast cancer stage I or II who are being followed-up in the ambulatory clinic A
I: High-intensity aerobic training for three months
C: Breast cancer stage I or II who are being followed up in the ambulatory clinic B
O: Improved quality of life

Question: Among breast cancer (stage I or II ) patients who are being followed up in the ambulatory clinic A, what is the effect of the high-intensity aerobic training for three months on quality of life compared to breast cancer (stage I or II) patients who are being followed up in the ambulatory clinic B?

  1. Cancer patients who underwent mastectomy or breast reconstruction experienced severe post-operative pain. Opioids are often prescribed for the management of postoperative pain, however, there are serious adverse effects from opioids. Oral muscle relaxants or spasmolytics along with paracetamol are also considered a good alternative to opioids.

P: Breast cancer patients who underwent mastectomy or breast reconstruction surgical procedure
I: Oral administration of spasmolytics, such as thiocolchicoside, in combination with paracetamol
C: Breast cancer patients who underwent mastectomy or breast reconstruction surgical procedure who were prescribed with opioids as postoperative pain management
O: Reduced pain intensity

Question: In breast cancer patients who underwent mastectomy or breast reconstruction procedure, how does oral administration of spasmolytics, such as thiocolchicoside, in combination with paracetamol, compared with opioids affect the pain intensity postoperatively?

  1. Peripheral neuropathy is a serious and common side effect of chemotherapy. It occurs because some chemotherapeutic agents like vinca alkaloids, cisplatin, and podophyllotoxins damage the peripheral nerves. Acupuncture, as a novel regimen for peripheral neuropathy, is evidently associated with the reduction of pain intensity.

P: Patients diagnosed with cancer or any malignant or non-malignant tumor who are undergoing chemotherapy using vincristine.
I: Acupuncture sessions twice per week for eight weeks
C: Patients diagnosed with cancer or any malignant or non-malignant tumor who are undergoing chemotherapy using vincristine and not enrolled in the acupuncture sessions
O: Reduced pain intensity

Question: Does acupuncture sessions twice weekly has an effect on the reduction of pain intensity among patients diagnosed with cancer or any malignant or non-malignant tumor who are undergoing chemotherapy using vincristine within eight weeks?

  1. Administration of pain medications intrathecally is an established and safe method in the management of chronic pain among cancer patients. Opioid analgesics (like morphine) and non-opioid analgesics (zicotonide, for example) are some medications that can be administered thru intrathecal route. However, strict caution is observed due to tolerance, safety, and dosing issues.

P: Female patients diagnosed with bone or joint cancer (stage III/ IV)
I: Opioid analgesics being administered intrathecally
C: Female patients diagnosed with bone or joint cancer (stage III/ IV) receiving opioid analgesics via the intravenous route
O: Reduction of pain intensity

Question: In female patients diagnosed with bone or joint cancer (stage III/ IV), what is the effect of intrathecal opioid analgesics on the pain intensity compared with female patients diagnosed with bone or joint cancer who are receiving the same analgesics intravenously on the pain intensity?

  1. Olanzapine, an anti-psychotic drug, is also routinely used as an anti-emetic agent for patients undergoing chemotherapy or chemoradiotherapy. Nausea and vomiting is a common side effect of chemotherapeutic agents. However, as this is a new indication for the drug, there is limited evidence supporting its anti-emetic properties.

P: Male patients diagnosed with cancer who are undergoing chemotherapy or chemoradiotherapy and experiencing nausea and vomiting
I: Use of oral olanzapine as a treatment for chemotherapy-related emesis
C: Male patients diagnosed with cancer who are undergoing chemotherapy or chemoradiotherapy and being managed with other anti-emetics for their nausea and vomiting
O: Absence of nausea and vomiting

Question: Does the use of oral olanzapine has an effect as a treatment for chemotherapy-related nausea and vomiting of male cancer patients undergoing chemotherapy or chemoradiotherapy?

  1. Exercise is an effective intervention associated with improving the quality of life of patients diagnosed with cancer. Additionally, exercise has positive effects on the patient’s fatigue and sleep quality.

P: Pediatric patients diagnosed with cancer and admitted in hematology and oncology wards in one medical facility
I: Five-week walking regimen consists of 20 minutes a day walk
C: Pediatric patients diagnosed with cancer and admitted in hematology and oncology wards in one medical facility who are not enrolled in the five-week walking regimen
O: Decreased general fatigue

Question: In pediatric patients diagnosed with cancer and admitted in hematology and oncology wards in one medical facility, does a five-week walking regimen has an effect on reduction of general fatigue compared to pediatric patients not enrolled in the regimen?

  1. Integrating play therapy in the care and management of pediatric patients diagnosed with cancer has numerous benefits. When applied in a setting that is traumatic and usually results in pain and discomfort, play therapy allows children to communicate their pains and fears more openly.

P: Pediatric patients diagnosed with bone or joint cancer and admitted in the oncology ward of a tertiary hospital
I: Play therapy which includes storytelling, drawing, and games
C: (none)
O: Decreased pain occurrence

Question: Does play therapy (i.e. storytelling, drawing, games) has an effect on the pain occurrence among pediatric patients diagnosed with bone or joint cancer and admitted in the oncology ward of a tertiary hospital?

  1. Music therapy is an integral part of palliative and hospice care which primarily aims to improve the quality of life and enable open communication. There is a growing body of scientific evidence that supports the beneficial effects of music therapy particularly for chronically ill or end-of-life patients.

P: Patients diagnosed with liver carcinoma who are admitted in the hospice care unit of a medical center
I: Music therapy for at least six months of duration
C: Patients diagnosed with liver carcinoma who are admitted in the hospice care unit of a medical center who are not required to receive music therapy
O: Improved quality of life

Question: How do patients diagnosed with liver carcinoma who are admitted in the hospice care unit of a medical center perceive the quality of their lives after receiving music therapy for at least six months?

PICO Questions for Cardiac Patients

  1. Atrial fibrillation remains a prevalent complication following cardiac surgery. To effectively manage atrial fibrillation, cardiac rhythm and rate need to be controlled with the use of beta-blockers, calcium channel blockers, and antiarrhythmic drugs. Meanwhile, warfarin is used for patients with non-valvular atrial fibrillation or for patients with a history of stroke.

P: Patients who had an aortic valve replacement
I: Use of intravenous beta-blockers preoperatively
C: (None)
O: Shortened ICU stay

Question: In patients who had an aortic valve replacement, does the preoperative use of intravenous beta-blockers can shorten the ICU stay?

  1. Studies demonstrate that women have higher risks of death following a coronary artery bypass grafting (CABG). The cited causes for the gender differences in the outcome of CABG can be attributed to older age, smaller body size, coronary artery diameters, and a higher incidence of underlying comorbidities (i.e diabetes, hypercholesterolemia, hypertension).

P: Women who had coronary artery bypass grafting procedure
I: Aged 60 and above
C: Men who had coronary artery bypass grafting procedure
O: Mortality

Question: Are women who had coronary artery bypass grafting procedure with the age of 60 and above at increased risk for death than men who had coronary artery bypass grafting procedure and aged 50-60 years old?

  1. In pulmonary artery hypertension, there is increased pressure in the pulmonary artery which leads to right-sided heart failure. The use of prostacyclin, a potent vasodilator, is still one of the most effective treatments of pulmonary arterial hypertension. Because prostacyclins are expensive, prostacyclin analogs like iloprost and treprostinil are widely used instead.

P: Patients diagnosed with pulmonary artery hypertension
I: Intravenous use of epoprostenol, a synthetic prostacyclin
C: Use of prostacyclin analogs like iloprost and treprostinil
O: Better patient survival outcome

Question: Does intravenous use of epoprostenol, a synthetic prostacyclin, have an effect on the survival rate of patients diagnosed with pulmonary artery hypertension as opposed to patients who are being treated with prostacyclin analogs like iloprost and treprostinil?

  1. Recent updates on cardiac medicine include the combination of anticoagulants and antiplatelet therapy as the treatment of peripheral arterial disease. Peripheral arterial disease is a condition characterized by reduced blood flow to lower extremities because of the narrowing of arteries.

P: Patients with peripheral arterial disease
I: Combination therapy of anticoagulant and antiplatelet medications
C: Anticoagulant agent alone, or antiplatelet agent alone
O: Prevention of myocardial infarction

Question: Does the combination therapy of anticoagulant and antiplatelet agents in patients with peripheral arterial disease, prevent myocardial infarction compared to single therapy of anticoagulant or antiplatelet alone?

  1. Nurse-managed interventions have found to improve the functioning and self-care and lower emergency hospitalizations among an ethnically diverse patient population who have heart failure. More often, patients with an ethnic background like Hispanic, black, Asian, and others, have low knowledge of patient self-management and clinical care.

P: Hispanic patients aged 65 years and older who presented to the ambulatory care unit in one medium-sized municipal hospital
I: Nurse-managed interventions such as patient counseling on diet, medication adherence, and follow-up calls in bilingual language (i.e. English, Spanish)
C: Other white American patients aged 65 years and older who presented to the ambulatory care unit in one medium-sized municipal hospital.
O: Better functioning and self-care at home when discharged and lower emergency hospitalizations.

Question: Do nurse-led interventions improve patient functioning and self-care at home and lower emergency hospitalizations?

  1. Scientific evidence demonstrates that hyperkalemia is associated with increased mortality in patients with myocardial infarction. Extracellular potassium levels should be maintained at a range of 3.5- 5.2 mmol/ l. In patients with myocardial infarction, both low and high potassium levels can cause cardiac arrhythmia and must be prevented.

P: Patients with myocardial infarction
I: Constant monitoring and maintenance of potassium levels within 3.5- 5.2 mmol/l
C: (none)
O: Prevention of cardiac arrhythmias

Question: In patients with myocardial infarction, do constant monitoring and maintenance of potassium levels within 3.5 to 5.2 mmol/l have an effect on prevention of cardiac arrhythmias?

  1. Recent updates found out that a coronary computed tomographic angiography (CTA), when used as an initial diagnostic strategy for patients with coronary artery disease, had fewer adverse cardiac effects than a functional stress test. Coronary CTA involves the use of iodine-containing contrast material and CT scanning in examining the narrowing of arteries while a functional stress test is characterized by the evaluation of blood flow during a physical exercise.

P: Patients diagnosed with coronary artery disease
I: Use of coronary computed tomographic angiography as an initial diagnostic strategy
C: Use of functional stress test
O: Decreased adverse effects such as myocardial infarction

Question: Is a coronary computed tomographic angiography as an initial diagnostic strategy for patients diagnosed with coronary artery disease safer and has fewer adverse effects (like myocardial infarction) compared to the use of functional stress test?

  1. Vitamin D has protective benefits on the cardiovascular system. Some benefits of Vitamin D include suppression of the renin-angiotensin system, regulation of cardiac processes, effects on smooth muscle functioning, and lower incidences of diabetes and lipid problems.

P: Patients diagnosed with diabetes mellitus
I: Daily oral use of vitamin D supplementation (4,000 IU)
C: (none)
O: Prevention of myocardial infarction

Question: In patients diagnosed with diabetes mellitus, does daily oral use of vitamin D supplementation (4,000 IU) prevent myocardial infarction?

  1. The goal of nursing care for patients with acute heart failure includes the prevention of signs of fluid overload and therefore preserving peripheral perfusion. One nursing implication is to diligently monitor the hourly urinary output which should be greater than 0.5 ml/kg/hour.

P: Patients diagnosed with acute heart failure
I: Hourly monitoring of urinary output
C: (none)
O: Prevention of fluid overload symptoms (i.e. edema, headache, stomach bloating, and difficulty of breathing)

Question: Does hourly monitoring of urinary output in patients with acute cardiac failure help prevent fluid overload symptoms (i.e. edema, headache, stomach bloating, and difficulty of breathing)?

  1. Ultrafiltration is a novel therapeutic intervention where excess body fluids are removed to prevent hypervolemia in patients with heart failure. This process is positively associated with fewer rehospitalizations as compared to diuretic infusion or injections.

P: Patients with decompensated heart failure
I: Use of ultrafiltration
C: Use of diuretic infusions
O: Fewer rehospitalizations

Question: In patients with decompensated heart failure, what is the effect of ultrafiltration on patient rehospitalization compared to the use of diuretic infusions?

PICO Questions for Geriatrics

  1. Falls among the elderly population is common particularly among those who are taking medications. Medications such as vasodilators, alpha blockers, oral hypoglycemics, opioids, diuretics, antipsychotics, and sedative psychotics are found out to increase the elderly patients’ likelihood to have fall injuries.

P: Elderly patients that are being followed up in one community clinic
I: Use of medications (vasodilators, alpha blockers, oral hypoglycemics, opioids, diuretics, and sedative psychotics)
C: Elderly patients that are being followed up in one community clinic who are not taking any of the following vasodilators, alpha blockers, oral hypoglycemic, opioids, diuretics, antipsychotics, and sedative psychotics
O: Incidence of fall in the past year

Question: In elderly patients, does the use of medications (vasodilators, alpha blockers, oral hypoglycemic, opioids, diuretics, antipsychotics, and sedative psychotics) have an effect on the incidence of fall in the past year?

  1. The physical environment has been linked to a positive coping and better quality of life among the elderly. Some studies observed that the physical environment is an integral domain to help the elderly feel safe and have adequate access to information and the availability of health services. There is a discordance on the available researches on which between own family home or health facility has a greater effect on the elderly’s mental health and quality of life.

P: Elderly patients diagnosed with early stage of dementia.
I: Living in a community facility
C: Elderly patients diagnosed with early stage of dementia who are living in their own family house, with an intended caregiver
O: Quality of life

Question: Does living in a community facility among the elderly patients diagnosed with early stage of dementia improve their quality of life as opposed to those who are living in their own family house with an intended caregiver?

  1. Fractures are one of the priority public health problems because the elderly population is growing. It also affects public healthcare because of its straining demands on the resources caused by long-term disability. There are several ways in preventing fractures in the elderly such as the use of pharmacological modalities (i.e. calcium, Vitamin D, biphosphonates, selective estrogen receptor inhibitors, estrogen, calcitonin, recombinant human parathyroid hormone). The use of recombinant parathyroid hormone as a subcutaneous injection decreases fractures by almost 60%.

P: Female elderly patients aged > 65 years old with no previous history of fractures
I: Use of recombinant parathyroid hormone
C: Female elderly patients aged > 65 years old with no previous history of fractures who are not using recombinant parathyroid hormone
O: Impaired balance and coordination

Question: Does the use of recombinant parathyroid hormone has an effect on the balance and coordination of female elderly patients aged > 65 years old as opposed to other female elderly patients who are not using the recombinant parathyroid hormone?

  1. Telemonitoring applications have been potentially useful in delivering health services to the elderly and in maintaining their independence. Examples of telemonitoring applications include the aid of a remote device in the monitoring of vital signs or health education with a nurse or doctor. Studies demonstrate that home telemonitoring and management of blood glucose is effective in type 2 diabetic patients.

P: Elderly patients aged > 65 years old and above and diagnosed with type-2 diabetes mellitus
I: Use of telemonitoring in sending reminders for insulin injections
C: Elderly patients aged > 65 years old and above and diagnosed with type-2 diabetes mellitus who were not monitored remotely using any telemonitoring applications
O: Reduce HbA1c levels

Question: In elderly patients aged > 65 years old and above and diagnosed with type-2 diabetes mellitus, what is the effect of the use of telemonitoring on the reduction of HbA1c levels as compared to elderly patients who were not monitored remotely using any telemonitoring applications?

  1. Undernutrition is prevalent among the elderly population and predominantly due to protein-energy wasting. Some of the causes of undernutrition in the elderly include dehydration, malabsorption, anorexia, and hypermetabolism. Early detection and use of reliable assessment tools are necessary to determine the undernutrition risks which are often underreported. Examples of reliable and validated instruments are the Nutritional Form of the Elderly or NUFFE and the Mini Nutritional Assessment.

P: Elderly patients who are attending an out-patient facility
I: Use of the Nutritional Form of the Elderly or NUFFE
C: Use of the Mini-Nutritional Assessment (MNA)
O: Sensitive and reliable in identifying actual undernutrition.

Questions: Does the use of the Nutritional Form of the Elderly or NUFFE in assessing the elderly patients who are attending an out-patient facility is more sensitive and reliable in identifying actual undernutrition compared to the use of the Mini-Nutritional Assessment or MNA?

  1. Polypharmacy is becoming an area of concern for the elderly. Polypharmacy is defined as the use of at least five clinically prescribed medications per day. Studies show that elderly patients averagely take 2-9 medications per day. It is a pressing health issue because the elderly are more predisposed to experience adverse drug reactions due to drug-to-drug interactions, poor metabolism, and ineffective drug clearance.

P: Elderly patients who are taking at least five medications per day
I: Monthly evaluations of a doctor
C: (none)
O: Better quality of life scores using a standardized tool

Question: In elderly patients who are taking at least five medications per day, what are the effects of a doctor’s monthly evaluations on the patients’ quality of life?

  1. Music intervention has been proven to reduce the likelihood of depression and dementia among the elderly. Interventions such as group music therapy or choir singing can improve the mood and cognitive function in dementia patients.

P: Care home residents aged > 65 years old with dementia or depression symptoms
I: Combination of group music therapy and recreational choir singing for at least six months
C: No music intervention
O: Reduced depressive symptoms using the Montgomery-Asberg Depression Rating Scale

Question: In care home residents aged > 65 years old with dementia or depression symptoms, does the implementation of a combination of group music therapy and recreational choir singing for at least six months can reduce the depressive symptoms as opposed to patients who do not receive any music intervention?

  1. Cognitive stimulation therapy (CST) is deemed to have beneficial effects against dementia. It is often implemented among patients with mild or moderate dementia and involves weekly sessions of themed activities. The main objective of the CST sessions is to stimulate demented patients in an optimal social and cognitive conducive learning environment.

P: Patients diagnosed with mild or moderate dementia and are admitted in a nursing care facility
I: Cognitive stimulation therapy sessions of at least three times per week
C: One (1) cognitive stimulation therapy session per week
O: Improved cognitive ability

Question: Does cognitive stimulation therapy sessions of at least three times per week improve the cognitive ability of patients diagnosed with mild or moderate dementia admitted in a nursing care facility compared to one (1) cognitive stimulation therapy session per week?

  1. Urinary incontinence among the elderly is caused by various reasons such as underlying chronic diseases, physiological loss of pelvic muscle strength, stress, effects of medication like diuretics, among others. Pelvic muscle exercises are one of the non-pharmacological interventions that can help reduce urinary incontinence and eventually improve the self-esteem of the elderly.

P: Female elderly patients who are being followed up in a tertiary hospital
I: Pelvic muscle exercises
C: (none)
O: Improved self-esteem

Question: In female elderly patients who are being followed up in a tertiary hospital, what are the effects of pelvic muscle exercises on their self-esteem?

  1. The elderly and debilitated patients suffer from pressure ulcers and are predisposed to higher infection risks. Because of immobility, poor nutrition, dehydration, and chronic diseases, the elderly develop pressure ulcers. Pressure ulcers are localized skin damage usually located over bony prominences. Turning the patient’s position every two hours is considered to be effective in preventing the occurrence of pressure ulcers.

P: Elderly patients with spinal cord injury admitted in a long-term nursing facility
I: Turning to sides every two hours
C: (none)
O: Prevention of pressure ulcers

Question: In elderly patients with spinal cord injury admitted in a long-term nursing facility, does turning to sides every two hours prevent pressure ulcers?

PICO Questions for Stroke Patients

  1. Racial and ethnic background is considered a demographic factor that predisposes individuals to suffer from a stroke. Of all the races, African-Americans and Caribbean-Hispanics have higher risks to stroke than the whites. Understanding the racial and cultural differences in stroke risks is significant in ensuring that medical care is appropriate and effective.

P: African-American patients who suffered from a stroke
I: Post-stroke rehabilitation therapy consisting of physical, occupational, speech, and language therapy of at least six months
C: (none)
O: Prevention of post-stroke disability

Question: Does a six-month post-stroke rehabilitation therapy consisting of physical, occupational, speech, and language therapy has an effect on the prevention of post-stroke disability in African- American stroke patients?

  1. A regular and frequent form of exercises in the first six months following an ischemic stroke occurrence can regain the loss of sensory and motor function. Aerobic and strength training are good examples of exercise for patients who suffered from a stroke. The positive benefits of exercise include, but not limited to, improvement of functional capacity, ability to perform activities of daily living, quality of life, and prevention of other cardiovascular illness.

P: Patients who had an ischemic stroke 48 hours prior to admission
I: Bilateral passive range of motion exercises for the first six months after the stroke
C: Patients who had an ischemic stroke 48 hours prior to admission and were not enrolled in the exercise regimen
O: Improved arm muscle strength

Question: In patients who had ischemic stroke 48 hours prior to admission, do bilateral passive range of motion exercises for the first six months after the stroke has an effect on their arm muscle strength compared to patients who are not enrolled in the regimen?

  1. Stroke subtype classification is pertinent in preventing recurrent minor ischemic stroke attack. The Atherosclerosis, Small vessel disease, Cardiac source, Others (ASCO), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Causative Classification System are three classification systems that are used in classifying stroke subtypes. These classification systems can aid in identifying environmental and genetic risk factors.

P: First-time minor stroke patients
I: Using the ASCO stroke classification system
C: Stroke patients who were classified using the TOAST system
O: Decreased recurrence of minor stroke attack

Question: Among first-time minor stroke patients, does the ASCO stroke classification system has an effect on decreasing the recurrence of minor stroke attack compared to stroke patients classified by the TOAST system?

  1. Depression is common in one-third of stroke survivors. Most survivors experience depression because of the sudden changes (physiological, neurological, and socio-emotional) associated with stroke and its impact on daily living and quality of life. Elderly stroke survivors have a higher likelihood to have depression because of feelings of alienation and helplessness. Support groups for post-stroke survivors are deemed to be effective in the prevention of depression.

P: Elderly patients (aged 65 years old and above) who suffered from a stroke attack in the past month
I: Participation in a post-stroke support group
C: (none)
O: Decreased occurrence of depression

Question: For elderly patients (aged 65 years old and above) who suffered from a stroke attack in the past month, does participation in a post-stroke support group reduce the future risks of having depression?

  1. Intravenous recombinant tissue plasminogen activator (rtPA) had proven to be an effective intervention in the first three hours following an ischemic stroke. However, there are studies that demonstrate a larger therapeutic window in the administration of rtPA to 3 to 6 hours after the onset of symptoms. Furthermore, re-occlusion after the administration of an effective thrombolytic agent is apparent especially for cases of proximal occlusion. New updates on stroke management include the combination of mechanical thrombectomy in adjunct with intravenous thrombolysis. Mechanical thrombectomy is a novel intervention where the blood clots are dislodged using a catheter stent inserted in an artery.

P: Patients who presented with clinical manifestations of ischemic stroke
I: Mechanical thrombectomy in adjunct with intravenous thrombolytic agent administered within 3-6 hours after onset of stroke symptoms
C: Intravenous thrombolytic agent only administered within 3-6 hours after onset of stroke symptoms
O: Reduced occurrence of re-occlusion

Question: In patients with clinical manifestations of ischemic stroke, what is the effect of the combination of mechanical thrombectomy and intravenous thrombolytic agent administered within 3-6 hours after onset of symptoms to the reduction of the occurrence of re-occlusion as compared to intravenous thrombolytic agent alone?

  1. Endovascular treatment is a non-surgical intervention where microcatheters are inserted in the groin or arm, guided by an X-ray imaging, and directed to the clotted blood vessels. When blood clots are not removed, they are liquefied using drugs. For patients with tandem occlusion (i.e. proximal intracranial occlusion and cervical carotid artery occlusion), they were treated by a combination of treatment such as thrombectomy, carotid stenting, antithrombotic agents for better blood vessel reperfusion.

P: Acute ischemic stroke patients diagnosed with tandem lesions
I: Carotid stenting in addition to thrombectomy and antithrombotic agents
C: Acute ischemic stroke patients diagnosed with tandem lesions who are treated with thrombectomy and antithrombotic agents only
O: Higher reperfusion rates

Question: What is the effect of a combination of three interventions (carotid stenting, thrombectomy, and antithrombotic agents) to reperfusion rates of acute ischemic stroke patients diagnosed with tandem lesions as opposed to a treatment of thrombectomy and antithrombotic agents only?

  1. Technological advances in post-stroke management include robotic-assisted rehabilitation. Robotic devices used in the rehabilitation are found out to reduce motor impairment and improve functional recovery because of delivery of high-intensity and high-dosage training. The three types of robotic devices are based on the part of the body which the therapy is focused on, their mechanical characteristics, and exercise program.

P: Acute stroke patients who have hemiplegic upper limb disability
I: Robotic-assisted sensorimotor rehabilitation of the upper limb
C: Acute stroke patients who have hemiplegic upper limb disability who are receiving rehabilitation therapy assisted by a physical therapist
O: Reduce motor impairment

Question: In acute stroke patients who have hemiplegia, does a robotic-assisted sensorimotor rehabilitation therapy have an effect on the reduction of motor impairment compared to being assisted by a physical therapist?

  1. Statins are lipid-lowering medications that specifically work in lowering the level of low-density lipoproteins in the body. Evidence shows that statins may help in preventing future ischemic events after an acute ischemic stroke. This is also in concordance to AHA/ ASA guidelines on the management of stroke.

P: Patients who suffered from an acute ischemic stroke with atrial fibrillation
I: Use of statins
C: Patients who suffered from an acute ischemic stroke with an atherothrombotic cause
O: Reduced stroke recurrence

Question: Does the use of statins in patients who suffered from an acute ischemic stroke with atrial fibrillation has effects on stroke recurrence as opposed to stroke patients with an atherothrombotic cause?

  1. Quite recently, Edoxaban, a new oral anticoagulant medication has been launched in the market. It is primarily marketed for the prevention of stroke among patients with atrial fibrillation. Similar to warfarin, Edoxaban is found to prevent stroke, embolism, and bleeding.

P: Stroke patients with nonvalvular atrial fibrillation
I: Edoxaban use
C: Stroke patients with nonvalvular atrial fibrillation being treated with warfarin
O: Prevention of recurrent stroke attacks

Question: In stroke patients with nonvalvular atrial fibrillation, does edoxaban prevent recurrent stroke attacks compared with other stroke patients with nonvalvular atrial fibrillation being treated with warfarin?

  1. Studies illustrate that higher dairy consumption is linked to lower stroke risks. Specifically, in the study of Laursen ASD et al (2019)1, whole-fat yogurt can be used in substitution for low-fat yogurt, cheese, butter, or milk regardless of fat content to lower the incidence of stroke.

P: Acute ischemic stroke patients
I: Whole fat yogurt (diet)
C: Stroke patients who are not limited to eat dairy products such as low-fat yogurt, cheese, butter, or buttermilk
O: Lower stroke incidence

Question: In acute ischemic stroke patients, what are the effects of consuming whole-fat yogurt in lowering stroke incidence as compared to other dairy products such as low-fat yogurt, cheese, butter, or buttermilk?

PICO Questions for ICU Patients

  1. Critically-ill patients on mechanical ventilators require intensive and quality pulmonary rehabilitation. Evidence proved that pulmonary rehabilitation such as inspiratory muscle training can help improve respiratory muscle strength and prevent respiratory atrophy, weaning difficulties, and other respiratory complications.

P: Patients on a mechanical ventilator and admitted in the cardiovascular intensive care unit
I: Daily inspiratory muscle training
C: No intervention
O: Successful weaning and shorter weaning duration

Question: Does daily inspiratory muscle training in patients on a mechanical ventilator and admitted in the cardiovascular intensive care unit help in weaning patients successfully and shorten the duration of weaning?

  1. Weaning patients from mechanical ventilator support requires preparation and careful evaluation of clinical status. Studies show that automated weaning can help facilitate patients’ ability to breathe spontaneously and subsequent weaning from mechanical ventilation. Additionally, automated weaning can enforce compliance with a standardized weaning process without being affected by external factors.

P: Critically-ill adults on mechanical ventilator support
I: Use of automated closed -oop weaning system
C: Spontaneous manual breathing
O: Duration of ventilator support

Question: In critically-ill adults on mechanical ventilator support, does the use of automated closed-loop weaning system has an effect on the duration of ventilator support compared to patients on spontaneous manual breathing weaning?

  1. High-flow nasal cannula oxygen therapy is recently being used to deliver humidified high flow oxygen rates (between 15 to 60L/ min) through the nasal cannula for patients with acute hypoxemic respiratory failure. This is also provided to hypoxemic and respiratory-distressed patients as an alternative to invasive mechanical ventilation.

P: Adults diagnosed with acute hypoxemic respiratory failure
I: Use of high-flow nasal cannula
C: Conventional oxygen therapy
O: Incidence of endotracheal intubation

Question: Does the use of high-flow nasal cannula in adults diagnosed with acute hypoxemic respiratory failure lower the incidence of endotracheal intubation as opposed to conventional oxygen therapy?

  1. β- adrenergic agonists such as salbutamol is an effective agent for airway hygiene. Salbutamol works in increasing large airway mucociliary clearance. Existing scientific evidence demonstrated that transtracheal instillation of ipratropium and salbutamol is effective in preventing ventilator-associated pneumonia.

P: Mechanically-ventilated patients with endotracheal tube or tracheostomy
I: Transtracheal instillation of ipratropium and salbutamol after aspiration or suctioning of secretions
C: Instillation of saline solution
O: Prevention of ventilator-associated pneumonia

Question: In mechanically-ventilated patients with endotracheal tube or tracheostomy, does transtracheal instillation of ipratropium and salbutamol after aspiration or suctioning of secretions prevent ventilator-associate pneumonia compared to instillation of the saline solution?

  1. Enteral nutrition is a significant intervention to achieve optimal nutritional requirements for critically-ill patients. There is a discordance on the mode of tube feedings between bolus and continuous parenteral feeding particularly on insulin usage, differences in glycemic functions, and caloric delivery.

P: Critically-ill adult patients who are undergoing percutaneous endoscopic gastrostomy (PEG) feeding
I: Continuous enteral feeding
C: Bolus tube feeding
O: Reduced hypoglycemic episodes

Question: Does continuous percutaneous endoscopic gastrostomy (PEG) feeding in critically-ill adult patients has an effect on the reduction of hypoglycemic episodes as compared to bolus tube feeding?

  1. Critical illness often induces anorexia and loss of ability to eat. Scientific evidence supports that early initiation of supplemental enteral nutrition is found to have harmful effects compared to parental nutrition in pediatric and adult patients admitted in intensive care units. The potential reason is associated with overdosing of energy with minimal protein and the overuse of the gut in the acute phase. Meanwhile, combining enteral and parenteral nutrition can also contribute to liver dysfunction and infection.

P: Pediatric patients admitted to the pediatric intensive care unit
I: Withholding parenteral nutrition for one (1) week
C: Initiating enteral nutrition within 24 hours or 1 day of admission in the pediatric intensive care unit.
O: Duration of recovery time

Question: In critically ill pediatric patients admitted in the pediatric intensive care unit, does withholding parenteral nutrition for one week has an effect on the duration of patient recovery as opposed to initiating enteral nutrition within 24 hours or 1 day of admission?

  1. Epinephrine injections are often administered to patients during cardiac resuscitation. There are studies which found out that continuous epinephrine infusion administration had significant effects on improving cerebral oxygenation.

P: Critically-ill patients who are being given with cardiac resuscitation
I: Continuous epinephrine infusion
C: Epinephrine injections administered as boluses
O: Reduced neurological deficits

Question: Does the use of continuous epinephrine infusion in critically ill patients who are being given with cardiac resuscitation have an effect on the reduction of neurological deficits?

  1. Nosocomial infections are prevalent among patients who are admitted to intensive care units. Recent advances demonstrate the use of nebulized antibiotics as an effective treatment for multidrug-resistant ventilator-associated pneumonia because of its significant localized concentrations.

P: Post cardio-thoracic surgical patients with nosocomial pneumonia caused by multidrug-resistant Gram-negative bacilli
I: Nebulized amikacin twice daily
C: Amikacin administered intravenously
O: Length of hospital days
(T): Seven days of treatment

Question: In post-cardiothoracic surgical patients with nosocomial pneumonia caused by multi-drug resistant Gram-negative bacilli, what is the effect of nebulized amikacin done twice daily to the length of hospital days compared to amikacin administered intravenously after seven days of treatment?

  1. Central-line catheters predispose patients in intensive care units to higher risks of bloodstream infections. Often, uncomplicated central-line bloodstream infections or CLABSI is caused by organisms such as Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus, Micrococcus, Propionibacteria, or fungi. It is imperative that healthcare workers observe optimal handwashing practices and catheter-hygiene to help prevent CLABSI.

P: Patients admitted to an adult general intensive care unit
I: With a central venous catheter
C: With a peripheral intravenous line
O: Length of hospital stay

Question: Are patients admitted in an adult general intensive care unit who have central venous catheter at risk for longer hospital stay than those with peripheral intravenous line only?

  1. One of the most effective ways of preventing catheter-associated urinary tract infections or CAUTI is the early removal of the indwelling catheter. Among urinary tract infections acquired nosocomially, 75% are associated with a urinary catheter in place and almost 15-25% of patients who are hospitalized receive urinary catheters during their stay. Some strategies to avoid CAUTI include daily evaluation of the need for catheters, preventing irrigation for the purpose of avoiding infection, closed drainage system, hand hygiene, and others.

P: Patients admitted in the adult intensive care unit with an indwelling catheter
I: Use of the closed drainage system
C: none
O: Reduced rates of CAUTI and bacteremia

Question: In patients admitted in the adult intensive care unit with an indwelling catheter, does the use of a closed drainage system reduce the rates of CAUTI and bacteremia?

PICO Questions for Pressure Ulcers

  1. Cytokines and growth factors play a significant role in wound healing. Presently, the use of cytokines and growth factors is common in the management of pressure ulcers. These include granulocyte-macrophage-colony-stimulating factor, platelet-derived growth factor, vascular endothelial growth factor, and basic fibroblast growth factor.

P: Patients with non-healing wound pressure ulcers
I: Use of any of these cytokines and growth factors granulocyte-macrophage-colony-stimulating factor, platelet-derived growth factor, vascular endothelial growth factor, and basic fibroblast growth factor
C: (none)
O: Wound healing (change in wound size, time to healing, the rate of healing)

Question: Does the use of cytokines and growth factors such as granulocyte-macrophage-colony-stimulating factor, platelet-derived growth factor, vascular endothelial growth factor, and the basic fibroblast growth factor have an effect on wound healing in patients with pressure ulcers?

  1. Tragacanth cream is now being adapted as an effective intervention in the prevention of decubitus ulcers. Gum tragacanth is a natural mixture of polysaccharide and alkaline materials which is extracted from the Astragalus plant. It works in stimulating the production of T-cells and antibody-producing plasma cells.

P: Long-term facility bedridden patients with Stage III/ Stage IV decubitus ulcer
I: Use of 6% tragacanth cream applied on the wound twice daily
C: Application of any drug-free cream twice daily
O: Time of healing (in days)

Question: In long-term facility bedridden patients with Stage III/ Stage IV decubitus ulcer, does the use of 6% tragacanth cream applied on the wound twice daily has an effect on the time of healing as compared to the application of any drug-free cream twice daily?

  1. Pressure ulcers are localized areas of skin injury or underlying tissues that are usually on bony prominences. Available scientific evidence shows that moisture-retentive wound dressing facilitates the migration of epidermal cells and epithelialization. Foam dressings are indicated to moderate or severe exudating wounds and pressure sores.

P: Adult patients admitted in a long-term facility
I: Use of foam dressing for eight weeks
C: Hydrocolloid dressing
O: Reduction in pressure ulcer size

Question: Does the use of foam dressing in adult patients admitted in a long-term facility have an effect on the reduction in pressure ulcer size as compared to hydrocolloid dressing within eight weeks?

  1. Telemedicine or teleconsultations can aid in evaluating wound care, particularly to remote and rural populations. It is found to be safe and effective as in-person consultation since the treatment of skin ulcers requires a frequent assessment of wound status which can be provided also by telemedicine.

P: Adult out-patients with Stage I/ II pressure ulcers
I: Use of teleconsultation once every week
C: Face-to-face visits once every three weeks
O: Reduction in hospital admissions

Question: In adult out-patients with Stage I/ II pressure ulcers, what are the effects of weekly teleconsultations on reduction in hospital admission compared to face-to-face visits every three weeks?

  1. Hyperbaric oxygen therapy is an evidence-based adjunct intervention which facilitates wound healing. It is described as the use of 100% oxygen at pressures higher than the atmospheric pressure and administered inside a chamber. It works primarily for hyperoxygenation because oxygen is vital in oxidizing proteins and membrane lipids and inhibits bacterial growth.

P: Adult patients with pressure ulcers
I: Administration of hyperbaric oxygen therapy
C: (none)
O: Wound healing

Question: Does the administration of hyperbaric oxygen therapy in adult patients with pressure ulcers have an effect on wound healing?

  1. Higher functional and cognitive impairment is observed in patients with dementia and this predisposes the elderly to higher risks of pressure ulcers. Family and caregivers must of elderly with dementia must be educated on how to prevent pressure sores. These preventative measures include regular skin assessment, using food cradle, and regular turning and shifting of positions.

P: Frail elderly patients
I: Diagnosed with dementia
C: Non-dementia patients
O: Risks of developing pressure ulcers

Question: Are frail elderly patients who have dementia at increased risk to develop pressure ulcers than non-dementia patients?

  1. Several risk factors such as impaired physical mobility, diabetes mellitus, dehydration, and poor nutrition can contribute to higher risks of having pressure ulcers. The areas of the body that are commonly predisposed to having pressure sores are heels, hip, elbows, shoulder, knees, thighs, back of the head, and toes. Dressings and topical agents can be used to facilitate wound healing and prevent the worsening of pressure ulcers. Additionally, there is varied scientific evidence on which dressing has the most efficiency in the management of pressure ulcers.

P: Elderly patients with pressure ulcers and admitted in a long-term nursing facility with pressure ulcers
I: Daily silicone foam dressing
C: Daily polyurethane dressing
O: Better wound healing

Question: In elderly patients with pressure ulcers and admitted in a long-term nursing facility with pressure ulcers, does the daily silicone foam dressing facilitate wound healing better as compared to daily polyurethane dressing?

  1. Nutrition is imperative for the prevention of pressure ulcers. However, nutritional intervention can be a challenge for frail elderly patients. There are several ways on nutritional management in the elderly and this includes providing support during mealtimes, performing a regular assessment of malnutrition risk, provision of high energy and high protein diet, and offering food that is preferred by the elderly.

P: Elderly patients who are admitted in a nursing care facility
I: Regular assessment of the nutritional status
C: (none)
O: Lower risk of pressure ulcers

Question: Does a regular assessment of nutritional status lower the risk of pressure ulcers in elderly patients who are admitted in a nursing care facility?

  1. Dermal gel pads are being used as an intervention in preventing pressure ulcers and work in redistributing pressure to protect the critical bony areas. Evidence shows that there is an almost 70% reduction in hospital-acquired pressure ulcers with the use of dermal gel pads.

P: Patients with spinal cord injury who are admitted in the intensive care unit
I: Use of dermal gel pads
C: (none)
O: Lower risk of pressure ulcers

Question: Do dermal gel pads lower the risk of pressure ulcers in patients with spinal cord injury?

  1. The use of pressure-relieving bed cushions, mattresses, and beds are commonly used by nursing care facilities and hospitals to prevent the occurrence of pressure ulcers in their patients. Pressure sores are common in localized skin areas and underlying tissues because of pressure, shear, or friction.

P: Elderly patients admitted in one long-term facility
I: Use of pressure-relieving bed cushions, mattresses, and beds
C: Standard support bed or mattress
O: Lower risk of pressure ulcers

Question: In elderly patients admitted in one long-term facility, what are the effects of the use of pressure-relieving bed cushions, mattresses, and beds in lowering the risk of pressure ulcers as opposed to standard support bed or mattress?

PICO Questions for Maternal Nursing

  1. WHO recommends early initiation of breastfeeding within the first hour of birth and exclusive breastfeeding for the first six months of a newborn’s life. Furthermore, in 2018, WHO reported that 3 out of 5 babies are not breastfed within the first hour of life and this puts them at higher risks of morbidity and mortality. Of note, newborns who began breastfeeding between two and 23 hours after birth had a 33% risk of mortality compared to those who began breastfeeding within an hour.

P: Newborns delivered in an obstetric-gynecological hospital
I: Early initiation of breastfeeding within one hour of birth
C: Initiation of breastfeeding beyond one hour of birth
O: Lower risks of neonatal mortality

Question: Does early initiation of breastfeeding within one hour of birth among newborns delivered in an obstetric-gynecological hospital lower the risks of neonatal mortality as opposed to babies who were breastfed beyond one hour of birth?

  1. Mothers use a nipple shield to prevent discomfort or pain associated with breastfeeding. It is a flexible silicone nipple that is worn over the nipple. Nipple shields are recommended not to be used during the first week of birth unless there are problems with improper latching or sore and infected nipples as nipple shields might affect the mother’s milk supply and the baby’s latching.

P: Postpartum women who are breastfeeding
I: Use of nipple shields during the first week of birth
C: Postpartum women who are not using nipple shields
O: Poor latching of the baby

Question: In postpartum women who are breastfeeding, what are the effects of the use of nipple shields during the first week of birth on baby’s latching as compared to postpartum women who are not using nipple shields?

  1. Skin-to-skin contact immediately after birth benefits the baby particularly on the success of early initiation of breastfeeding, optimal newborn temperature, and shorter duration of the third stage of labor. Skin-to-skin care with mothers also provides the warmth and security that the babies need when outside the womb. It is defined as placing the naked baby on the mother’s bare abdomen or chest immediately or less than 10 minutes after birth.

P: Babies born in the maternity ward
I: Skin-to-skin contact with their mothers within the first ten minutes after birth
C: No skin-to-skin contact
O: Earlier initiation of breastfeeding

Question: In babies born in the maternity ward, does skin-to-skin contact with their mothers within the first ten minutes after birth have an effect on initiation of breastfeeding as compared to babies who did not receive any skin-to-skin contact with their mothers?

  1. Normal spontaneous vaginal delivery outcomes can be improved by various interventions including encouraging patients to walk in the first stage of labor, providing continuous labor support, adequate and effective pain management during labor, and timely pushing. Mobility is encouraged for women in active labor because women on their backs may have detrimental effects on uterine contractions, can impede labor progress, and may reduce perineal blood flow.

P: Women in active labor
I: Walking in the first stage of labor
C: Women in active labor who are lying on their backs on the first stage of labor
O: Shorter duration of labor

Question: Does walking in the first stage of labor in women who are in active labor shorten the duration of labor as opposed to women who are lying on their backs on the first stage of labor?

  1. Studies show that breastfeeding is associated with lower risks of pre- and post-menopausal breast cancer. Furthermore, a longer duration of breastfeeding beyond six months can give additional protection. The exact mechanisms involve are the hormonal change that women experience during lactation and the tissues with potential DNA damage can be shed off during breastfeeding.

P: Breastfeeding women
I: Duration of breastfeeding beyond six months
C: Women who did not breastfeed or breastfed only for less than six months
O: Reduced risk of breast cancer

Question: In breastfeeding women, does the duration of breastfeeding beyond six months reduce the risks of breast cancer than women who did not breastfeed or breastfed only for less than six months?

  1. Rooming-in of newborns with their mothers has been shown to improve breastfeeding since this allows the mothers to breastfeed frequently on demand. Almost 3 out of 4 babies who are roomed-in with their mothers began breastfeeding within 12 hours after birth compared with those who are in the nursery.

P: Newborns delivered in the maternity clinic
I: Rooming-in with mothers
C: Newborns delivered in the maternity clinic who are in the nursery or separate care
O: Earlier initiation and sustained breastfeeding

Question: Does the rooming-in of newborns delivered in the maternity clinic with their mothers have an effect on earlier initiation and sustained breastfeeding than newborns who are in the nursery or separate care?

  1. 25% of maternal deaths worldwide are caused by postpartum hemorrhage. Postpartum hemorrhage is defined as blood loss >500 ml in the first 24 hours after delivery. Antifibrinolytic agents such as tranexamic acid are used in adjunct to oxytocin to reduce maternal blood loss.

P: Women who are in active labor
I: Use of prophylactic use of tranexamic acid in adjunct to oxytocin
C: No use of tranexamic acid
O: Incidence of postpartum hemorrhage

Question: In women who are in active labor, what are the effects of prophylactic use of tranexamic acid in adjunct to oxytocin on the incidence of postpartum hemorrhage as compared to women who did not receive tranexamic acid as an additional therapy?

PICO Questions for Mental Health

  1. Postpartum depression is prevalent among new mothers and manifested by mood swings, crying episodes, anxiety, or difficulty sleeping. It occurs more in women who have cesarean section deliveries, underweight, obese, and other co-morbidities. Moreover, it was also found to be associated with elevated blood pressure, as well as with diseases that affect other vital organs such as the heart, brain, and kidneys.

P: Postpartum women who gave birth in the previous six weeks
I: Had pre-eclampsia during their pregnancies
C: (none)
O: Higher anxiety scores using a standardized tool

Question: Are postpartum women who gave birth in the previous six weeks who had preeclampsia during their pregnancies at higher risks of developing anxiety when measured with a standardized tool?

  1. Autoimmune disorders are found to have an association with the development of psychotic disorders. The mechanism has been characterized by the increased levels of inflammatory markers and excess autoreactivity that are genetic in nature. Autoimmune disorders such as multiple sclerosis and lupus were noted to exhibit more neuropsychiatric symptoms.

P: Adult individuals
I: Diagnosed with autoimmune disorders such as multiple sclerosis and lupus
C: No autoimmune disorders
O: Increased incidence of psychotic disorders manifested by delusions, hallucinations, loss of contact with reality, and bizarre behavior

Question: Are adult patients diagnosed with autoimmune disorders like multiple sclerosis and lupus are at higher risks of increased incidence of psychotic disorders manifested by delusions, hallucinations, and loss of contact with reality, and bizarre behavior?

  1. Substance abuse has been demonstrated to co-occur in individuals with schizophrenia. Alcohol, nicotine, cocaine, and cannabis are all found to be the most commonly abused substances in schizophrenic patients. The decreased cognitive functioning during intoxication and substance misuse in schizophrenic patients predisposes them to higher rates of poor clinical outcomes and treatment compliance and increased emergency admissions.

P: Patients diagnosed with schizophrenia
I: Substance abuse, particularly alcohol, nicotine, cocaine, and cannabis
C: No abuse of misuse of alcohol, nicotine, cocaine, and cannabis
O: Higher rates of emergency admissions

Question: Are patients diagnosed with schizophrenia who are abusing substances such as alcohol, nicotine, cocaine, and cannabis are at higher risks to increased emergency admissions as compared to schizophrenic patients without substance abuse?

  1. Management of psychiatric disorders is consists of a combination of therapies including pharmacologic treatment, electroconvulsive therapy, and counseling. Electroconvulsive therapy (ECT), however, is discouraged as a first-line antidepressant regimen because of the lack of scientific evidence on its efficiency and is only indicated for patients with high treatment resistance or relapse. On the other hand, psychotropic drugs are prescribed initially as the first-line treatment regimen, including fluoxetine. Fluoxetine is a serotonin uptake inhibitor that is often prescribed in adjunct to ECT.

P: Patients diagnosed with major depressive disorders
I: 12 sessions of standard bi-temporal modified ECT and 20 mg/ day of fluoxetine for six weeks
C: 20 mg/day of fluoxetine, alone
O: Lower rates of depression symptoms

Question: In patients diagnosed with major depressive disorders, does the combination of 12 sessions of standard bi-temporal modified ECT and 20 mg/ day of fluoxetine lower the rate of depressive symptoms as compared to 20 mg/day of fluoxetine only for six weeks?

  1. Psychotropic medications are prescribed in combination therapy to achieve the desired treatment effects. One example is the use of olanzapine and fluoxetine combination in the management of the treatment-resistant major depressive disorder. Studies demonstrate that almost one-third of patients receiving monotherapy for their depressive disorders experience remission. The combination of the anti-psychotic drug, olanzapine, and the antidepressant, fluoxetine, works in sustaining the improvement of depressive symptoms in patients.

P: Patients diagnosed with major depressive disorder
I: Combination therapy of olanzapine and fluoxetine for eight weeks
C: Use of fluoxetine alone
O: Time-to-relapse

Question: Does the combination therapy of olanzapine and fluoxetine for eight weeks in patients diagnosed with major depressive disorder have an effect on relapse time as compared to the use of fluoxetine alone?

  1. Chlorpromazine, an antipsychotic, is known to cause ocular toxicity if on prolonged use such as 3-5 years. The association is due to pigmentary deposits on both corneas and the anterior lens surface and may cause a decrease in vision.

P: Patients diagnosed with psychotic disorders
I: Prolonged use of chlorpromazine
C: (none)
O: Complaints of visual symptoms

Question: In patients diagnosed with psychotic disorders, does the prolonged use of chlorpromazine has an effect on increased complaints of visual symptoms?

  1. Several adverse events are demonstrated to have an association with antipsychotic drugs which include tardive dyskinesia, neuroleptic malignant syndrome, hypertension, and hyperglycemia or diabetes, among others. Previous studies found out that a higher risk of stroke occurs with atypical antipsychotics (or newer drugs developed since the 1990s) than conventional antipsychotics.

P: Patients diagnosed with psychotic disorders
I: Use of atypical antipsychotics (like clozapine, olanzapine, etc.)
C: Use of conventional antipsychotics (e.g. chlorpromazine, haloperidol, loxapine, etc.)
O: Increased risks of stroke

Question: In patients diagnosed with psychotic disorders, what are the effects of the use of atypical antipsychotics such as clozapine and olanzapine on the risks of developing stroke as compared to the use of conventional antipsychotics like chlorpromazine, haloperidol, and loxapine?

  1. One of the most common side effects of psychotropic drugs is weight gain. Weight gain predisposes patients to higher risks of hypertension, coronary heart disease, type 2 diabetes mellitus, dyslipidemia, and cancer. Weight gain can also contribute to the patient’s poor compliance with medications and higher risks to remissions or rehospitalizations. Mood stabilizers such as valproic acid and lithium can adversely cause weight gain.

P: Bipolar patients
I: Taking mood stabilizers such as valproic acid and lithium
C: (none)
O: Weight gain

Question: Does taking mood stabilizers such as valproic acid and lithium in bipolar patients to have an effect on weight gain?

  1. Topiramate is a novel anticonvulsant that is now being prescribed as an adjunct treatment for patients with bipolar disorder. It is primarily indicated for neurological conditions such as migraine, neuropathic pain, and psychological conditions like bulimia, schizoaffective disorder, and bipolar disorder. The advantages of topiramate as compared to other mood stabilizers are minimal hepatic metabolism, unchanged renal excretions, and minimal drug interactions. However, the adverse side effects are attention, concentration and memory problems, fatigue, transient paraesthesias, nausea, and anorexia.

P: Patients diagnosed with bipolar disorder
I: Use of topiramate as an adjunct treatment along with other psychotropic medicines
C: No topiramate in the pharmacologic therapy
O: Fewer manic episodes

Question: In patients diagnosed with bipolar disorder, does the use of topiramate as an adjunct treatment along with other psychotropic medicines cause fewer manic episodes as opposed to patients with no prescribed topiramate?

  1. Cognitive behavioral therapy is most commonly used to treat anxiety and depression and it is characterized by talking out thoughts, feelings, or sensations and help in breaking down these thoughts in a more positive way. It is often run from 5 to 20 sessions with each session lasting 30 to 1 hour long.

P: Patients diagnosed with major depressive disorder
I: Use of cognitive behavioral therapy
C: (none)
O: Lesser depressive and anxiety symptoms as measured by standardized tools

Question: Does cognitive behavioral therapy in patients diagnosed with major depressive disorder contribute to lesser depressive and anxiety symptoms?

PICO Questions for Psychiatric Nursing

  1. Non-pharmacologic care-delivery interventions can be implemented in the management of agitation and aggression in patients admitted in a mental health facility. Some examples cited by researches include adequate staff training, care-delivery models (i.e. patient-centered care, illness-care mapping, emotion-oriented care), and changes made in the environment. Emotion-oriented approaches employ validation, reminiscence, sensory integration/ stimulation, simulated presence therapy.

P: Patients admitted in a mental health facility
I: Use of emotion-oriented approaches in caring
C: (none)
O: Reduced agitation and aggression episodes

Question: In patients admitted in a mental health facility, does the use of emotion-oriented approaches in caring reduced agitation and aggression episodes?

  1. High- quality psychiatric nursing care entails restraint-free care or the prevention of the use of physical restraints. One effective approach in limiting the use of physical restraints in the nursing care is staff education on the possible alternatives to physical restraint use such as the use of other technical devices, changes to the environment, and organizational culture modifications.

P: Nursing staff in one psychiatric ward
I: Staff education on possible alternatives to physical restraints
C: Usual staff education with no inclusion of topics on possible alternatives to physical restraints
O: Reduced adverse events related to physical restraint use such as pressure ulcers

Question: In the nursing staff in one psychiatric ward, does staff education on possible alternatives to physical restraints reduce adverse events related to restraints as compared to the usual staff education without the inclusion of topics related to physical restraints?

  1. Risperidone is widely used in children who are diagnosed with autism, ADHD, and those manifesting aggression and behavior conduct problems. It is an atypical or second-generation antipsychotic medication that can cause serious adverse effects such as extrapyramidal symptoms. Scientific evidence demonstrates that aggression, irritability, and self-injurious behavior can be worsened by long-term intake of risperidone.

P: Children diagnosed with ADHD
I: Taking risperidone medication for more than one month
C: (none)
O: Exhibits self-injurious behavior

Question: In children diagnosed with ADHD, does taking risperidone medication for more than one month contribute to the children exhibiting more self-injurious behavior?

  1. Conduct disorders are one of the most common mental health disorders among children and adolescents. Atypical antipsychotics, like risperidone, have been an efficient pharmacologic agent for conduct disorders particularly for short-term treatment of aggression. Evidence demonstrates that aside from risperidone, clozapine can also be used in treating children diagnosed with conduct disorders and is considered to have stronger efficacy than risperidone in conduct externalization factors, delinquency traits, and global functioning.

P: Children aged 6 until 16 years old diagnosed with conduct disorders
I: Use of clozapine as a short-term treatment
C: Use of risperidone
O: Manifesting better externalization and internalization factors

Question: Does the use of clozapine as a short-term pharmacologic treatment in children aged 6 until 16 years old diagnosed with conduct disorders have an effect on externalization and internalization factors as compared to the use of risperidone?

  1. Patients diagnosed with major depressive disorders suffer from depressive symptoms which persist for many years even taking anti-depressants. It has been known that almost two-thirds of depressed patients do not experience the adequate response with initial pharmacotherapy. In cases of non-response, patients are prescribed with the combination of antipsychotic to achieve the desired response. Aripiprazole, a dopamine D2 and 5- HT1A receptor partial agonist, is an example of a medication which augments antidepressant treatment.

P: Patients diagnosed with major depressive disorders
I: Combination of anti-depressant and antipsychotic (aripiprazole)
C: Patients diagnosed with major depressive disorders who are on monotherapy
O: Achieves remission
(T): Week 2-3

Question: In patients diagnosed with major depressive disorders, does the combination of anti-depressant and antipsychotic, aripiprazole, have an effect on achieving remission as compared to patients on monotherapy (antidepressants alone) after second or third weeks of treatment?

  1. Haloperidol is prescribed to control severe agitation in patients manifesting delirium symptoms. However, there is a discordance in the available scientific evidence on whether benzodiazepines should be administered along with haloperidol upon the onset of agitation episode.

P: Patients manifesting severe agitation episodes
I: Combination of haloperidol and benzodiazepines (i.e. lorazepam)
C: Haloperidol alone
O: Change in agitation-sedation scale score
(T): After 8 hours of treatment administration

Question: Does the combination of haloperidol and benzodiazepines (i.e. lorazepam when administered to patients manifesting severe agitation episodes bring a change in the patients’ agitation-sedation scale score than treating with haloperidol alone within 8 hours after treatment administration?

  1. Discontinuing psychotropic drugs require extra vigilance from the medical practitioners and the patients’ family or caregivers. Stopping these medications abruptly is dangerous and can cause the return of the illness in the case of anti-depressants, or severe seizures for a high dose of benzodiazepines. Prior to discontinuing the medications, it is required that every patient receives a thorough and careful assessment and team counseling should be provided to their families.

P: Depressed patients who will need to discontinue the anti-depressants
I: Thorough assessment from their physicians prior to the discontinuation
C: (none)
O: Absence of withdrawal symptoms

Question: In depressed patients who will need to discontinue the anti-depressants, does a thorough assessment from their physicians prior to the medication discontinuation have an effect on the absence of withdrawal symptoms?

PICO Questions about Cancer

  1. Non-pharmacologic therapy is a vital aspect of palliative nursing care of patients diagnosed with cancer. Newly diagnosed patients with cancer experience a considerable level of psychological distress which may further compromise their immune function. Few studies have evaluated the effects of mindfulness-based stress reduction techniques and concluded that this intervention not only provides psychological benefits but also optimize the immune function.

P: Women who are newly diagnosed with breast cancer
I: Use of mindfulness-based stress reduction techniques
C: (none)
O: Improved immune function and coping effectiveness

Question: In women who are newly diagnosed with breast cancer, what are the effects of mindfulness-based reduction techniques to the improvement of immune function and coping effectiveness?

  1. Chemotherapy-induced nausea and vomiting need to be optimally controlled to prevent further discomfort among cancer patients. Several cancer guidelines suggest the combination therapy of antiemetic agents. However, studies have found out that substituting olanzapine with NK-1 receptor antagonists can be deemed as less costly but with similar or better effectiveness for chemotherapy-induced nausea and vomiting.

P: Cancer patients on chemotherapy
I: Combination therapy of antiemetic agents consisting of palonosetron, dexamethasone, and olanzapine
C: Combination therapy of palonosetron, dexamethasone, and NK-1 receptor antagonists
O: Reduced incidence of chemotherapy-induced nausea and vomiting

Question: In cancer patients on chemotherapy, does the combination therapy of antiemetic agents consisting of palonosetron, dexamethasone, and olanzapine reduce the incidence of chemotherapy-induced nausea and vomiting as compared to combination therapy of palonosetron, dexamethasone, and NK-1 receptor antagonists?

  1. Scalp hypothermia is a preventive approach for chemotherapy-induced alopecia. It involves cooling the scalp with ice packs and cooling caps for a certain period of time before, during, and after every chemotherapy to reduce hair loss. The exact mechanism is through the vasoconstriction of blood vessels in the scalp which reduces the concentration of the chemotherapeutic agent in the hair follicles.

P: Cancer patients on chemotherapy
I: Use of cooling caps or scalp hypothermia
C: (none)
O: Reduction of chemotherapy-induced alopecia

Question: In cancer patients on chemotherapy, does the use of cooling caps or scalp hypothermia reduces chemotherapy-induced alopecia compared to those who did not use cooling caps?

  1. Almost 50% of patients undergoing chemotherapy receive highly emetogenic agents and around 80% experienced chemotherapy-induced nausea and vomiting if not treated well. The discomfort can lead to anticipatory nausea and vomiting in the next treatment and can significantly affect the patient’s quality of life. Several clinical assessment tools are available to aid nurses in assessing the impact of chemotherapy-induced nausea and vomiting.

P: Nurses in a cancer ward or facility
I: Use of standardized assessment tools such as The Index of Nausea, Vomiting, and Retching (INVR) and the Functional Living Index-Emesis along with proper chart documentation of an episode
C: Standard documentation of nausea and vomiting episodes in the patient charting
O: Design of better management strategies for chemotherapy-induced nausea and vomiting

Question: Does the use of standardized assessment tools and proper chart documentation of chemotherapy-induced nausea and vomiting have an effect on designing better management strategies as compared to documentation on patient charting alone?

  1. Approximately, 30-40% of patients experienced peripheral neuropathy while in chemotherapy. Peripheral neuropathy is commonly experienced with chemotherapeutic agents such as taxanes, platinum, vinca alkaloids, and bortezomib. Acupuncture is another non-pharmacologic intervention with established effects on preventing chemotherapy-induced peripheral neuropathy.

P: Cancer patients on chemotherapy
I: Use of acupuncture or electroacupuncture for at least 12 weeks
C: (none)
O: Reduced incidence of chemotherapy-induced peripheral neuropathy

Question: In cancer patients on chemotherapy, does the use of acupuncture or electroacupuncture for at least 12 weeks help reduce the incidence of chemotherapy-induced peripheral neuropathy?

  1. Chemotherapy-induced peripheral neuropathy is a common adverse event of patients on chemotherapy. It is characterized by the presence of tingling, burning, itching, and unpleasant sensation in hands and feet because of the nerve damage brought about by chemotherapeutic agents. The effectiveness of muscle strengthening and balancing exercises on chemotherapy-induced peripheral neuropathy is demonstrated by a few observational studies.

P: Cancer patients on chemotherapy
I: Muscle strengthening and balancing exercises
C: (none)
O: Decreased incidence of chemotherapy-induced peripheral neuropathy

Question: Do muscle strengthening and balancing exercises in cancer patients on chemotherapy decrease the incidence of chemotherapy-induced peripheral neuropathy?

  1. Pain management is a complex aspect of palliative nursing care. Even with high-level analgesics such as opioids, pain is still inadequately controlled. One significant nursing intervention that can aid in effective pain management is providing sufficient patient education and counseling on pain with the use of written materials or booklet.

P: Nurses in a cancer ward or facility
I: Use of a patient information booklet on cancer pain and management
C: Patient education on cancer pain and management without the use of written material
O: Decreased severity of pain

Question: Does the use of patient information booklet on cancer pain and management among nurses in a cancer ward or facility help decrease pain severity as compared to patient education without the use of written materials?

PICO Questions for Cardiovascular Disease

  1. Transcatheter aortic valve replacement is a minimally invasive valve-to-valve surgical procedure wherein it puts a replacement valve into the damaged valve. This novel surgical procedure is indicated for patients with aortic stenosis and can be considered safer than the standard valve replacement where the procedure requires a sternotomy. Many cardiovascular surgeons are opting for the transcatheter aortic valve replacement because of lesser complications such as infections and shorter hospital stay.

P: Patients diagnosed with aortic stenosis and requiring a surgical procedure
I: Transcatheter aortic valve replacement
C: Standard valve replacement procedure
O: Shorter duration of hospitalization

Question: In patients diagnosed with aortic stenosis and requiring a surgical procedure, what are the effects of transcatheter aortic valve replacement on the patients’ duration of hospitalization as compared to the standard valve replacement procedure?

  1. Gallstone disease is found to be associated with cardiovascular diseases. More specifically, observational studies demonstrate that the risks of fatal and nonfatal cardiovascular disease events are higher among patients with gallstone diseases. When a gallbladder excretion is compromised, there is also an associated dysfunction in cardiac rhythm and coronary blood flow, especially with poor coronary circulation. Additionally, both gallstone disease and cardiovascular diseases share common risk factors like age, obesity, race, diabetes mellitus, and increased blood pressure.

P: Patients diagnosed with cardiovascular diseases
I: Gallstone disease
C: Without gallstone disease
O: Incidence of heart attack or stroke

Question: Are patients diagnosed with cardiovascular diseases who have gallstones at increased risk for heart attack or stroke compared with those without gallstones?

  1. Body composition indices are considered to be one predictor of future cardiovascular risks. Fat-to-muscle ratio is an alternative anthropometric measurement of body fat. Previous studies show that low levels of muscle mass can indicate increased risks of insulin resistance and cardiovascular disease.

P: Adult individuals who have a family history of hypertension
I: Assessment of fat-to-muscle ratio
C: (none)
O: Can predict cardiovascular diseases

Question: For adult individuals who have a family history of hypertension, how does the assessment of fat-to-muscle ratio compared to not measuring the fat-to-muscle ratio predict cardiovascular diseases?

  1. Health education is an important aspect of controlling the risks of diseases wherein lifestyle modifications are necessary. Nurses as frontline health providers need to develop and implement an education program for patients with cardiovascular disease to improve outcomes.

P: Patients who have high cardiovascular risks (i.e. hypertension, smoking status, obesity)
I: 20-minute-one-on-one counseling regarding coronary heart disease, treatment, and prevention, and healthy lifestyle
C: Group education program with similar topics
O: Decreased incidence of myocardial infarction

Question: In patients who have high cardiovascular risks (i.e. hypertension, smoking status, obesity), does 20-minute-one-on-one counseling regarding coronary heart disease, treatment, prevention, and healthy lifestyle decrease the incidence of myocardial infarction compared to a group education program with similar topics?

  1. Mobile health (mHealth) can help deliver quality patient care particularly on medication adherence which is an integral part of the management of cardiovascular diseases. mHealth strategies such as text messaging or remote video consultations are efficient tools because they can be delivered in a low-cost setting and have similar effectiveness as face-to-face consultations.

P: Patients diagnosed with Type-2 diabetes mellitus
I: Daily automated text messages focusing on medication adherence
C: Monthly face-to-face consultations
O: Optimal management of blood glucose levels

Question: In patients diagnosed with Type-2 diabetes mellitus, do daily automated text messages focusing on medication adherence have an effect on optimal management of blood glucose levels compared to monthly face-to-face consultations?

  1. Bisphosphonates can lower the risks of cardiovascular events due to the reduction of arterial wall calcification and atherosclerosis. Individuals with low bone mass have higher tendencies to develop vascular calcification as compared to those with normal bone mass. This is because studies have demonstrated that vascular calcification and bone mineralization have similar biological mechanisms, therefore, bisphosphonates are suggested to help prevent cardiovascular risks.

P: Patients with cardiovascular risks such as obesity, hypertension, smoking, and diabetes
I: Treatment with bisphosphonates
C: No bisphosphonates in the treatment regimen
O: Reduced risk of cardiovascular mortality

Question: Does treatment with bisphosphonates among patients with cardiovascular risks such as obesity, hypertension, smoking, and diabetes help reduce the risks of cardiovascular mortality as compared to those with no bisphosphonates in the treatment regimen?

  1. Evidence demonstrates that physical inactivity and low cardiovascular fitness can facilitate the development of heart failure. Studies demonstrate that cardiorespiratory fitness promotes overall cardiovascular health, improve quality of life, and lower the risks of mortality due to cardiovascular events. Physical activity is associated with reducing the risk factors contributed by hypertension, dyslipidemia, smoking, and type 2 diabetes mellitus.

P: Patients with cardiovascular risks such as hypertension, obesity, smoking, diabetes mellitus
I: Daily 20-minute exercise or fitness program
C: No exercise or fitness program
O: Reduced risks of cardiovascular mortality

Question: Does daily 20-minute exercise or fitness program reduce the risks of cardiovascular mortality in patients with cardiovascular risks (i.e. hypertension, obesity, smoking, and type 2 diabetes mellitus)?

PICO Questions for Dementia

  1. The risks of developing dementia were found to be higher among patients with renal dysfunction. The exact mechanism is still insufficiently known, however, albuminuria is associated with a higher likelihood of developing cognitive impairment or dementia. Similarly, chronic kidney disease and dementia share similar risks profile such as hypertension, diabetes mellitus, or hyperlipidemia.

P: Patients aged 45 years old and above
I: Diagnosed with chronic kidney disease
C: Not diagnosed with chronic kidney disease
O: Increased likelihood to develop dementia at latter onset

Question: Are patients aged 45 years old and above who are diagnosed with chronic kidney disease at an increased risk to develop dementia at a later onset than those without chronic kidney disease?

  1. Long-term use of hormone therapy among postmenopausal women is linked with an estimated 9-17% increased risk of Alzheimer’s disease. According to the study of Savolainen-Peltonen et al (2019), the risks increase for women who had long-term exposure to hormone therapy for more than 10 years.

P: Postmenopausal women
I: At least 10-year of exposure to hormone therapy
C: Less than 10 years of exposure to hormone therapy
O: Increased risk of Alzheimer’s disease

Question: Are postmenopausal women with at least 10-year exposure to hormone therapy at an increased risk of Alzheimer’s disease than postmenopausal women with less than 10-year exposure to hormone therapy?

  1. Mild cognitive impairment can be difficult to measure or detect in older adults. Although assessment tools and checklists are available, these tools still lack sensitivity and reliability to detect cognitive dysfunction. Current technological advances introduce the use of sensor-based technology to monitor the elderly’s activities of daily living and predict cognitive impairment.

P: Older adults aged 50 years old and above
I: Use of sensor-based technology
C: Use of standardized assessment tools or checklists
O: Higher sensitivity and reliability to predict mild cognitive impairment

Question: Does the use of sensor-based technology in older adults aged 50 years old and above have higher sensitivity and reliability in predicting mild cognitive impairment than the use of standardized assessment tools or checklists?

  1. Physical activity has been found to alleviate the cognitive impairment of Alzheimer’s disease. Moderate physical exercise modulates the systemic inflammation markers which are often absent or lacking in neurodegenerative diseases. Additionally, physical exercise can also improve the quality of life and well-being of individuals with Alzheimer’s disease and dementia.

P: Older adults diagnosed with early-stage Alzheimer’s disease
I: 16-weeks of moderate physical exercise
C: No strict exercise program
O: Improved cognitive function

Question: In older adults diagnosed with early-stage Alzheimer’s disease, does 16-weeks of moderate physical exercise improve cognitive function as compared to those without strict exercise program?

  1. A growing body of research demonstrates that depression is associated with dementia in older adults. Specifically, late-onset depression is defined as experiencing depressive syndrome occurring for the first time after 45-65 years of age. It is therefore imperative to identify cognitive impairment in depressed individuals which can be manifested as more complaints of difficulties with concentration and memory, poor effort on examination, and inconsistency in sequential functioning.

P: Older adults
I: Had late-onset depression for the first time during 45-65 years of age
C: No late-onset depression
O: Increased incidence of dementia

Question: Are older adults who had late-onset depression for the first time during 45-65 years of age at increased risk of dementia as compared to those without late-onset depression?

  1. Type 2 diabetes mellitus and obesity are potential risk factors for Alzheimer’s disease. Numerous lifestyle interventions such as physical exercise and a healthy diet can help avert these risks. The Mediterranean diet which consists of fruits, vegetables, olive oil, and fish is positively associated with lowering the risks of cardiovascular disorders and may also have a beneficial role against the development of Alzheimer’s disease.

P: Older adults with type 2 diabetes mellitus and obesity
I: Intake of the Mediterranean diet
C: (none)
O: Reduced risks of having Alzheimer’s disease

Question: In older adults with type 2 diabetes mellitus and obesity, does the intake of the Mediterranean diet can reduce the risks of having Alzheimer’s disease?

  1. Communication and language ability is impaired in patients with Alzheimer’s disease. Growing evidence suggests that memantine, a medication that is widely used in treating Alzheimer’s disease, can be administered in combination with non-pharmacologic therapy modalities including music therapy.

P: Patients with mild to moderate Alzheimer’s disease
I: Combination of memantine and music therapy
C: Memantine, alone
O: Improved communication and language ability

Question: In patients with mild to moderate Alzheimer’s disease, does the combination of memantine and music therapy have an effect on the improvement of communication and language ability as opposed to memantine alone?

PICO Questions for Depression

  1. Bipolar disorder is a multi-causative illness which is characterized by episodes of mood disturbance, neurocognitive imbalances, immunological changes, and disruption in normal functioning. Some risk factors include demographic (such as unemployment, age between 20-30 years old, unmarried), genetic, and environmental factors (i.e. prenatal viral illness, childhood maltreatment, psychological stressors).

P: Adults aged 20 to 30 years old
I: Prenatal exposure to cytomegalovirus
C: Without prenatal exposure to cytomegalovirus
O: Increased risk of bipolar disorder

Question: Are adults aged 20 to 30 years old with prenatal exposure to cytomegalovirus at increased risk of having bipolar disorder than those without prenatal exposure to cytomegalovirus?

  1. Psychological interventions have beneficial effects on people at risk for bipolar disorder. These interventions include family-focused therapy, mindfulness-based cognitive therapy, and interpersonal social interventions, and can help in reducing time to relapse, and decreasing symptoms of anxiety, depression, and mania.

P: Young people at risk for bipolar disorder
I: Use of family-focused therapy
C: Use of mindfulness-based cognitive therapy
O: Decreased symptoms of depression

Question: In young people at risk for bipolar disorder, does the use of family-focused therapy have an effect on decreasing symptoms of depression than the use of mindfulness-based cognitive therapy?

  1. The association of alcohol consumption and depression is unclear. However, studies demonstrate that heavy alcohol drinking can increase the risk of major depressive disorder to two or three times. Moreover, heavy alcohol drinking during childhood, adolescence, or early adulthood can predict a person’s major depressive disorder in their late twenties.

P: Adults
I: Heavy alcohol use during adolescence or early adulthood
C: Mild to moderate alcohol use during adolescence or early adulthood
O: Increased risk of major depressive disorder

Question: Are adults with heavy alcohol use during adolescence or early adulthood at increased risk of having a major depressive disorder than adults with mild to moderate alcohol use?

  1. Major depressive disorders are known to be caused by several risk factors, including early life adversity. Observational studies show that emotional state can affect cognitive processes thereby predisposing an individual to develop a major depressive disorder.

P: Adults aged 20 to 30 years old
I: Had experienced early life adversity such as the death of a close family member
C: Adults aged 20 to 30 years old who did not experience early life adversity such as the death of a close family member
O: Increased risk of major depressive disorder

Question: Are adults aged 20 to 30 years old who had experienced early life adversity such as the death of a close family member at increased risk of major depressive disorder than those without early life adversity?

  1. Treatment-resistant depressed individuals often fail to attain remission even after being initiated with the recommended antidepressant medications. Individuals who have treatment-resistant depression are at higher risks for compromised cognitive functioning, decreased workplace performance, and elevated risks of developing comorbidities. It is imperative for clinicians to identify treatment-resistant depression through the use of available standardized tools such as the Quick Inventory of Depressive Symptomatology (QIDS-SR16) and the 9-question Patient Health Questionnaire (PHQ-9). Early identification can help patients achieve remission.

P: Psychiatric clinicians
I: Use of the 9-question Patient Health Questionnaire (PHQ-9), along with clinical evidence
C: Use of clinical evidence only
O: Early identification of treatment-resistant depression

Question: Does the use of the 9-question Patient Health Questionnaire or PHQ-9 along with clinical evidence in psychiatric clinicians have an effect on the early identification of treatment-resistant depression as compared to the use of clinical evidence only?

  1. One in every four people with diabetes mellitus suffers from depression. Studies found out that depression increases the risk of the development of type 2 diabetes mellitus, along with elevated insulin resistance, hyperglycemia, and vascular complications. Recommended therapy for type 2 diabetes mellitus patients with depression should include psychotherapy, antidepressant medication, and cognitive behavior therapy.

P: Patients diagnosed with type 2 diabetes mellitus and manifesting depressive symptoms
I: Combination therapy of pharmacologic treatment, psychotherapy, and cognitive behavior therapy
C: Pharmacologic treatment only
O: Reduced symptoms of depression

Question: In patients diagnosed with type 2 diabetes mellitus and manifesting depressive symptoms, does the combination therapy of pharmacologic treatment, psychotherapy, and cognitive behavior therapy have an effect on the reduction of depressive symptoms as compared to those who have pharmacologic treatment only?

  1. Stress management training program such as yoga, progressive muscle relaxation, breathing exercises, meditation, and mental imagery can help reduce depression and anxiety symptoms. These interventions can be adjunct to pharmacologic therapy and may help the patient to achieve remission if done correctly.

P: Patients diagnosed with major depressive disorders
I: Use of stress management training program with pharmacologic therapy
C: Pharmacologic treatment only
O: Patient remission

Question: Does the use of stress management training program with pharmacologic therapy in patients diagnosed with major depressive disorders have an effect on patient remission than pharmacologic treatment only?

PICO Questions for Med Surgery

  1. Bed rest after coronary angiography is indicated to patients to avoid vascular complications. However, immobility and bed rest post-surgery can contribute to the development of back pain and other surgical complications such as pneumonia and decubitus ulcers. Observational evidence concludes that early ambulation and correct positioning 2-4 hours after angiography can help reduce the severity of back pain.

P: Patients who underwent coronary angiography
I: Early ambulation 2-4 hours after angiography
C: Bed rest
O: Reduced incidence of back pain

Question: In patients who underwent coronary angiography, does early ambulation 2-4 hours after angiography reduce the incidence of back pain as compared to bed rest?

  1. Recent standard guidelines emphasize the intraoperative use of dexamethasone in tonsillectomy patients. Intraoperative administration of systemic steroids has shown prevention of surgical complications such as pain, nausea, and vomiting. However, there should be caution in the use of steroids intraoperatively as studies found out that there is a higher risk of bleeding episode post-tonsillectomy.

P: Pediatric patients who were indicated for tonsillectomy
I: Preoperative administration of intravenous dexamethasone
C: (none)
O: Increased risks of bleeding episodes post-tonsillectomy

Question: Does preoperative administration of intravenous dexamethasone in pediatric patients who were indicated for tonsillectomy increase the risks of bleeding episodes post-tonsillectomy?

  1. Incisional negative pressure wound therapy (INPWT) is a new therapeutic intervention for post-operative surgical site incisions. INPWT facilitates removal of edema, increases blood circulation, reduces bacterial contamination, and provides adequate moist-wound healing environment and granulation tissue formation. As compared to conventional surgical wound, INPWT has lesser incidence of reoperation rates.

P: Patients who had an abdominal surgical procedure
I: Use of incisional negative pressure wound therapy
C: Use of sterile dry dressings
O: Lesser incidence rate of reoperation

Question: In patients who had abdominal surgical procedure, does the use of incisional negative pressure wound therapy have a reduced effect on the incidence of reoperation as compared to the use of sterile dry dressings?

  1. Antiseptic solutions are a significant aspect of postsurgical wound care. Some commonly used antiseptic solutions include povidone iodine, chlorhexidine, and alcohol. Several studies have demonstrated the effectiveness of the preoperative application of antiseptic solutions particularly in reducing surgical site infections.

P: Patients who had an insertion of central vascular catheters
I: Preoperative cleaning of the incision site with 2% chlorhexidine-based antiseptic agent
C: Preoperative use of povidone-iodine
O: Reduced surgical site infections
(T): Within 30 days after surgery

Question: Does the preoperative cleaning of incision site with 2% chlorhexidine-based antiseptic solution in patients who had an insertion of central vascular catheters reduces surgical site infection compared to preoperative use of povidone-iodine, after 30 days of surgery?

  1. Preoperative topical administration of antiseptic agents is a common surgical practice. Povidone-iodine is routinely used as a preoperative topical agent in cataract surgery and it has been demonstrated to prevent postoperative endophthalmitis.

P: Patients attending for routine cataract surgery
I: Preoperative irrigation of conjunctival fornices with 5% povidone-iodine
C: Preoperative irrigation with 1% povidone-iodine
O: Reduction of postoperative endophthalmitis

Question: In patients attending for routine cataract surgery, what are the effects of preoperative irrigation of conjunctival fornices with 5% povidone-iodine in the reduction of postoperative endophthalmitis as compared to preoperative use with 1% povidone iodine?

  1. Endotracheal suctioning is a necessary airway intervention which aims in clearing the endotracheal tube and airways of respiratory secretions. The instillation of normal saline into the endotracheal tube or tracheostomy is an effective recruitment maneuver in endotracheal suctioning. However, studies showed that it has been associated with dyspnea, increasing heart rate, deoxygenation, and decreasing blood pressure.

P: Patients who are mechanically ventilated through an endotracheal tube
I: Use of normal saline instillation before suctioning
C: No normal saline instillation before suctioning
O: Decreasing blood pressure

Question: In patients who are mechanically ventilated through an endotracheal tube, what are the effects of normal saline instillation before suctioning to the patients’ blood pressure as compared to no normal saline instillation?

  1. Chest thoracotomy tubes are a significant part of routine standard care for treating patients with empyema, pneumothorax, hemothorax, hemopneumothorax, and pleural effusion. Quality nursing care includes using a comprehensive chest thoracotomy tube (CTT) checklist once every shift to monitor the patient’s status and the integrity of the tubes.

P: Nursing staff in one cardiovascular facility
I: Use of a comprehensive chest thoracotomy tube checklist once every shift
C: (none)
O: Reduced complications of patients on chest tube such as infections

Question: Does the use of a comprehensive chest thoracotomy tube checklist once every shift among the nursing staff in one cardiovascular facility reduces the complications of patients on chest tube such as infections?

PICO Questions for Obesity

  1. The prevalence of childhood obesity has become an alarming public health concern. Studies show that globally, there are over 200 million school-aged children who are overweight and over 40 million of those are classified as obese. Childhood obesity is associated with a higher chance of obesity, premature death, and disability in adulthood. Moreover, children who are obese before the age of 8 years old, severe obesity is expected in adulthood.

P: School-aged children
I: Obesity before eight years of age
C: Not obese before eight years of age
O: Increased risks of severe obesity in adulthood

Question: Are school-aged children who have obesity before eight years of age at increased risks of severe obesity in adulthood?

  1. A ketogenic diet is a high-fat, moderate-proteins, and very-low carbohydrates diet. It works by making the body burn more fats and proteins instead of carbohydrates. The main idea is to deprive the body of glucose which is from carbohydrates and draw out 80% of the alternative fuel from fats. Studies show that a keto diet is an effective diet regimen for weight loss only for short-term (up to two years). A person on keto diet is advised to eat keto friendly foods like oils (olive oil, coconut oil), avocado, butter, cream, cheese, nuts, seeds (chia seeds, flaxseed, sunflower seeds), green leafy vegetables, non-starchy vegetables, meat, eggs, and fatty fish (salmon, sardines). Some foods to avoid are whole fruits, dried fruits, whole grains, cold cuts, milk, chicken nuggets, ice cream, desserts, and alcohol.

P: Overweight or obese adults
I: Ketogenic diet for three months
C: Low-fat diet
O: Weight loss

Question: In overweight or obese adults, what is the effect of a ketogenic diet for three months on weight loss as compared to a low-fat diet?

  1. Lifestyle modifications such as exercise, diet management, education, and self-monitoring of blood glucose are effective methods in controlling gestational diabetes and its complications to the mother and the unborn baby. Evidence demonstrates that the combination of lifestyle interventions prevent preeclampsia, cesarean section delivery, and perineal trauma. Meanwhile, effects to the baby include prevention of risks of being born large-for-gestational-age and perinatal death.

P: Pregnant women with gestational diabetes
I: Combination of lifestyle interventions such as exercise, diet management, education, and self-monitoring of blood glucose
C: Antenatal care only
O: Reduced incidence of cesarean section delivery

Question: In pregnant women with gestational diabetes, does the combination of lifestyle interventions like exercise, diet management, education, and self-monitoring of blood glucose reduce the incidence of cesarean section delivery than the usual antenatal care only?

  1. Bariatric surgery is one of the therapeutic interventions in obesity management that ensure substantial and sustained weight loss and reduces obesity-associated morbidities and mortality. Some established bariatric procedures include laparoscopic Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch.

P: Patients with a body mass index of 40 kg/m2
I: Sleeve gastrectomy procedure
C: Laparoscopic Roux-en-Y gastric bypass procedure
O: Amount of weight loss

Question: In patients with a body mass index of 40 kg/m2, what are the effects of sleeve gastrectomy procedure to the amount of weight loss as compared to laparoscopic Roux-en-Y gastric bypass procedure?

  1. Pharmacologic agents like orlistat, lorcaserin, liraglutide, phentermine/ topiramate, and naltrexone/bupropion can help in weight management if other interventions like diet and exercise seem to be not effective. However, the use of weight-reduction medications should be carefully monitored because of the presence of adverse effects like gastrointestinal symptoms, headaches, anorexia, and decreased absorption of fat-soluble vitamins.

P: Overweight or obese adults
I: Use of weight-reduction medications like orlistat
C: Lifestyle modifications like diet and exercise
O: Amount of weight loss

Question: In overweight or obese adults, does the use of weight-reduction medications like orlistat contribute to the amount of weight loss as compared to lifestyle modifications like diet and exercise?

  1. Obese individuals often have poor cognitive functioning particularly in planning, controlling impulses, and decision-making. Scientific evidence demonstrates that obesity can impair biological mechanisms such as glucose abnormalities and inflammatory markers which can lead to deficits in cognitive functioning. Cognitive remediation therapy is found to be effective in improving the cognitive strategies, skills, and information processing of obese individuals.

P: Overweight or obese individuals
I: Cognitive remediation therapy in adjunct to diet and exercise
C: Diet and exercise alone
O: Prevention of weight gain

Question: In overweight or obese individuals, does cognitive remediation therapy in adjunct to diet and exercise prevents further weight gain as compared to diet and exercise alone?

  1. Early onset of obesity is a risk factor for severe comorbidities in adulthood. Observational studies show that obesity onset in childhood or adolescence is associated with higher odds of prevalent comorbidities like hypertension, dyslipidemia, fatty liver disease, coronary heart disease, diabetes mellitus, and bone or joint disorders.

P: Adult women
I: Early onset of obesity in childhood or adolescence
C: Obesity onset in adulthood
O: Higher incidence of type 2 diabetes mellitus

Question: Are adult women who have an early onset of obesity in childhood or adolescence at increased risks of type 2 diabetes mellitus as compared to women with adult onset of obesity?

PICO Questions for PACU

  1. Assessment of perioperative pain in critically ill patients can be a challenging aspect of post-surgical nursing care. Nurses are often reliant on the use of numerical rating scales, critical care pain observation checklists, and behavior pain scales to assess and evaluate pain management, particularly in non-communicative post-surgical patients. However, recent studies show that pain assessment is complex and should be measured by multidimensional pain scales and not solely be based on one or two numerical or dichotomous pain scales.

P: Nurses in the post-anesthesia care unit
I: Use of multidimensional pain scales (i.e. a combination of numerical rating scales, patients’ opinion, and nurses’ observation)
C: Numerical rating scales, alone
O: Reliable assessment of patients’ post-surgical pain

Question: Does the use of multidimensional pain scales (i.e. a combination of numerical rating scales, patients’ opinion, and nurses’ observation) contribute to a reliable assessment of patients’ post-surgical pain compared to the use of numerical rating scales alone?

  1. Hemiarthroplasty is a common surgical procedure performed to patients with hip fractures or hip disorders caused by arthritis. It involves the replacement of a portion of a hip joint and is considered to have fewer complications such as infection or bleeding as opposed to a total hip replacement. Current observational studies noted that although complications are lesser, reoperation rates and poorer functional outcomes are higher in hemiarthroplasty than total hip replacement.

P: Elderly patients who presented a fractured neck in the emergency unit
I: Hemiarthroplasty surgical procedure
C: Total hip replacement
O: Higher reoperation rates

Question: In elderly patients who presented fractured neck in the emergency unit, does hemiarthroplasty surgical procedure have an effect on higher reoperation rates than total hip replacement?

  1. Magnesium sulfate administered perioperatively can help reduce postoperative pain and prevent chronic neuropathic pain after chest thoracotomy. It enhances the analgesic action of analgesia making it an effective adjuvant agent. The intervention involves administering magnesium sulfate following the induction of anesthesia and delivered on a 24 hour period as an intravenous infusion.

P: Patients who had chest thoracotomy procedure
I: Use of magnesium sulfate infusion during the surgery and within the first 24 hours after surgery
C: Anesthesia only
O: Lower risks of chronic neuropathic pain
(T): 30 to 90 days after surgery

Question: Does the use of adjuvant magnesium sulfate infusion during surgery and the first 24 hours after surgery lower the risks of chronic neuropathic pain in patients who had chest thoracotomy procedure compared to anesthesia alone within 30 to 90 days after surgery?

  1. Postoperative nausea and vomiting are common after laparoscopic cholecystectomy. Dexamethasone is administered before the induction of anesthesia to reduce the incidence of nausea and vomiting. However, current updates suggest that optimal reduction of nausea and vomiting can be achieved when dexamethasone is given with another anti-emetic medication.

P: Patients who underwent laparoscopic cholecystectomy
I: Administration of dexamethasone and ondansetron prior to the induction of anesthesia
C: Use of dexamethasone only
O: Prevalence of nausea and vomiting
(T): Within 24 hours after surgery

Question: In patients who underwent laparoscopic cholecystectomy, does the administration of dexamethasone and ondansetron prior the induction of anesthesia reduces the prevalence of nausea and vomiting as compared to the use of dexamethasone only within 24 hours after surgery?

  1. Adequate pain relief after the surgical procedure is one of the cornerstones of quality postoperative nursing care. Non-pharmacologic modalities are also being utilized to achieve optimal pain management. This is particularly observed for postpartum mothers who undergo elective cesarean delivery because pharmacologic agents can impair the bonding of the mother and her newborn necessary for breastfeeding.

P: Patients who undergo cesarean delivery
I: Patient-selected music therapy during and hours after the procedure
C: (none)
O: Reduce the need for analgesics

Question: In patients who undergo cesarean delivery, does patient-selected music therapy during and hours after the cesarean section reduce the need for analgesics?

  1. Management of postoperative pain poses a challenge in clinical practice. The use of opioids as postoperative analgesia can cause severe adverse effects like respiratory distress, nausea, and constipation which can affect patient recovery. Non-opioids, like lidocaine, are also considered a good alternative to opioids to facilitate recovery and reduce postoperative pain.

P: Patients who had an open abdominal surgical procedure
I: Intravenous lidocaine infusion started prior to incision and continued until the end of the surgery
C: Intraoperative use of opioid analgesics
O: Shorter duration of patient recovery

Question: Does intravenous lidocaine infusion started prior incision and continued until the end of the surgery in patients who had open abdominal surgical procedure contribute to the shorter duration of patient recovery as compared to patients who had intraoperative use of opioid analgesics?

  1. Preoperative patient counseling is associated with the better patient recovery and functional outcomes. It is the responsibility of the medical team to prepare the patients for the procedure, the recovery process, and potential complications. Patients who received adequate health education and were provided opportunities to be involved in the process were found to have a positive recovery, health-related quality of life, and overall health.

P: Patients who need to undergo the surgical procedure
I: Preoperative counseling about the procedure, recovery process, and complications
C: (none)
O: Fewer postoperative complications

Question: In patients who need to undergo the surgical procedure, does preoperative counseling have an effect on the likelihood of fewer postoperative complications?

PICO Questions for Physical Therapy

  1. Knee arthroplasty or commonly known as a knee replacement is a surgical procedure which replaces the weight-bearing areas of the knee joints to prevent pain and disability. Early mobilization after surgery in patients who had total knee arthroplasty was found to decrease the patients’ length of hospitalization stay.

P: Patients who had total knee arthroplasty
I: Early mobilization on the afternoon following the surgical procedure
C: Mobilization beyond 24 hours after the procedure
O: Decreased length of hospitalization stay

Question: Does early mobilization on the afternoon following the surgical procedure in patients who had total knee arthroplasty have an effect on decreasing the length of hospitalization stay as compared to patients who were mobilized after 24 hours post-surgery?

  1. Falls and its related injuries are among the most pressing concerns of the elderly population. Several pieces of research suggest that exercise interventions can help in preventing injuries related to falls by lowering the risk factors. Stay Active and Independent for Life (SAIL), a strength, balance, and fitness program, and the Lebed method, a therapeutic exercise program accompanied by music, are two examples of exercise interventions among the elderly.

P: Elderly patients in a community-dwelling facility
I: Stay Active and Independent for Life (SAIL) exercise program
C: Lebed method
O: Prevalence of fall-related injuries

Question: In elderly patients living in a community-dwelling facility, does the Stay Active and Independent for Life (SAIL) exercise program reduces the prevalence of fall-related injuries as opposed to elderly patients on the Lebed exercise method?

  1. Balance is concluded as one of the most important factors of functional dependency and one risk factor for fall-related injuries. There are several simple exercises that the older, aging population can perform in order to improve their balance. Some of these balance exercises include back and side leg raises wall pushups and squats.

P: Elderly aged 65 years old and above
I: Performing balance exercises at least 20 minutes daily
C: no physical activity intervention
O: Reduction of fall-related injuries

Question: In elderly aged 65 years old and above, what are the effects of daily balance exercises at least 20 minutes in the reduction of fall-related injuries?

  1. Whole body vibration is a therapeutic intervention wherein vibrations are applied to the body using a vibration platform to improve muscle strength or body composition. Numerous studies observed that whole body vibration can provide short-term improvements in the motor performance and postural stability or control of patients with Parkinson’s disease.

P: Patients diagnosed with Parkinson’s disease who are taking dopamine medications
I: One month daily sessions of whole body vibration exercises on the oscillating platform
C: Conventional exercise therapy
O: Improved motor strength

Question: Do one month daily sessions of whole body vibration exercises improve the motor strength in patients diagnosed with Parkinson’s disease who are taking dopamine medications as opposed to those who are in conventional exercise therapy?

  1. Sensorimotor interventions such as proprioception retraining can help reduce pain, improve neuromuscular control and functional outcomes for patients with a ligament injury. Proprioceptive training is characterized by exercise interventions which aid the proprioceptive function by focusing on improving somatosensory signals.

P: Patients with a wrist ligament injury
I: 3 months of proprioceptive training before muscle strengthening exercises
C: Muscle strengthening exercises alone
O: Prevention of disability

Question: In patients with a wrist ligament injury, what are the effects of implementing a proprioceptive training before muscle strengthening exercises on the prevention of disability as compared to those who had muscle strengthening exercises alone after three months?

  1. Virtual reality exercise programs are gaining popularity because of its effectiveness in delivering similar results as conventional rehabilitation therapy. However, scientific evidence supporting the effectiveness and efficacy of virtual reality exercise programs are limited. Virtual reality assisted interventions can be delivered with the use of video gaming platforms such as Nintendo Wii.

P: Patients with functional ankle disability
I: 10- minute strength and balance exercises using a Nintendo Wii program
C: Traditional strength and balance rehabilitation exercises using a Theraband
O: Improved static and dynamic balance scores

Question: Do a 10-minute strength and balance exercises delivered using a Nintendo Wii program have an effect on improved static and dynamic balance scores in patients with functional ankle disability as compared to patients on traditional rehabilitation exercises using a Theraband?

  1. Cryotherapy or the use of cold therapy in rehabilitation has been demonstrated to have beneficial effects particularly on pain reduction and recovery of injuries. Cold therapy is implemented with the use of cooling modalities such as ice packs, ice towels, ice massage, frozen gel packs, vapocoolants, and other chemical reaction devices.

P: Patients with knee osteoarthritis
I: Use of cryotherapy such as ice packs during the rehabilitation period
C: (none)
O: Lesser knee stiffness and better range of motion

Question: In patients with knee osteoarthritis, what are the effects of cryotherapy during the rehabilitation period on knee stiffness and range of motion?

PICO Questions for Pregnancy

  1. Low birth weight in babies is prevalent to mothers who have received poor prenatal care. Additionally, low birth weight is a significant factor in the development of perinatal morbidity or mortality. Effective prenatal care includes providing appropriate and adequate prenatal information, screening for abnormalities, and timely intervention for both the mother and child may help prevent the risk of the baby having low birth weight. Many factors cause a mother to not seek adequate prenatal care such as socioeconomic factors including race, age, maternal education, family income, and other healthcare barriers like inaccessibility of the health facility.

P: Pregnant women
I: Eight prenatal visits with health providers throughout the entire pregnancy
C: Receiving none or less than the recommended number of prenatal visits
O: Lower risks for their babies to have a low birth weight

Question: Do eight prenatal visits with healthcare providers among pregnant women lower the risks for their babies to have low birth weight compared with women who are receiving none or less than the recommended number of prenatal visits?

  1. Gestational diabetes mellitus is characterized as any degree of glucose intolerance with onset during pregnancy. Studies show that gestational diabetes mellitus occurs in almost 7% of all pregnancies. It is diagnosed when the fasting plasma glucose level is > 126 mg/dl or 7.0 mmol/ l or when the serum plasma glucose is > 200 mg/dl or 11.1 mmol/l. Women who are at higher risks are women with age >25 years old, pre-pregnancy weight gain or obesity, with known diabetes in first-degree relatives, with a history of abnormal glucose tolerance or hypertension, and with a history of the poor obstetric outcome.

P: Pregnant women
I: With a history of hypertension
C: With no history of hypertension
O: Increased risks of gestational diabetes mellitus

Question: Are pregnant women with a history of hypertension has increased risks of gestational diabetes mellitus as compared with pregnant women with no history of hypertension?

  1. Supplementation with myo-inositol reduces the development of gestational diabetes mellitus. The mechanism of myo-inositol supplementation is that it increases the action of endogenous insulin and lowers insulin resistance. Several studies demonstrate that supplementation with myo-inositol in the first trimester can drastically reduce the incidence of gestational diabetes.

P: Pregnant women with high risks to develop gestational diabetes
I: Supplementation with myo-inositol in the first trimester
C: No supplementation with myo-inositol
O: Lower incidence of gestational diabetes

Question: In pregnant women with high risks to develop gestational diabetes, what are the effects of myo-inositol supplementation during the first trimester to the likelihood of having gestational diabetes as opposed to pregnant women with no myositol supplementation?

  1. Intrahepatic cholestasis of pregnancy is a liver disorder which appears on the third trimester of pregnancy and is characterized by impaired excretion and abnormal building up of bile in the liver. Intrahepatic cholestasis of pregnancy is a serious maternal health concern as it is associated with increased risks of premature delivery, stillbirth, and fetal distress. This condition causes severe itchiness or pruritus on the palms of the hands and soles of the feet and may manifest by yellowing of the skin and eyes (jaundice).

P: Pregnant women
I: Diagnosed with intrahepatic cholestasis
C: (none)
O: Increased risk to have premature delivery or stillbirth

Question: Does intrahepatic cholestasis in pregnant women have an effect on higher risks to have premature delivery or stillbirth?

  1. Prenatal iron supplementation has been proven to prevent iron deficiency among pregnant women and prevent other maternal and neonatal illnesses. According to WHO, 38.2% of pregnant women aged 15-49 years old have anemia. It is recommended to take iron supplements containing folic acid and essential B-vitamin because of the increased body requirements during pregnancy caused by the rapidly-dividing fetal cells and high urinary losses.

P: Pregnant women
I: Daily iron (with folic) supplementation of 60 mg/ day
C: none
O: Prevent the incidence of maternal anemia

Question: In pregnant women, does daily iron with folic supplementation of 60 mg/day help prevent the incidence of maternal anemia as compared to pregnant women with no iron and folic supplementation?

  1. Pregnant women are vulnerable to develop vitamin and mineral deficiencies due to high fetal nutritional demands for growth and development. The most common vitamin and mineral deficiencies among pregnant women include iron, folate, iodine, and calcium. Vitamin and mineral deficiencies are associated with adverse health outcomes in both the mother and the baby. For example, iron deficiency is associated with maternal mortality, premature delivery, and low birth weight. Meanwhile, iodine deficiency can cause brain damage in childhood, poor thyroid function and goiter in adults. Inadequate antenatal intake of calcium, on the other hand, is linked with gestational hypertension, tremor, and delayed fetal growth. These health problems can be prevented by the use of fortified and multiple micronutrient powders.

P: Pregnant women (any trimester and parity)
I: Use of fortified and multiple micronutrient powders
C: (none)
O: Low risks of having maternal anemia and low birth weight in their babies

Question: In pregnant women of any trimester and parity, does the use of fortified and multiple micronutrient powders reduce the risks of having maternal anemia and low birth weight in their babies?

  1. The complications of gestational diabetes can severely affect the health of the baby. Uncontrolled gestational diabetes in the mother may contribute to the baby’s excessive birth weight, early preterm birth and respiratory distress syndrome, hypoglycemia, and adult-onset of type 2 diabetes mellitus.

P: Pregnant mothers
I: With gestational diabetes
C: Without gestational diabetes
O: Increased risks for their babies to have respiratory distress syndrome

Question: Are pregnant mothers with gestational diabetes at an increased risk for their babies to have respiratory distress syndrome as opposed to mothers without gestational diabetes?

PICO Questions for Hypertension

  1. Treatment adherence remains a problem in the management of hypertension in spite of increased patient awareness. With poor medication adherence, patients are predisposed to severe cardiovascular events such as stroke or coronary heart disease. An effective approach in promoting treatment adherence in patients is proper education and counseling of their family to encourage higher social support.

P: Hypertensive patients
I: Family education and counseling to ensure social support
C: No family education and counseling
O: Reduced likelihood to develop coronary heart disease

Question: In hypertensive patients, does family education and counseling to ensure social support have an effect on reduced likelihood in developing coronary heart disease as compared to patients with no family education and counseling?

  1. Pregnancy-induced hypertension is a condition characterized by high blood pressure during pregnancy and can be classified as chronic hypertension, gestational hypertension, and preeclampsia. Maternal pregnancy-induced hypertension has been demonstrated to disrupt the immune system of the newborn thus increasing the risk of neonatal candidiasis.

P: Pregnant mothers
I: Diagnosed with pregnancy-induced hypertension
C: Not diagnosed with pregnancy-induced hypertension
O: Increased risk of neonatal candidiasis

Question: Are pregnant mothers diagnosed with pregnancy-induced hypertension at increased risk of neonatal candidiasis as compared to those without pregnancy-induced hypertension?

  1. Health dietary practices help in preventing severe complications of hypertension such as heart failure. One effective dietary intervention is the implementation of the Dietary Approaches to Stop Hypertension (DASH). In DASH diet, patients are encouraged to eat more fruits, vegetables, whole-grain foods, fish, poultry, and nuts, consume foods with less saturated fats, trans fats, and cholesterol, and limit sodium and processed sugar intake.

P: Patients diagnosed with chronic hypertension
I: Adopting the Dietary Approaches to Stop Hypertension or DASH diet
C: Without dietary restrictions
O: Low predisposition to having heart failure

Question: In patients diagnosed with chronic hypertension, what are the effects of adopting Dietary Approaches to Stop Hypertension or DASH diet on the likelihood of having heart failure than hypertensive patients without dietary restrictions?

  1. Dietary nitrate has the potential to lower blood pressure as studies have demonstrated. For example, consumption of beet juice daily can help in improving the systolic and diastolic blood pressure. The improvement of the blood pressure is attributed to the conversion of the dietary inorganic nitrates to nitric oxide which is considered as a vasodilator.

P: Hypertensive patients
I: Daily consumption of beet juice for one month
C: (none)
O: Lowering of systolic and diastolic blood pressure measurements

Question: Does daily consumption of beet juice for one month in hypertensive patients help lower the systolic and diastolic blood pressure measurements?

  1. Preeclampsia is defined as the onset of hypertension after 20 weeks of gestation which is often accompanied by proteinuria. Scientific evidence claims that mothers with preeclampsia have a higher likelihood to have hypertension and stroke in the fifth or sixth decade of life.

P: Pregnant mothers
I: Diagnosed with preeclampsia
C: Pregnant mothers without preeclampsia
O: Higher risk of stroke in the fifth or sixth decade of life

Question: Are pregnant mothers who have preeclampsia at increased risk of stroke in the fifth or sixth decade of life as compared to pregnant mothers without preeclampsia?

  1. Polycystic ovary syndrome (PCOS) can be considered as a significant risk factor of hypertension. However, the association of PCOS and hypertension is unclear as women with PCOS have a higher prevalence of obesity which is also considered risk factors of hypertension. Other potential causes of hypertension in women with PCOS aside from obesity are insulin resistance, androgen excess, and increased sympathetic nervous system activity.

P: Women of reproductive age of 15-49 years old
I: Diagnosed with polycystic ovary syndrome (PCOS)
C: Women of reproductive age 15-49 years old without PCOS
O: Increased risk of hypertension

Question: Are women of reproductive age of 15-49 years old who are diagnosed with polycystic ovary syndrome (PCOS) at increased risk of hypertension as compared to women without PCOS?

  1. Tai Chi is an effective potential adjunct to pharmacologic management of hypertension. Few observational studies show that Tai Chi exercise is more effective than brisk walking in reducing the risks of cardiovascular events among hypertensive patients. In the study of Chan AWK et al (2018), tai chi exercise has significantly lowered the blood pressure, fasting blood glucose, perceived stress, and improved perceived mental status and self-efficacy at 9 months of intervention.

P: Hypertensive patients
I: Tai chi exercise
C: Brisk walking
O: Improved systolic and diastolic blood pressure
(T): After 12 months of intervention

Question: In hypertensive patients, does tai chi exercise have an effect in improved systolic and diastolic blood pressure as compared to patients who do brisk walking exercise after 12 months of intervention?

PICO Questions for Occupational Therapy

  1. Stroke patients develop motor disability or dysfunction depending on the severity of the vessel blockage. Locomotor training is prescribed to help improve the gait performance and aid in the recovery of walking function. One example of locomotor training is the gait training on a treadmill with body-weight support. However, locomotor training requires long-term sessions lasting for about three to six months as gains are found to be minimal when sessions are done within one month.

P: Post-stroke patients
I: Locomotor training sessions which are done three times per week for at least twelve weeks
C: Same locomotor training sessions done for only four weeks
O: Improved gait speed and walking endurance

Question: In post-stroke patients, what are the effects of locomotor training sessions which are done three times per week for at least twelve weeks in improving the gait speed and walking endurance as compared to doing locomotor training sessions for only four weeks?

  1. Physical rehabilitation programs are often implemented in combination to achieve optimal recovery results. Some interventions combine strength and balance exercises with aerobic fitness, meanwhile, some include functional electrical stimulation therapy. Functional electrical stimulation plays a vital role in the rehabilitation of patients after stroke. It involves the electrical stimulation of motor neurons where the muscles are triggered to contract.

P: Post-stroke patients
I: Combination therapy of conventional physiotherapy and ergometer cycling with functional electrical stimulation
C: Conventional physiotherapy and ergometer cycling
O: Improvement of ambulatory function
(T): Eight weeks

Question: In post-stroke patients, does the combination therapy of conventional physiotherapy and ergometer cycling with functional electrical stimulation have an effect on the improvement of ambulatory function as opposed to conventional physiotherapy and ergometer cycling only for eight weeks of intervention?

  1. Persons suffering from dementia have compromised functioning in their activities of daily living. Occupational therapy is a caring domain wherein the therapist applies a wide range of interventions and approaches to aid the patient to restore or recover his loss of functioning. One effective intervention that can be included in the caring plan is using cooking activities for the patient to work on his functional cognitive skills, life skills acquisition, emotional regulation, and practice communication and interaction skills.

P: Patients diagnosed with early-stage dementia
I: Cooking activities as part of the therapeutic care plan
C: (none)
O: Improved functional cognitive skills

Question: In patients diagnosed with early-stage dementia, does the use of cooking activities as part of the therapeutic care plan has an effect on improved functional cognitive skills?

  1. Creative activities can be used in occupational therapy to meet a range of therapeutic goals including the improvement of developmental needs (i.e. social, emotional, cognitive, language, physical). Some examples of creative activities are the use of drama, art, dance, music, poetry, writing, or pottery.

P: Post-stroke patients with language deficits
I: Implementation of creative activities as part of occupational therapy
C: (none)
O: Improved expression of emotions

Question: In post-stroke patients with language deficits, does the implementation of creative activities as part of occupational therapy help improve the expression of emotions?

  1. Sensory integration therapy is a neuroscience-based intervention which is used for children and adults with noted problems in their sensory functioning, such as autism and developmental disabilities. Patients with autism have problems in integrating or organizing their sensory inputs and may produce problems in information processing or behavior. An example of a sensory integration technique is the use of pressure-touch which can facilitate awareness, attention, and concentration, and can decrease overstimulation or over-arousal.

P: Children diagnosed with autism
I: Use of sensory integration therapy such as pressure-touch
C: (none)
O: Increased attention and concentration

Question: Does the use of sensory integration therapy such as pressure-touch have an effect on increased attention and concentration in children diagnosed with autism?

  1. Adequate occupational therapy has the potential to yield positive results in helping chronically-ill patients to restore and maintain their self-care and optimize their occupational functioning. For patients with multiple sclerosis, occupational therapy interventions are geared towards the patients’ symptoms or dysfunctional areas such as personal hygiene, fatigue, mobility, communication, and among others. It is therefore imperative that a comprehensive assessment must be performed to guide the planning and implementation of therapeutic care.

P: Patients diagnosed with multiple sclerosis
I: Use of standardized occupational performance measurement tools
C: (none)
O: Design better-individualized patient care plans

Question: In patients diagnosed with multiple sclerosis, does the use of standardized occupational performance measurement tools influence the design of better-individualized patient care plans?

  1. Cognitive behavioral therapy is an effective management strategy for patients with chronic fatigue. It is a form of psychotherapy that is structured, goal-oriented and focused on modifying the patient’s thoughts and behavioral patterns. It is administered by a licensed therapist.

P: Patients with chronic fatigue
I: Cognitive behavioral therapy sessions
C: (none)
O: Reduced complaints of fatigue symptoms

Question: In patients with chronic fatigue, does the use of cognitive behavioral therapy sessions have an effect on reduced complaints of fatigue symptoms?

PICO Questions Orthopedics

  1. Acute compartment syndrome occurs subsequently after a traumatic fracture or any damaging event resulting in severe muscle or nerve ischemia. It is considered an orthopedic emergency which requires prompt identification and management because if left untreated it can result in complications such as limb amputation. One of the confirmatory diagnostic procedures for acute compartment syndrome is the use of tools or devices measuring the intramuscular pressure and confirming for the need for surgery.

P: Patients diagnosed with acute compartment syndrome
I: Clinical assessment and use of non-invasive ultrasound technique estimating the intramuscular pressure
C: Clinical diagnosis only
O: Prompt medical decision-making for fasciotomy procedure

Question: In patients diagnosed with acute compartment syndrome, does the clinical assessment and use of non-invasive ultrasound technique estimating intramuscular pressure influence the prompt medical decision-making for surgical procedure compared to clinical diagnosis only?

  1. Foot drop is a prevalent complication among frail elderly or patients with underlying neurological, muscular, or anatomic problem. Management of foot drop varies depending on the severity of the mobility limitation. Two conventional treatment for foot drop includes ankle-foot orthosis and functional electrical stimulation. Ankle-foot orthosis involves the use of external frame around the foot, ankle and knee area for support. On the other hand, the functional electrical stimulation is the application of electrical current to a peripheral nerve via cutaneous or implanted electrodes.

P: Patients diagnosed with multiple sclerosis and manifesting foot drop
I: Use of functional electrical stimulation
C: Use of ankle-foot orthosis
O: Improvements in gait performance and balance

Question: Does the use of functional electrical stimulation have an effect on the improvements in gait and balance performance as compared to the use of ankle-foot orthosis in patients diagnosed with multiple sclerosis and manifesting foot drop?

  1. Osteoarthritis is the most prevalent disease of the elderly population which can lead to permanent disability, if not properly managed. Multiple factors play a significant role in the incidence of osteoarthritis, including old age, female gender, sports participation, obesity, genetic susceptibility, joint injury or trauma, poor bone density, and muscle weakness.

P: Female adults aged 40 to 50 years old
I: Overweight or obese
C: Weight within the normal range
O: Increased risk of osteoarthritis

Question: Are female adults aged 40 to 50 years old who are overweight or obese at increased risk of osteoarthritis as compared to those whose weight is within the normal range?

  1. Frequent squatting increases the likelihood of having knee osteoarthritis among the elderly. Studies found out that occupations involving squatting or kneeling more than two hours daily are associated with two-fold increased risk of moderate to severe knee osteoarthritis. Squatting or kneeling positions can pose repetitive trauma and damage to the joints.

P: Adult individuals
I: Employed in occupations with prolonged squatting or kneeling
C: (none)
O: Increased incidence of knee osteoarthritis in old age

Question: Are adult individuals who are employed in occupations with prolonged squatting or kneeling at increased incidence of knee osteoarthritis in old age?

  1. Several non-surgical interventions, such as home exercise program, knee braces hydrotherapy, and weight loss, have demonstrated its effectiveness for patients with degenerative knee osteoarthritis. Aerobic and non-weight bearing exercises are recommended because it promotes functioning and movement and relieves pain. On the other hand, a knee brace can also help reduce pain and relieve unnecessary pressure on the damaged area.

P: Patients diagnosed with knee osteoarthritis
I: Use of combined interventions of drugs, exercise program, and knee braces
C: Use of knee braces in adjunct to pharmacologic agents
O: Reduced severity of pain in the affected knee

Question: In patients diagnosed with knee osteoarthritis, does the use of combined interventions of drugs, exercise program and knee braces reduce the severity of pain in the affected knee as compared to the combination therapy of drugs and knee braces?

  1. Neurogenic bladder dysfunction is characterized as a dysfunction in the urinary bladder caused by disease or injury on the central nervous system or peripheral nerves involved in the control of urination. One of the common causes of neurogenic bladder dysfunction is spinal cord injury. Patients with neurogenic bladder dysfunction are often prescribed with long-term bladder training guidance, clean and intermittent self-catheterization, and drinking guidance. However, studies found out that patients on intermittent urinary catheters have low adherence and has an effect on their quality of life.

P: Patients with neurogenic bladder dysfunction caused by spinal cord injury
I: On intermittent self-catheterization
C: Not on intermittent self-catheterization
O: Decreased quality of life scores

Question: Are patients with neurogenic bladder dysfunction caused by spinal cord injury who are on intermittent self-catheterization at an increased likelihood to have a lower quality of life scores compared to those who are not on intermittent self-catheterization?

  1. Body mass index (BMI) has been reported to have an association with fractures. However, there are inconsistencies in the available scientific evidence wherein few studies found out that low BMI can be a risk factor for fractures because of the low bone mass density, meanwhile, obesity can only be protective depending on the fracture site.

P: Adult individuals
I: With low body mass index
C: With overweight or obese body mass index
O: Increased risk of fractures

Question: Are adult individuals with low body mass index at an increased risk of fractures as compared to those with overweight or obese body mass index?

PICO Questions Related to Sepsis

  1. Neonatal sepsis is defined by the presence of positive blood culture with or without associated clinical signs consistent with infection. Very-low-birth-weight (< 1500 g birth weight) infants are at increased risk for neonatal sepsis. Studies show that the common causative agents of neonatal sepsis are gram-negative organisms (Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp.) and gram-positive bacteria (Staphylococcus aureus).

P: Neonates
I: With very-low-birth-weight or <1500 g birth weight
C: With normal-birth-weight or >2500 g birth weight
O: Increased risk of neonatal sepsis

Question: Are neonates with very-low-birth-weight (<1500 g birth weight) at increased risk of neonatal sepsis as compared to neonates with normal birth weight (> 2500 g birth weight)?

  1. Emergency surgical procedures predispose patients to higher mortality rate as compared to elective surgeries. This is due to serious complications such as postoperative sepsis or septic shock. Early identification of severe sepsis is a critical and crucial aspect of preventing sepsis-related multiple organ dysfunction and mortality. The primary method of diagnosing intra-abdominal sepsis, for example, is clinical assessment. However, scientific advances support the use of ultrasonography, computed tomography, or bedside laparoscopy.

P: Patients who presented in the emergency department with peritonitis
I: Diagnosis by clinical assessment and ultrasonography
C: Clinical diagnosis alone
O: Early detection of intra-abdominal sepsis

Question: For patients who presented in the emergency department with peritonitis, how does the diagnosis by clinical assessment and ultrasonography compared to clinical diagnosis alone influence the early detection of abdominal sepsis?

  1. The first-line management of a patient with sepsis is the administration of intravenous antibiotic therapy. Observational evidence shows that delays in antibiotic administration are associated with an increased likelihood of mortality. However, shortening the time to administer antibiotics can also incur potential harms particularly in administering antibiotics without evaluating the etiology of sepsis.

P: Patients manifesting signs of sepsis or infection
I: Prompt administration of first-line antibiotics within 2 hours of admission and without blood culture results
C: Delayed administration of antibiotics and with culture results
O: Better patient outcomes and shorter duration of recovery

Question: In patients manifesting signs of sepsis or infection, does prompt administration of first-line antibiotics within 2 hours of admission and without blood culture results contribute to better patient outcomes and shorter duration of recover as compared to delayed antibiotic administration and with culture results?

  1. WHO guidelines for preventing neonatal infection recommends providing intramuscular or intravenous ampicillin and gentamicin in neonates with known risk factors for infection for at least 2 days as prophylaxis. For neonates with persistent signs of infection, treatment should be continued with combined antibiotic therapy gentamicin and benzylpenicillin or ampicillin for at least 7-10 days.

P: Newborns aged less than 2 months with signs of bacterial infection
I: Combined antibiotic therapy of gentamicin and ampicillin for at least 7 days
C: (none)
O: Prevention of sepsis

Question: In newborns aged less than 2 months with signs of bacterial infection, does the combined antibiotic therapy of gentamicin and ampicillin for at least 7 days have an effect on prevention of sepsis?

  1. Sepsis management includes antibiotic therapy, fluid resuscitation, and supportive care. Growing evidence shows that intravenous administration of ascorbic acid, corticosteroids, and thiamine can be an adjunct treatment for patients with sepsis. The combination of intravenous ascorbic acid, thiamine, and hydrocortisone has been shown to reduce organ dysfunction by suppressing the generation of new free radicals and facilitate cellular metabolic processes.

P: Patients in septic shock
I: Adjunct therapy of combined ascorbic acid, corticosteroids, and thiamine administered intravenously
C: (none)
O: Reduced incidence of mortality

Question: Does the intravenous administration of the adjunct therapy of combined ascorbic acid, corticosteroids, and thiamine reduces the incidence of mortality in septic shock patients?

  1. Vasopressin is an antidiuretic hormone which has a significant role in septic shock states. It binds to vascular smooth muscle receptors that can lead to vasoconstriction and maintenance of blood pressure. Vasopressin has been observed to increase the mean arterial pressure in the early stage of shock, however, some studies recommend further investigation as the role of vasopressin is similar to that of other vasopressors such as norepinephrine, epinephrine, and phenylephrine and inotropes like dopamine.

P: Patients in septic shock
I: Intravenous use of fixed-dose vasopressin infusion
C: Administration of other vasopressors such as epinephrine or norepinephrine
O: Improvement of blood pressure

Question: Among patients in septic shock, does the intravenous use of fixed-dose vasopressin infusion has an effect on the improvement of blood pressure as opposed to the administration of other vasopressors such as epinephrine or norepinephrine?

  1. Septic shock is caused by sepsis or infection and is clinically defined as low systolic blood pressure (< 90 mmHg) or mean arterial blood pressure (< 65 mmHg) accompanied by oliguria, poor peripheral perfusion or altered mental status. Fluid resuscitation is an imperative part of shock management. Some fluids that are routinely used include crystalloids solution, balanced crystalloids, and albumin solutions. However, debates exist on which fluids provide the most efficient shock resuscitation.

P: Patients in septic shock
I: Use of a crystalloid solution such as normal saline solution
C: Use of lactated Ringer’s solution
O: Rapid improvement of blood pressure

Question: In patients in septic shock, what are the effects of the use of a crystalloid solution such as a normal saline solution to the rapid improvement of blood pressure as opposed to the use of lactated Ringer’s solution?

PICO Questions Speech Pathology

  1. Ankyloglossia, or commonly known tongue-tie, is characterized by short or tight lingual frenulum which can limit tongue mobility and may cause speech, feeding, and swallowing difficulties. Current scientific evidence is focused on the effects of ankyloglossia on breastfeeding difficulties in infants. However, reports claim that it can also increase the risk of speech-related issues or articulation problems because of the limited tongue movement.

P: Infants
I: With posterior ankyloglossia
C: Without posterior ankyloglossia
O: Speech-related difficulties in childhood years

Question: Are infants with posterior ankyloglossia at increased risk of speech-related difficulties in childhood years as compared to those without posterior ankyloglossia?

  1. Frenotomy is a surgical procedure indicated to correct anterior and posterior ankyloglossia. Studies show that children who received frenotomy to release anterior and posterior tongue ties have demonstrated better feeding practices. However, the evidence is still lacking in determining the potential outcomes of frenotomy on speech difficulties in the childhood years.

P: Infants with anterior and posterior ankyloglossia
I: Frenotomy
C: Infants who did not have their anterior and posterior ankyloglossia released
O: Absence of speech difficulties?

Question: In infants with anterior and posterior ankyloglossia, does frenotomy have an effect on the absence of speech difficulties as compared to infants who did not have their anterior and posterior ankyloglossia released?

  1. Technological advances allow computer-based programs to aid in the delivery of speech therapy for children with stuttering or speech sound difficulties. It can also potentially address problems on service inaccessibility and able to provide more individualized direct approach.

P: Children with stuttering problems
I: Use of the computer-based speech therapy program
C: One-on-one session with a speech therapist using printed aids
O: Rapid improvement in speech difficulties

Question: In children with stuttering problems, does the use of computer-based speech therapy program have an effect on rapid improvement in speech difficulties than a one-on-one session with a speech therapist using printed aids?

  1. Empirical evidence proves that speech interventions are more effective than oral motor exercises in the management of children with speech delays. However, few studies found out that non-speech oral motor exercises, when used in adjunct with the conventional speech therapy program, can facilitate speech improvements.

P: Children with speech delays
I: Use of non-speech oral motor exercises in adjunct with the conventional speech therapy program
C: Conventional speech therapy program, alone
O: Rapid speech improvements

Question: Does the use of non-speech oral motor exercises in adjunct with the conventional speech therapy program in children with speech delays have an effect on rapid speech improvements?

  1. Speech disabilities are demonstrated to have an association with cleft lip or palate. Some determinants or risk factors of the likelihood to have speech disabilities associated with cleft lip or palate are maternal speech disability, parental child-bearing age, and low levels of parental education.

P: Children with oral cleft problems
I: Mothers with speech disabilities
C: Without maternal speech disabilities
O: Increased risks of speech problems

Question: Are children with oral cleft problems who have mothers with speech disabilities at increased risks of speech problems as compared to those whose mothers do not have speech difficulties?

  1. Childhood apraxia of speech is a motor speech disorder characterized by the inability of the child to consistently produce sounds or syllables or accurately produce words or sentences. Distinct risk factors of childhood apraxia of speech are familial predisposition, neurological injury or trauma, and metabolic disorders such as galactosemia.

P: Preschool children
I: Diagnosed with galactosemia
C: Without galactosemia
O: Increased risk of childhood apraxia of speech

Question: Are preschool children diagnosed with galactosemia at increased risk of childhood apraxia of speech as compared to those without galactosemia?

  1. Visual-acoustic biofeedback, traditional articulation therapy, ultrasound imagery, and acoustic education are effective interventions used for patients with a lisp. These interventions are often combined to achieve desired positive results. However, visual-acoustic biofeedback is prescribed more to patients whose visual skills are better than the auditory skills.

P: Children with a lisp
I: Visual-acoustic biofeedback
C: Traditional articulation therapy
O: Resolution of lisp

Question: In children with a lisp, does the visual-acoustic feedback have an effect on the resolution of lisp as compared to traditional articulation therapy?

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