CONTINUATION OF EBP ASSIGNMENT
duduke78
WK5AssgnEBP1.pptxAdvanced Levels of Clinical Inquiry and Systematic Reviews University Essentials of Evidenced-Based Practice Instructor 2020
Clinical Issue Of Interest-Posttraumatic stress disorder (PTSD)
Is an acute psychological disorder affecting many adults and children Develops after exposure to traumatic event or experience.
It is among the leading mental health disorders in the U.S.
Causes are exposure to serious injury, sexual violence, death, and combat
Interventions are pharmacotherapies (cortisol) and psychotherapies (exposure-based therapy)
According to Lancaster, Teeters, Gros, & Back (2016), PTSD is a psychological disorder resulting from experiencing or being exposed to traumatic events such as death, severe injuries, combat, natural disasters, fatal accidents, and sexual violence. Both evidence-based pharmacotherapies such as cortisol and psychotherapies such as exposure-based therapy. This clinical issue causes people to develop and show acute reactions such as nightmares, hyper-alertness, or recurrent intrusive thoughts.
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Traumatic event experience is not a must to cause PTSD
About 8.7% is estimated PTSD’s prevalence
Between 7 to 8 percent of population experience PTSD
United States military veterans are vulnerable population to PTSD
Some of the people experiencing a traumatic occurrence in their lifetime may not develop PTSD. 8.3% is the approximated lifetime prevalence of PTSD (Lancaster, Teeters, Gros, & Back, 2016). During the days before traumatic events, most people start showing acute reactions, such as intrusive thoughts or nightmares regarding the occurrence, hyper-alertness, and difficulties with sleep, and paying attention. According to the U.S. Department of Veterans Affairs, approximately 7-8% of the population experience PTSD in their lives. Among the U.S. Army veterans, this rate is higher (Katon, Callegari, Bossick, Fortney, Gerber, Lehavot, & Gray, 2020).
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How PICOT Has Been Developed
Setting the PICOT framework
Thinking about every single aspect or element of the framework
Identifying the thought main elements of the question using the framework
Writing the question statement
Elias, B. L., Polancich, S., Jones, C., & Colvin, S. (2015). Evolving the PICOT Method for the Digital Age: The PICOT-D...Population, Intervention, Comparison, Outcome, Time. Journal of Nursing Education, 54(10), 594–599. https://doi-org.ezp.waldenulibrary.org/10.3928/01484834-20150916-09
In absence of well-framed question, it can be challenging and take time to find relevant resources and search for appropriate evidence. As a practitioner of evidence-based practice (EBP), I used a unique framework, called PICOT, to build the question and enable the literature search. PICOT stands for:
Patient issue or population)
Intervention,
Comparison or control
Outcome
Time
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What I considered when developing the question:
What are the patient’s demographics such as gender, ethnicity, and age?
What intervention am I looking for?
What is the available comparison for treatment to consider?
What is the desired effect I would like to see?
What unexpected effects are associated with the consider intervention?
Hastings, C., & Fisher, C. A. (2014). Searching for proof: Creating and using an actionable PICO question. Nursing Management, 45(8), 9–12. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NUMA.0000452006.79838.67
Within the PICOT framework, it is crucial to consider the patient items, intervention, comparison, outcome, and time. Each of these elements change per to the type of the question framed. Question type can be therapy, prevention, diagnosis, prognosis, or etiology. As a result, it is important to think about the question to ask when forming the question using the PICOT Framework.
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Developed PICOT
PICOT Question: Among military veterans with PTSD (P), does exposure-based therapy (I), compared to cortisol (C), assist to reduce hyper-alertness and increase mental recovery (O) over lifespan? (T)
Defined elements of the above question:
Patient: military veterans
Intervention: exposure-based therapy
Comparison: cortisol
Outcome: reduced hyper-alertness and increased mental recovery
Time: over lifespan
The question compares the best effective intervention to use to help military veterans with PTSD recover from recurrent intrusive thoughts and nightmares. Exposure-based therapy is psychotherapy treatment tested to prove whether it is more effective than cortisol, a thermotherapy treatment.
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Research Databases For Conducting Search For The Peer-reviewed Articles
ScienceDirect
PubMed
ProQuest Research library
Library Articles Search
Peer-reviewed Articles
Katon, J. G., Callegari, L. S., Bossick, A. S., Fortney, J., Gerber, M. R., Lehavot, K., ... & Gray, K. E. (2020). Association of depression and post-traumatic stress disorder with receipt of minimally invasive hysterectomy for uterine fibroids: findings from the US department of veterans affairs. Women's Health Issues, 4(8), 45-52. The above article has level I evidence
Lancaster, C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016). Posttraumatic stress disorder: overview of evidence-based assessment and treatment. Journal of clinical medicine, 5(11), 105. Level of evidence is V
Poyner, G. (2010). Psychological evaluations of veterans claiming PTSD disability with the Department of Veterans Affairs: A clinician's viewpoint. (2), 130-132. Psychological Injury and Law. Evidence level is I.
Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N. J., Stockton, S., Bhutani, G., Grey, N., Leach, J., Greenberg, N., Katona, C., El-Leithy, S., & Pilling, S. (2020). Psychological treatments for post-traumatic stress disorder in adults: A network meta-analysis. Psychological Medicine, 50(4), 542–555. https://doi-org.ezp.waldenulibrary.org/10.1017/S0033291720000070
Article 1 has a level I evidence because it presents a therapy type of clinical question. The evidence is from a systematic review of all relevant randomized controlled trial.
Article 2 has level V evidence. For instance, the evidence is from systematic reviews of descriptive and qualitative studies.
Article 3 has a level I evidence. For instance, the evidence is from the researcher’s clinical experience and systematic review.
Article 4 has level IV evidence. For instance, the evidence is from participants exposed to combat and those not exposed to compare and make a conclusion. The study uses a well-designed case-control to justify this level IV evidence.
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Peer-reviewed articles
Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N. J., Stockton, S., Bhutani, G., Grey, N., Leach, J., Greenberg, N., Katona, C., El-Leithy, S., & Pilling, S. (2020). Psychological treatments for post-traumatic stress disorder in adults: A network meta-analysis. Psychological Medicine, 50(4), 542–555. https:// doi-org.ezp.waldenulibrary.org /10.1017/S0033291720000070
Decker, S. E., Pavlo, A., Harper, A., Herring, Y., & Black, A. C. (2020). Themes in experiences of PTSD symptoms and relationships among male veterans with risky sexual behavior. Psychological Trauma: Theory, Research, Practice, and Policy, 12(7), 678–686. https://doi-org.ezp.waldenulibrary.org/10.1037/tra0000569.supp (Supplemental)
