Hepatitis C PICOT Questions no plagiarize, spell check, and check your grammar. Please only use the references below. A. Write a summary of the significa

Hepatitis C PICOT Questions no plagiarize, spell check, and check your grammar. Please only use the references below.

A. Write a summary of the significance and background of a healthcare problem by doing the following:

1. Describe a healthcare problem that can be used to develop a PICO question.

2. Explain the significance of the problem from part A1.

3. Describe the current healthcare practices related to the problem from part A1.

4. Discuss how the problem affects the organization and patients’ cultural background (i.e., values, health behavior, and preferences).

References

Evidence-Based Clinical Practice: Asking Focused Questions (PICO)

https://guides.mclibrary.duke.edu/ebm/pico

Researchers recommend universal screening to tackle rise in hep C. (2018, Oct 17). R & D, Retrieved from https://search-proquest-com.proxy-library.ashford…. 1040-5488/16/9310-1187/0 VOL. 93, NO. 10, PP. 1187Y1188
OPTOMETRY AND VISION SCIENCE
Copyright * 2016 American Academy of Optometry
EDITORIAL
Evidence-Based Clinical Practice: Asking
Focused Questions (PICO)
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T
raining health care providers in the United States was
modeled on the apprenticeship system for hundreds of
years.1 In 1910, Abraham Flexner helped take an important
step towards evidence-based practice when he authored a landmark study of the state of physician training practices in the
United States. The Flexner Report exposed deficiencies in the
quality and practices of current medical training. This report
called for the elimination of many medical training programs and
fundamental revisions to the system of medical education in the
United States. A key recommendation from this report was a
requirement to ‘‘Train physicians to practice in a scientific manner
and engage medical faculty in research.’’ By 1930, the number of
training programs was reduced from 160 to 97Vwhen 71 programs either closed or merged with existing university-based
programs. Another key recommendation of this report was a
proposal to establish clinical professorships, recognizing the
valuable role that clinical educators serve spanning the classroom
and the clinic.2 The Flexner report firmly established an important
principle necessary to advance medical educationVa basis on
scientific evidence. Nevertheless, that alone was not sufficient.
Fundamental Principles of Evidence-Based Practice
The term evidence-based practice was coined by Gordon
Guyatt in 1991 to encompass the idea of teaching clinicians how
to find, interpret, and use the best available evidence for clinical
practice.3 David Sackett, a pioneer in clinical epidemiology, once
described evidence-based practice as ‘‘Ithe conscientious, explicit, and judicious use of current best evidence in making decisions
about the care of individual patients.’’4 Critics of evidence-based
practice claim that the approach is formulaic and devalues the
knowledge and insights of experienced clinicians, or that it fails to
take into consideration the context of an individual patient. In its
infancy, the field was focused on critical appraisal and the development of methods necessary to assess the quality of available
evidence. Early efforts were also focused on identifying areas
where additional evidence was needed. Nevertheless, there are
three components that define the framework for evidence-based
practice, and each is essential: quality scientific evidence, clinical
expertise and judgment, and patient values and perspective.
Evidence exists on a continuum from clinical observations to
highly structured controlled clinical trials. At the most basic level,
clinicians make observations, e.g. that light exposure may reduce
the risk for myopia progression, or that oral statin use could
protect against neurodegeneration in glaucoma. What begins as a
clinical observation becomes less anecdotal when controlled systematic studies are undertaken to reduce bias and control for potential
confounding factors related to study design and execution. When
relevant evidence is available, providers should then critically appraise
the quality and strength of that evidence so that they can use it appropriately and effectively. Clinical expertise and judgment are then
combined with careful interpretation. Finally, the practical application of evidence must consider each patient’s values and preferences
to make the best informed decision for each individual.
Asking Focused Clinical Questions
At the heart of evidence-based practice is a clinical question.
Unstructured clinical questions could be as simple as: Should I
change my patient’s glaucoma therapy? This question could be
rephrased as several different questions about treatment comparisons,
the benefit of diagnostic procedures, prognosis, or harm. To help
bring structure to these clinical questions, evidence-based practitioners have adopted the PICO acronym,5 where P represents the
patient, problem, or population of interest; I represents the intervention, treatment, or diagnostic procedure; C is the comparison or
control group; and O is the outcome of interest, e.g. morbidity or
mortality. Thoughtful specification of each of these parameters can
help move from a general idea to a more focused, actionable
question or hypothesis. Working through this acronym is an exercise
that can help define the terms needed to guide a search for existing
evidence. The structured clinical question may also serve as the
starting point for generating new evidence as the rationale for a
clinical study. Table 1 shows an example of how one might generate
search terms related to the general clinical observation that young
women on both isotretinoin and birth control pills seem to have
greater meibomian gland dysfunction. Transforming this clinical
observation into a structured question can create the stem and key
words needed to search the available evidence. This focused question
can also serve as the framework for an evidence-based study design.
How and Where to Search
Browsing is one of the more common strategies for those who
use the medical literature. Browsers are often busy clinicians who
wade through a torrent of emails containing the latest table of
Optometry and Vision Science, Vol. 93, No. 10, October 2016
Copyright © American Academy of Optometry. Unauthorized reproduction of this article is prohibited.
1188 Editorial
TABLE 1.
PICO search strategy for evidence on the impact of combination therapy (isotretinoin + BCP) on meibomian gland
dysfunction
P
(Patients)
Young women
I
C
O
(Intervention)
Isotretinoin + BCP
Oral contraceptives
Progesterone
Estrogen
(Comparison)
Isotretinoin j BCP
(Outcome)
Meibomian gland dysfunction
Dry eye
contents from preferred journals and the headlines from secondary
sources that aggregate popular information from media outlets,
and pharmaceutical and device manufacturers. Problem solving
is another common way that clinicians use available evidence.
Problem solving is a more targeted way to seek and find specific
information relevant to a particular case. For example, when faced
with a clinical case of optic neuritis, one might ask if the use of oral
prednisone associated with better visual outcomes when compared
to other therapies for recurrent optic neuritis in multiple sclerosis?
Problem solvers will seek material to help address a specific need.
Younger practitioners with less clinical exposure will also use the
literature to accumulate essential background knowledge, often
stimulated by specific clinical encounters. One of the less common
uses of the literature is for collecting foreground information, e.g. is
treatment A better than treatment B? This use of the evidence base
could take the form of journal clubs or study groups.
New clinical evidence is accumulating faster than ever. Fortunately, there are better tools for aggregating this evidence, making
it more accessible for those who wish to incorporate evidence in
their practice. Primary sources are easily searched through PubMed,
Scopus, OVID, Web of Science, Google Scholar, and others. Numerous content providers are also emerging to provide easier and
more targeted access to clinically actionable evidence. Wolters-Kluwer
publishes Up to Date and is one example of such an evidence resource.
Wiley publishes Essential Evidence Plus, which includes access to the
Cochrane Library. Both publishers offer patient-oriented evidence
through primary sources, screened and identified as high-quality
evidence. Other available databases exist and include DynaMed
Plus from EBSCO, and BMJ Clinical Evidence.
Not every clinician will aspire to be an expert in evidence-based
practice, but developing a culture of informed and critical consumers of clinical evidence is essential to advancing our field and
properly caring for our patients. Optometry and Vision Science is
making investments in our journal to improve the quality of the
evidence that we publish. In January 2016, Optometry and Vision
Science established a working collaboration with the Cochrane
Eyes and Vision Initiative to promote the publication of better
evidence. Jimmy Le from the Johns Hopkins Bloomberg School
of Public Health was appointed as an Associate Topical Editor
to help manage systematic reviews and meta-analyses. This is an
important first step that demonstrates our commitment to advancing the field by providing better quality reviews to our authors
and, ultimately, by publishing better quality evidence. We recognize that integrating that evidence with individual patient values
and preferences is no small challenge. We will continue to play our
part in advancing evidence-based practice by bringing the best
available evidence to our readers.
REFERENCES
1. Flexner A, Carnegie Foundation for the Advancement of Teaching,
Pritchett HS. Medical education in the United States and Canada;
a report to the Carnegie Foundation for the Advancement of Teaching.
New York City; 1910.
2. Maeshiro R, Johnson I, Koo D, Parboosingh J, Carney JK, Gesundheit N,
Ho ET, Butler-Jones D, Donovan D, Finkelstein JA, Bennett NM,
Shore B, McCurdy SA, Novick LF, Velarde LD, Dent MM,
Banchoff A, Cohen L. Medical education for a healthier population:
reflections on the Flexner Report from a public health perspective. Acad
Med 2010;85:211Y9.
3. Guyatt G, Voelker R. Everything you ever wanted to know about
evidence-based medicine. JAMA 2015;313:1783Y5.
4. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS.
Evidence based medicine: what it is and what it isn’t. BMJ 1996;
312:71Y2.
5. Center For Evidence Based Medicine: Asking Focused Questions.
Available at: http://www.cebm.net/asking-focused-questions/; 2016
[updated 2016. Accessed: 2016 9/5/2016].
Michael D. Twa
Editor-in-Chief
Optometry and Vision Science
Optometry and Vision Science, Vol. 93, No. 10, October 2016
Copyright © American Academy of Optometry. Unauthorized reproduction of this article is prohibited.
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Researchers Recommend Universal Screening to
Tackle Rise in Hep C
Publication info: R & D ; Highlands Ranch (Oct 17, 2018).
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ABSTRACT (ENGLISH)
Photo: University of Cincinnati College of Medicine Physicians are encountering a growing number of younger
patients who are testing positive for hepatitis C virus (HCV) fueled largely by the opioid crisis impacting
communities around the country. The researchers used a computerized Markov state transition model to estimate
the impact of one-time universal screening of adults 18 years of age and older compared either with no screening
at all or with the current guideline-based strategy of largely screening baby boomers–adults born between 1945
and 1965–for HCV, says Mark Eckman, MD, Posey Professor of Clinical Medicine and Director of UC Division of
General Internal Medicine. The Centers for Disease Control and Prevention (CDC) estimates 2.7 million individuals
in the U.S. have chronic HCV infection with 81 percent of that group consisting of baby boomer adults.
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Physicians are encountering a growing number of younger patients who are testing positive for hepatitis C virus
(HCV) fueled largely by the opioid crisis impacting communities around the country. That increase and more
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effective and tolerable drug regimens for HCV infection, means one-time universal screening of all adults for HCV
is now cost effective and recommended, say physician-researchers in the University of Cincinnati (UC) College of
Medicine.
The researchers used a computerized Markov state transition model to estimate the impact of one-time universal
screening of adults 18 years of age and older compared either with no screening at all or with the current guidelinebased strategy of largely screening baby boomers–adults born between 1945 and 1965–for HCV, says Mark
Eckman, MD, Posey Professor of Clinical Medicine and Director of UC Division of General Internal Medicine.
They measured effectiveness with quality-adjusted life years (QALYs)–that’s the gain of in life expectancy adjusted
for the quality of life–and costs from the health system perspective in 2017 U.S. dollars, says Eckman, lead author
of the study and a UC Health physician. Universal screening followed by guideline-based treatment of all those
with chronic HCV infection has an incremental cost effectiveness ratio of $11,378 per quality-adjusted life year
compared with birth cohort-based screening alone.
“Most health economists consider anything less than $50,000 per quality-adjusted life year to be highly costeffective,” says Eckman.
The results of the study are available online in the scholarly journal Clinical Gastroenterology and Hepatology.
The Centers for Disease Control and Prevention (CDC) estimates 2.7 million individuals in the U.S. have chronic
HCV infection with 81 percent of that group consisting of baby boomer adults. In 2011, in addition to testing
individuals at high risk due to intravenous drug use or other possible exposures to HCV, the CDC recommended
one-time testing for the baby boomer cohort. That recommendation was later endorsed by the U.S. Preventive
Services Task Force.
But since then the face and treatment of hepatitis C has changed.
“So what happened to make it reasonable to screen a wider population for HCV?” asks Eckman. “The incidence of
hepatitis C among younger drug-injecting patients is skyrocketing so we have a blip in HCV cases that’s no longer
isolated to the baby boomer cohort.
“We are also now in an era of HCV treatments that are more effective than even five or six years ago. Furthermore,
these new regimens are easier to tolerate, have fewer severe side effects and require a short period of treatment,”
says Eckman.
“All these factors coming together are what drove the model to show that screening a broader population than just
the baby boomer cohort is effective,” says Eckman,
The baby boomer generation came of age during a time of experimentation, and many individuals who may have
tried injectable drugs, even once, and never thought of themselves as having a problem, may be infected with the
hepatitis C virus, says Eckman. “While these silent cases have been hanging out for decades what has changed
recently is the new epidemic of hepatitis C in younger patients related to drug use,” he says.
Eckman says the cost to treat HCV can range from $9,000 to $30,000 per month depending on the medications
being used, and that many health insurance plans, including Medicare Part D and most Medicaid plans cover the
costs of treatment. For individuals without health insurance, treatment may remain a challenge, he adds.
Eckman says the U.S. Preventive Services Task Force is currently reviewing and updating guidelines for hepatitis C
and it’s possible a broadening of the current screening recommendations may occur.
Credit: University of Cincinnati Academic Health Center
DETAILS
Subject:
Infections; Internal medicine; Researchers; Medicine; Task forces; Health insurance;
Baby boomers; Substance abuse treatment; Hepatitis
Location:
United States–US
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Company / organization:
Name: University of Cincinnati College of Medicine; NAICS: 611310; Name: Centers
for Disease Control &Prevention–CDC; NAICS: 923120; Name: University of
Cincinnati; NAICS: 611310
Publication title:
R &D; Highlands Ranch
Publication year:
2018
Publication date:
Oct 17, 2018
Publisher:
Advantage Business Media
Place of publication:
Highlands Ranch
Country of publication:
United States, Highlands Ranch
Publication subject:
Business And Economics, Engineering, Technology: Comprehensive Works, Sciences:
Comprehensive Works
ISSN:
07469179
Source type:
Magazines
Language of publication:
English
Document type:
News
ProQuest document ID:
2123254125
Document URL:
https://search.proquest.com/docview/2123254125?accountid=32521
Copyright:
Copyright Advantage Business Media Oct 17, 2018
Last updated:
2018-10-21
Database:
ProQuest Central
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