Formulate Searchable Clinical Questions In The PICO(T) Form

Formulate searchable, clinical questions in the PICO(T) format using the material is this case study

John Is A 56 Year Old Male Who Was Initially Diagnosed Six Months Ago

John is a 56-year-old male who was initially diagnosed six months ago with Heart Failure. He was treated via a three-day stay in the hospital and sent home with a drug regime and since then has been seen in the ER two times and now re-hospitalized with shortness of breath, pedal edema, and weight gain. He does not understand why the medications are not working. He cannot miss anymore days at work or he will lose his job and medical insurance for him and his family. His wife is a stay at home mom for their three boys.

John is a construction worker and does take his medications as directed but continues to eat what he wants. He states he cannot exercise because he works six days a week and is just too tired when he gets home. He is always tired, up all night going to the bathroom, and is extremely worried about his health issues and the future. His wife Kathy is a stay-at-home mom and finds herself overwhelmed with the diagnosis and worried she may have to go back to work. During this hospital stay, another cardiac catheterization reveals his ejection fraction is only 40.

The doctor has told him he needs to change his lifestyle, continue with his meds, and monitor his vital signs at home. Kathy wants to know what she can do to help John and will do anything but is unsure what will help. A nurse provided her with informational materials about diet and exercise, and a home health nurse will assist with home monitoring. He will stay at home for monitoring and cardiac rehabilitation for six weeks.

Paper For Above instruction

Research question 1 (Assessment focus): In patients with heart failure (P), how effective is home monitoring of vital signs (I) compared to standard outpatient monitoring (C) in early detection of worsening symptoms and reduction of hospital readmissions (O) within six weeks (T)?

This question aims to assess the impact of home monitoring on patient outcomes, particularly regarding early detection of deterioration and hospital readmissions, which are critical issues for patients like John with recurrent exacerbations of heart failure. It addresses how effective an intervention (home vital signs monitoring) is in improving clinical outcomes relative to usual care.

Research question 2 (Treatment/Prognosis focus): In patients with reduced ejection fraction heart failure (P), does participation in a structured cardiac rehabilitation program (I) compared to usual care without supervised rehab (C) improve functional capacity and quality of life (O) over six weeks (T)?

This question investigates whether a specific treatment intervention (cardiac rehab) can positively influence prognosis by improving physical functioning and wellbeing, which are vital for patients’ recovery and long-term health management.

References

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• Ponikowski, P., Voors, A. A., Anker, S. D., et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 37(27), 2129-2200.
• Naylor, M. D., Brooten, D., Campbell, R., et al. (2004). Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA, 291(13), 1358–1367.
• Cleland, J. G. (2017). Cardiac rehabilitation for chronic heart failure. European Heart Journal, 38(36), 2783–2784.
• Kavalieratos, D., Gelfman, L. P., Stevenson, B. J., et al. (2017). Palliative Care in Heart Failure: Rethinking the Foundation of Management. Journal of the American College of Cardiology, 70(21), 2723–2735.
• Hwang, E. S., & Kwon, H. (2018). Home Monitoring and Heart Failure. Current Heart Failure Reports, 15(2), 105–113.
• McDonagh, T. A., et al. (2018). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 42(36), 3599–3726.
• Phillips, C. O., et al. (2018). Comprehensive discharge planning for patients with heart failure. Cochrane Database of Systematic Reviews, (3): CD002926.
• Clark, R. A., et al. (2018). Telemonitoring for Heart Failure Patients: A Systematic Review and Meta-Analysis. Health Technology Assessment, 22(9), 1–314.
• DeBusk, R., et al. (2006). A randomized controlled trial of a comprehensive home-based approach to cardiac rehabilitation. Journal of the American College of Cardiology, 48(9), 1904–1909.