1. CREATED BY: Shannon Dembowske
PICO presentation
CREATED BY: Shannon Dembowske

2. Objectives:
Recognize the inter-relationship of research and theory and its impact on the development of the healthcare research.
Assess current healthcare research findings for applicability to a variety of clinical practice.
Analyze the research process as a framework for clinical reasoning to improve quality and safety measures in healthcare practice.
(A. Njoku, personal communication, August 25, 2014)

3. What is PICO?
PICO is a systematic process for converting information needs/problems into clinical questions that define the: – Patient problem/population – Intervention – Comparison – Outcome
Problem or patient concern:
–problem or concern where an answer is sought
Intervention or exposure
–treatment of clinical condition of interest
Comparison
–alternative treatment or control
Outcome
–measure(s) used to assess effects
(Source: J.L. Forrest & S.A. Miller, 2002)

4. PICO Format Problem or patient concern: Intervention or exposure
Inpatients who are at risk for deep vein thrombosis (DVT)
Intervention or exposure
multiple DVT prophylactic measures
Comparison
one DVT prophylactic measure
Outcome
decrease the risk of a DVT

5. Clinical Question:
"In inpatients who are at risk for deep vein thrombosis (DVT), does using multiple DVT prophylactic measures further decrease the risk of a DVT as compared to using just one DVT prophylactic measure."

6. Literature Search Results
Search engines used:
Google, PubMed, Cochrane Library
Search words:
DVT prophylaxis, venous thromboembolism, VTE, thromboprophylaxis
Research articles:
“Preventing deep vein thrombosis in hospital inpatients” by William Cayley
“Combined modalities in the prevention of venous thromboembolism: a review of the literature” by S. K. Kakkos, J. Caprini, A.N. Nicolaides and D. Reddy

7. Rationale
I chose these two studies because they combine multiple studies. This gives me a larger spectrum of the patient population and research already provided on the topic of deep vein thrombosis (DVT) and emboli prevention. Venous thromboembolism (VTE) is a multi-factorial process, so it is important to have a large background of research and information. I think these studies do a good job a reviewing the multiple studies already completed on this subject and conclude on what the standard of practice should be.

8. Article #1: “Preventing deep vein thrombosis in hospital inpatients”
Evaluation of study:
Type of study- Clinical Review
Peer-Reviewed
Level VII
Free of bias
Design- Systematic Review
Method- Meta-analysis

9. Article #1 Findings & Credibility

10. Relevance:

11. Article #2: “Combined modalities in the prevention of venous thromboembolism: a review of the literature”
Evaluation of study:
Type of study- Clinical Review
Peer-Reviewed
Level VII
Free of bias
Design- Systematic Reviews
Method- Meta-analysis

12. Article #2: Findings & Credibility

13. Relevance:

14. Conclusion:
The results of these studies answered my clinical question, however it was not the answer I was hoping for. They concluded that depending on the patient and health status, multiple DVT prophylactic measures are indeed better than just one. The greatest reduction in DVTs were achieved when the use of at least one pharmacological measure and one mechanical measure were used at the same time.

15. References:
Cayley, W. (2007). Preventing deep vein thrombosis in hospital inpatients. BMJ, 335, doi: /bmj AE Forrest, J.L. & Miller, S.A. (2002). Evidence based decision making in action: part 1- finding the best clinical evidence. The journal of contemporary dental practice, 3(3). Kakkos, S.K., Caprini, J., Nicolaides, A.N., & Reddy, D. (2006). Combined modalities in the prevention of venous thromboembolism: a review of the literature. Phlebology, 21 (suppl 1), 1-6.