State a PICOT question.

• State your PICOT question.
• Indicate in parentheses after each segment, what part of PICOT the preceding words represent.
• For example: In patients recently discharged from the hospital following care for heart failure (P), do hand-off calls by the nurse to the primary care provider using the SBAR format (situation, background, assessment, recommendation) (I) compared to no calls (C) decrease readmission rates (O) over a one year period (T).
• Provide feedback to your classmates that focuses on:
• The use of correct PICOT format for the question to guide the literature search.
• Does the question reflect a clinical issue and one appropriate for an evidence-based practice project?
• Can this project be complete in a primary care setting if the student is in an NP program.  
• Can this project be complete in a setting appropriate to the students focus–NE, NA, NI?
• Does the student need to include time or a comparison group to get the answer to their question?
• Note:  many times the population chosen can serve as their own controls.

see attached document, the PICOT question needs to be created about the topic stated in the attached document which is heart disease.

Researching Background Question

Heart disease and stroke are major public health concerns especially in the United States. To put it into perspective, heart disease is the major cause of fatalities while stroke is the fifth leading cause of death in the nation (CDC, 2015). Heart disease and stroke have the highest prevalence rates in the United States. According to the CDC (2015), approximately 610,000 Americans succumb to heart disease annually, representing 1 heart disease casualty in every 4 deaths. With regard to type, coronary heart disease is the most common type, killing approximately 365,000 individuals in 2014 (CDC, 2015). Every year, heart disease also costs the US about $207 billion, which is inclusive of costs of medication, lost productivity and cost of healthcare services (CDC, 2015). On the contrary, stroke, which affects approximately 795,000 Americans annually, kills approximately 130,000 of the affected people, claiming the life of a person in every 4 minutes (CDC, 2015).

Noteworthy, incidence of these health conditions also varies by some parameters such as age, gender, socioeconomic status and racial background (CDC, 2015). Mosca et al. (2016) acknowledge that the prevalence of heart disease and stroke has been increasing because of various reasons. For instance, many people lack the educational and informational support necessary for understanding the risk factors associated with these conditions (Mosca et al., 2016). Most of the risk factors including high cholesterol, cigarette smoking, physical inactivity, being overweight, unhealthy diets and high blood pressure are modifiable (American Heart Association, 2015). Given the shocking statistics, it is paramount to take necessary steps for investigating the causes of these cardiovascular conditions and finding ways of reducing their prevalence in the nation.

The present study aims to uncover a number of issues related to stroke and heart disease in the US. Specifically, the main purposes include:

1.         Determining the causes for the high prevalence, mortality and morbidity associated with these conditions

2.         Identifying modifiable and non-modifiable factors that make individuals more susceptible to developing heart disease and stroke

3.         Ascertaining the most effective interventions or courses of action for combating the incidence of coronary diseases among Americans

4.         Determining the level of education and information that citizens have with regard to the health problems of stroke and heart disease

5.         Identifying whether there are significant racial disparities in the prevalence of these incapacitating conditions

6.         To create a responsive intervention plan for addressing the incidence of the identified health conditions

My PICOT question is,

 

 

(P) In patients with risk factors for CAD (I) how does exposure to extreme life stressors (C) vs patients with no known risk factors (I) contribute to the development of an acute STEMI/NSTEMI (T) in a 1-year time frame. 

 

Stressful life events, such as natural calamities, financial crises, terroristic attacks and wars, are known to be life-threatening acute triggers for cardiac events, as are positive emotionally charged events (sport matches and Christmas and New Year’s holidays), thus worsening the prognosis in vulnerable individuals. Chronic stressors such as negative psychosocial factors represent modifiable risk factors that could be linked to adverse cardiac prognosis and the mortality rate worldwide. The international INTERHEART case control study proved that psychosocial factors were significantly related to acute myocardial infarction, with an odds ratio. Further meta-analyses of prospective observational studies found that certain psychosocial factors, such as social isolation and loneliness, were associated with a 50% increased risk of CVD; work-related stress showed similar results, with a 40% risk of new CV events. (Fioranelli, M., Bottaccioli, A. G., Bottaccioli, F., Bianchi, M., Rovesti, M., & Roccia, M. G. 2018) 

 

Reference

 

Fioranelli, M., Bottaccioli, A. G., Bottaccioli, F., Bianchi, M., Rovesti, M., & Roccia, M. G. 

 

(2018). Stress and Inflammation in Coronary Artery Disease: A Review 

 

Psychoneuroendocrineimmunology-Based. Frontiers in immunology, 9, 2031. 

 

https://doi.org/10.3389/fimmu.2018.02031