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Post by Admin on Jan 17, 2016 22:11:41 GMT
PICO stands for Population, Intervention, Comparison, and Outcome
Using the Focused clinical question in Assignment 1 you have written. Organize your case by PICO. For example using the focused Breastfeeding clinical question we can organize that particular case into PICO as seen below.
You have just seen Lydia who recently delivered a healthy baby. She plans to breastfeed, but also wants to start oral contraception. You generally prefer to prescribe combination oral contraceptives (estrogen + progesterone) but you have been told that these might more negatively affect her breast milk production than progesterone only pills.
P - Population:
Multiple relevant population descriptors include:
1. post partum woman
2. breast feeding/lactating mother
3. breastfeeding mom desiring contraception
4. breast
I - Intervention:
Multiple relevant specific interventions or interest include:
1. combined contraceptives - estrogen and progesterone
2. estrogen
C - Comparison
Identifies specific alternative of interest since pt. wants to use
oral contraception
1. progesterone only contraception
O - Outcome
That is objective and meaningful to patient
1. infant growth rate
2. number of lactation "drop outs,"
3. maternal satisfaction with infant satiety
4. milk flow
Admin Note: This assignment must be posted on the forum before January 25th, 2016 8:00 am to receive points. All homework Assignments are worth 10 points each. Paper hand ins will not be accepted for credit.
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febi
New Member
Posts: 4 
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Post by febi on Jan 20, 2016 21:48:41 GMT
Jessica's chief complaints included hemoptysis, weight loss, fever, fatigue and night sweats- all indicative of an infection with Mycobacterium tuberculosis. However, upon past medical history, it was found that Jessica also has asthma, for which she has been taking Theophylline. Jessica remembers reading on WebMD that Rifampin is a potent anti-tuberculosis drug and she requests to be placed on that specific medication.
As a knowledgeable physician, I was able to advice Jessica that Rifampin would worsen her asthma symptoms as well as cause other unfavourable effects like reddish-orange sputum. An acceptable course of treatment for an asthmatic patient with T.B. would be amoxicillin/clavulanate.
PICO
Population:
- Patients with asthma (no gender or age distinction)
- Asthma patients with T.B infection
Intervention:
1) ACTH for the asthma + Streptomycin (for T.B)
2) Prednisone + Streptomycin is a combination that has received good reviews for the treatment of T.B in a patient with asthma
Comparison:
If patient desires to remain on Theophylline for asthma
- Amoxicillin/Clavulanate (for T.B)
In case Jessica REALLY wants to try Rifampin for her T.B, then:
- I.V Gamma globulin for bronchial asthma (i.e steroid-dependent asthma); no drug interaction between IVIG therapy and Rifampin.
Outcome:
- Safe treatment of T.B infection without aggravating their asthma, and vice versa (i.e ACTH treatment does not aggravate T.B symptoms).
- The prednisone option provides treatment for both asthma and T.B, hence, physician can tackle two problems with one solution.
- In general, patient achieves better respiration.
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Post by hyasin on Jan 23, 2016 22:24:45 GMT
A 24 year old well built male comes to your office. He tells you he has been taking steroids and is worried about the negative side effects when stopping use, which include gynecomastia among others. He says a friend mentioned he should take Clomid (Clomiphene) and asks you to prescribe it to him. You tell your patient to stop taking steroids immediately and inform him of the deleterious effects of abusing this class of drugs. You write him a prescription for Nolvadex (Tamoxifen) and advise him that it is more effective in bringing his natural testosterone levels to baseline than Clomid (Clomiphene) and has less side effects.
PICO
Population:
1. Individuals wanting to expedite growth of muscle mass
Intervention:
1. Nolvadex (Tamoxifen) - Anti-estrogen to control the deletrious effects of excess estrogen when steroid use is stopped
2. Clomid (Clomiphene) - Fertility drug used in same context
Comparison:
1. Nolvadex - More effective as an anti-estrogen and has less side effects
2. Clomid - Less effective as an anti-estrogen with greater chances of developing side effects
Outcome:
Patient won't suffer through:
1. Male menopause
2. Gynecomastia
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Post by siddhansh on Jan 23, 2016 23:05:50 GMT
A 65 year old male with a history of arthritis presents to you with knee pain. He says the pain has been increasing in severity for a few days and would like a stronger pain killer. He usually takes Tylenol for the arthritis, but it hasnt helped much for the recent knee pain. He says he usually takes one or two, but since the knee pain he has been taking four a day. He now wants a stronger medication. He looked up online about Diclofenac wants you to prescribe it.
You are aware of his history of hypertension, and tell him that Diclofenac is an NSAID and when mixed with antihypertensives, can be dangerous, therefore you cannot prescribe the oral medication. However, there is a topical form that can be used in episodes of severe pain. You warn him about the dangers of taking any pain killers in excess, such as Tylenol (acetominophen), which can cause liver damage. You also advise him to take glucosamine and chondroitin sulfate supplements, which are natural and have few side effects.
Population
-Patients with arthritis
-Patients with hypertension
Intervention
-Diclofenal gel (NSAID) - for severe pain
-Supplements: glucosamine, chondroitin sulfate
Comparison
-Topical gel form of an NSAID, compared to oral which has many contraindications with antihypertensives
Outcome:
-Topical treatment is safer, bypasses any undesired drug-drug interactions
-Supplements have very little sideeffects, and are proved to be effective
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Post by rehman on Jan 24, 2016 22:01:18 GMT
A patient is seen in the hospital is taking aspirin as a blood thinner. The patient has had previous clots before and aspirin is very important for the patient in maintaining that they do not go through the same situation again. While in the hospital, it is found that they patient has a strep infection, the physician is unsure of what to do in this situation because penicillin which is very good treatment for strep will increase the toxicity of the aspirin. The physician goes to a colleague who suggests another antibiotic similar to penicillin that wont have an effect on the aspirin and at a reasonable dose that will treat the strep and not have an adverse effect on the aspirin either.
Population:
-Patients on blood thinners
-Patients with strep infections
-Patients with acid toxicity
Intervention:
-amoxicillin, cephalexin as substitutes for penicillin that won't raise the acid levels.
Comparison:
-Amoxicillin and cephalexin comparison to penicillin, comparison to healing rates and outcomes and toxicity levels.
Outcome:
-Amoxicillin and cephalexin are also a good treatment for strep infection and have proven results of healing strep infections just as well as penicillin.
-Amoxicillin and cephalexin will not interfere in the toxicity level of the aspirin as penicillin would have.
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Post by Admin on Jan 24, 2016 22:29:54 GMT
Great Job! Reminder for those who still have not done the assighnment the deadline is 8:00 am Monday to post it in order to receive the points.
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Post by azaidi9213 on Jan 24, 2016 23:40:19 GMT
A 21-year-old woman known to have a protein C deficiency develops recurrent pulmonary thromboembolism. She has a sudden change in mental status and experiences difficulty speaking and swallowing. A cerebral angiogram shows a distal left middle cerebral artery occlusion caused by administration of anticoagulant therapy,heparin. There are prolonged PT and PTT times. The physician considers using thrombolytic therapy, although it is still controversial for patients with a pulmonary thromboembolism.
Population:
Patients with thromboembolism
Patients with pulmonary thromboembolism
Patients with protein c deficiency
Intervention:
Heparin
Thrombolytic therapy
Comparison:
Heparin: usually given to patients with a pulmonary thromboembolism
Thrombolytic therapy: controversial but can be used in treatment for pulmonary thromboembolism if the patient does not have hypertension
Outcome:
Although heparin is effective in treatment of patient with a pulmonary thromboembolism, thrombolytic therapy can also be effective in the case that the patient does not have hypertension.
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Post by Kaweng on Jan 24, 2016 23:55:25 GMT
A 23 year old student walked into the clinic in Nigeria with symptoms such as headache, high fever, muscular pains and difficulty in swallowing. After careful examination and history taking which includes the patient being exposed to grain stores where her mother sells grain produce, the physician ordered for An ELISA test for antigen and IgM antibodies. The test came back positive with a 92% sensitivity and 94% specificity to the viral hemorrhagic fever. The test also showed the patient had a low white blood cell count, platelet count and an elevated aminotransferase. Immediately she was quarantined and given an aggressive intravenous dose of ribavirin. With adequate fluid retention and blood transfusion.
POPULATION
- No gender specifics
- Lassa fever as viral haemorrhagic fever
- West African population
INTERVENTION
- Quarantine the patient (incubation 21days)
- Oral dose of ribavirin 30mg/kg as loading dose, followed by 16mg/kg every 6 hours for 4 days and then 8mg/kg every 8 hours for 3 days.
- Place in a private room with standard contact and droplet precautions
COMPARISON
- Patient desired to remain on oral ribavirin but it was not started promptly.
- Intravenous dosage, given at the site of quarantine to monitor the patient treatment. This helps to stop the spread of the disease.
OUTCOME
- Treatment with plasma from recovered patients is the best therapy
- Patients electrolyte balance, oxygenation and blood pressure is back to normal.
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Post by avazifdar on Jan 25, 2016 0:20:14 GMT
A 45 year old man presented with polyuria, blurry vision, and a random glucose level of 276 mg/dL. His HbA1c at that time was 8.0%. He was started on metformin 500 mg twice daily. When asked about his diet and social history he said he consumes fast food often and drinks frequently. He was given instructions about making healthy food choices that will help lower his blood glucose. He was also told about the harmful effects of alcohol interaction with metformin. Taking this combination may cause lactic acidosis. A glass of wine may be occasionally consumed keeping in mind the general risk of hypoglycemia. The patient remembered looking up hypoglycemia symptoms when his father was diagnosed with diabetes. He recalled them to be hunger, shakiness, nervousness, sweating, dizziness, sleepiness, confusion and difficulty speaking. He was told about the symptoms of lactic acidosis, which included nausea, vomiting, hyperventilation, abdominal pain, lethargy, anxiety, hypotension, rapid or irregular heart rate and metal status changes. He agreed on changing his lifestyle to better his health.
P - Population:
Multiple relevant population descriptors include:
1. new onset diabetics
2. diabetics who consume alcohol
I - Intervention:
Multiple relevant specific interventions or interest include:
1. oral blood glucose lowering drug-metformin
2. diet change-healthy eating as opposed to eating fast food
3. discussion about harmful effects of alcohol consumption with metformin
C - Comparison
Identifies specific alternative of interest
1. may have wine every now and then with attention to symptoms of hypoglycemia or lactic acidosis
O - Outcome
That is objective and meaningful to patient
1. betterment of overall health
2. may consume glass of wine every now and then
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Post by moaviah on Jan 25, 2016 1:22:41 GMT
An 60-year-old woman is referred for cardiovascular evaluation because of a diastolic murmur. She denies symptoms of angina, syncope, or heart failure. The physical examination and echocardiogram are consistent with mitral stenosis (AS). He notifies the patient that she need valve replacement surgery. The doctor considers the using bioprosthetic valve vs mechanical valve even though mechanical valve is more commonly use.
P-population
patient with mitral stenosis
patient with bioprosthetic vs mechanical valve
intervention
bioprosthetic valve
mechanical valve
comparison
bioprosthetic valve are made of animal tissue and more similar to the native valve
mechanical valve are more commonly use
outcome
there are benefit and side effect of both valve
even though mechanical valve is more commonly use but bioprosthetic will benefit more to the patient.
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Post by waliul on Jan 25, 2016 4:33:42 GMT
A 10 year old boy goes to the hospital with complaints of shortness of breath. He has a history of Asthma. The patient is also wheezing upon inspiration. The doctor administers Theophylline to treat his broncho-constriction. Further lab tests and blood cultures show that the patient is infected with Streptococcus pneumoniae bacteria. Erythromycin is also administered to the patient to treat his infection. A 2nd year resident tell his attending that giving Azithromycin instead of Erytrhomycin would be a better alternative because it would avoid the drug contraindicative interactions between Erythromycin and Theophylline; causing a high risk of Theophylline toxicity in the body.
PICO:
P - Population:
-Patients with Asthma or obstructive pulmonary disease
-Patients with respiratory infections
I - Intervention:
-Theophylline with Erythromycin to treat the asthma and the pulmonary infection
-Theophylline with Azithromycin to treat the asthma and the pulmonary infection
C - Comparison:
-Giving Erythromycin with Theophylline
O - Outcome:
-Erythromycin induced toxicity of Theophylline
-Toxicity of theophylline can induce tachycardia in the heart
-Erythromycin reduces the activity of CYTP450 enzymes, which are used to metabolize theophylline into its inactive form in the body.
-Azithromycin does not inhibit the activity of CYTP450 enzymes. It is not associated with risks of theophylline toxicity.
-Azithromycin can also be used to effectively treat pulmonary infection.
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Post by bdjessie on Jan 25, 2016 5:13:54 GMT
Beginning the day (7a.m.) working in an urgent care a family member brings Clint to be seen, Clint is now unconscious. Clint is a 66 year old male with a history of heart attack, hypertension, high cholesterol. Clint's wife stated that he woke up with chest pain, 6/10 on pain scale, he also complained of a slight headache. In order to relieve his pain Clint took a sub-lingual dose of nitroglycerin that his physician gave him for angina. Clint's family was instructed that this self-medication could be potentially dangerous. Treating chest pain with aspirin or nitroglycerin can be dangerous when also experiencing a headache. You are now suggesting that Clint is taken for a CT scan of his head to evaluated the possibility of a stroke.
P - Patients with a history of heart disease that takes aspirin and nitroglycerin for angina
I - Depending on the type of stroke will depend on intervention. Thrombolytic therapy is needed to stop the bleeding from the acute ischemic stroke.
C - Patient needs thrombolytic therapy as soon as possible to prevent further damage and death.
O - Patient gave himself nitroglycerin that is contraindicated with headache. The nitro dose leads to an acute ischemic stroke. In order to stop the bleeding thrombolytics are needed to stop further bleeding. The longer the wait to give the medication the worse the outcome will be for the patient.
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Post by roxanne on Jan 25, 2016 10:12:35 GMT
53y female who is moderately obese, postmenopausal w Type 2 diabetes comes in for annual examination. Upon examination, pt is significatn for abdominal obesity and has dark pigmented skin around her neck. Blood work reveals elevated LDL, TG, low HDL and glucose level of 145mg/dl (100-125mg/dl). Pt decides to modify her lifestyle focusing on low-fat, low-cholesterol diet and light exercise for 45 minutes 4d/wk. After 3months, her follow-up visit reveals unchanged weight and lipid profile. As a result, simvastatin is prescribed. Since, pt also has elevated blood triglycerides and low HDL cholesterol levels, fenofibrate is prescribed w caution. However, a trusted colleague suggests that its best to prescribe a different medication with statin due to high risk of myositis and hepatotoxicity.
Population:
- Patients w metabolic syndrome
- Patients w lipoprotein syndrome
- Patients w bad diet and lifestyle
Intervention:
- Combined medication for metabolic and lipid syndrome
- Combined drug medication and lifestyle change
Comparison
- If patient continues to use simvastatin then change fibrate to niacine or bile-sequestering resins
Outcome
- Treatment of patient metabolic syndrome
- Lower abdominal obesity
- Increase lipid (HDL) profile
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Post by kjb786 on Jan 25, 2016 12:19:24 GMT
Max, your first patient today, is a 40yr old obese male who leads a sedentary lifestyle, working a 9am to 5pm job, with little regard for diet and nutrition.
He has been recently diagnosed with type II diabetes mellitus, and has been prescribed metformin, but is seeking advice on how to manage his diabetes.
You suggest diet and exercise, and begin to explore other options on how to adjust Max's lifestyle to manage his condition.
Population
Individuals meeting criteria for metabolic syndrome
Individuals leading sedentary lifestyles
Individuals with Type II diabetes
Intervention
1. Rx metformin
2. Altered diet and increased exercise [lifestyle]
Comparison
The effect metformin only vs with change in diet/lifestyle has on managing diabetes
Outcome
1. BMI classification @ diagnosis vs post intervention
2. Quality of life increase dependant on intervention
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Post by dallen89 on Jan 25, 2016 12:23:44 GMT
P - Population:
Multiple relevant population descriptors include:
1. Men with Necrotizing fasciitis
2. Men with Diabetes mellitus
3. Workers in biologically hazardous occupations
4. Patients seeking treatment for NF after a prolonged time since injury/infection
I - Intervention:
Multiple relevant specific interventions or interest include:
1. IV antibiotics
2. Oral antibiotics
3. Mechanical debridement
4. Amputation
5. Hyperbaric oxygen treatment
C - Comparison
-Hyperbaric oxygen chamber in addition to to antibiotics and debridement vs antibiotics and debridement only.
O - Outcome
That is objective and meaningful to patient
-Differential rate of amputation following Necrotizing fasciitis diagnosis
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