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Evidence-based medicine is the conscientious, accurate, and meaningful use of the best results of clinical research in helping a particular patient. One of the critical stages of it is formulating a clinical question. This term refers to a question the answer to which allows the doctor to solve a clinical problem effectively. To make a clinical question correctly, it is necessary to identify the problem. Therefore, it is essential first to determine who this question is about (how would I describe a group of patients like mine). It is necessary to determine which intervention is being considered for prescribing to a particular patient (for example, drug therapy). In conclusion, a doctor should determine the desired or undesirable outcome and the time or age the doctor will take into account.
Experience in drawing up a clinical question helps to predict the course of the disease in advance. In medical practice, the speed of determining the patient’s diagnosis and the development of complications is essential. Therefore, knowing in advance the course of a particular clinical case helps to orient oneself faster. It is important to note that every doctor must know how to formulate a PICOT question. In evidence-based medicine, the definition of a clinical question is primarily a search for an answer to the question “what to do?”. Consequently, this skill helps to quickly navigate the patient’s diagnosis and care throughout the treatment. Moreover, the clinical question concerns the advantages and disadvantages of preventive or curative interventions.
The PICOT approach will be utilized to evaluate the efficacy of the coronavirus vaccine in providing acute care to prevent the occurrence of pneumonia. This particular issue has recently gained much attention, primarily because the global pandemic has caused a significant number of individuals to contract the virus and potentially develop pneumonia. With the increasing prevalence of this serious illness, it is of paramount importance to evaluate the vaccine’s effectiveness in providing the necessary protection to individuals. The PICOT question that can be developed to explore this practice issue is: “In patients over 50 years old, what is the effectiveness of having a coronavirus vaccine compared to not having a coronavirus vaccine in preventing the possibility of acquiring pneumonia during the winter period?” In PICOT format, the elements are as follows: (P) – patients over 50 years old, (I) – having a coronavirus vaccine, (K) – not having a coronavirus vaccine, (O) – the possibility of acquiring pneumonia, (T) – during the winter period.
Several databases can be explored to identify sources of evidence that can be used to answer the PICOT question. These databases include MEDLINE, CINAHL, Cochrane Library, and EMBASE, which are all reliable databases for medical research. Additionally, journals such as the Journal of the American Medical Association, BMC Medicine, and Vaccine can also be consulted, which contain the latest findings in medical research. Websites such as PubMed and the Centers for Disease Control and Prevention are also great sources of evidence, providing reliable and up-to-date information on various topics. Furthermore, research sources such as government publications and textbooks can be consulted to answer the PICO(T) question.
The four articles chosen for researching the PICOT question were selected from the databases of JAMA Network, ScienceDirect, PubMed, and The Lancet. The articles were chosen based on relevance to the research question and relevance to the research objectives. Each article was carefully examined and evaluated for its usefulness and relevance to the research question. The articles chosen were based on the criteria of relevance, accuracy, and the latest information available.
First, the effectiveness of mRNA and adenoviral vector-based COVID-19 vaccines in reducing the risk of ICU admission for COVID-19 pneumonia was studied in a cohort of people in Lombardy, Italy. Namely, Grasselli et al.’s (2022) study found that individuals who received vaccines based on mRNA technology or adenoviral vectors had a significantly decreased risk of ICU admission for COVID-19 pneumonia compared to unvaccinated individuals. Vaccinated patients were, on average, older, had more comorbidities, and had higher Pao2/FiO2 ratios at ICU admission than unvaccinated patients (Grasselli et al., 2022). Even with these differences in patient characteristics, ICU and hospital mortality outcomes were similar between vaccinated and unvaccinated individuals. These findings indicate that using mRNA or adenoviral vector-based COVID-19 vaccines could reduce the risk of developing severe acute respiratory failure requiring ICU admission, particularly among older adults. This finding is relevant for making a decision related to the PICOT question as it provides evidence that the use of the vaccine effectively reduces the risk of pneumonia in those over 50 years of age.
The following article focuses on the measures for diagnosing and treating infections caused by the novel coronavirus responsible for the pneumonia outbreak in Wuhan, China. The article reviews advances in technologies for rapid diagnosis and identification of respiratory infections caused by a coronavirus, as well as strategies for research and development of vaccines, prophylactics, and therapeutics to combat 2019-nCoV and other emerging coronaviruses (Yu et al., 2020). These findings are relevant for deciding the best strategies for diagnosing and treating infections caused by the novel coronavirus. This article is significant for formulating an effective response to the current pandemic and developing strategies for responding to future outbreaks of other emerging coronaviruses.
Furthermore, one article discusses the potential impact of seasonal influenza and pneumococcal polysaccharide vaccines in older adults to reduce COVID-19 mortality. According to Thindwa et al. (2020), the seasonal influenza vaccine is recommended for older adults and healthcare workers, and the effectiveness of the vaccine varies from around 20% to 60%, depending on the season (p. 5400). The 23-valent pneumococcal polysaccharide vaccine may protect up to 60% of older adults against pneumococcal-related COVID-19 infections and up to 66% in countries with infant PCV programs (Thindwa et al., 2020, p. 5400). These findings are relevant for making decisions related to a PICOT question regarding the effectiveness of seasonal influenza and pneumococcal polysaccharide vaccines in older adults to reduce COVID-19 mortality, as they suggest that these vaccines can provide significant protection against COVID-19 in this population.
The last article identifies geroprotectors as a promising approach to tackle immunosenescence to improve COVID-19 outcomes and vaccine response in older adults. Geroprotectors target the biological mechanisms of aging and can restore immune function and improve tissue and organ physiology (Cox et al., 2020). Preclinical trials have shown that geroprotectors such as mTOR inhibitors and statins can improve influenza vaccine responses and reduce the incidence and severity of respiratory tract infections in older adults (Cox et al., 2020). Additionally, these drugs can act as senolytics to selectively kill senescent cells and improve outcomes in age-related diseases (Cox et al., 2020). These findings suggest that geroprotectors could be beneficial in improving outcomes in older adults at high risk of adverse outcomes from infectious diseases such as COVID-19. This finding is relevant for making decisions related to a PICOT question because it supports using geroprotectors in older adults to prevent and treat COVID-19.
References
Cox, L. S., Bellantuono, I., Lord, J. M., Sapey, E., Mannick, J. B., Partridge, L., Gordon, A. L., Steves, C. J., & Witham, M. D. (2020). Tackling immunosenescence to improve COVID-19 outcomes and vaccine response in older adults. The Lancet Healthy Longevity, 1(2), e55–e57. Web.
Grasselli, G., Zanella, A., Carlesso, E., Florio, G., Canakoglu, A., Bellani, G., Bottino, N., Cabrini, L., Castelli, G. P., Catena, E., Cecconi, M., Cereda, D., Chiumello, D., Forastieri, A., Foti, G., Gemma, M., Giudici, R., Grazioli, L., Lombardo, A.,… Pozzi, M. (2022). Association of COVID-19 vaccinations with intensive care unit admissions and outcome of critically ill patients with COVID-19 pneumonia in Lombardy, Italy. JAMA Network Open, 5(10), e2238871. Web.
Thindwa, D., Garcia Quesada, M., Liu, Y., Bennett, J., Cohen, C., Knoll, M. D., von Gottberg, A., Hayford, K., & Flasche, S. (2020). Use of seasonal influenza and pneumococcal polysaccharide vaccines in older adults to reduce COVID-19 mortality. Vaccine, 38(34), 5398–5401. Web.
Yu, F., Du, L., Ojcius, D. M., Pan, C., & Jiang, S. (2020). Measures for diagnosing and treating infections by a novel coronavirus responsible for a pneumonia outbreak originating in Wuhan, China. Microbes and Infection, 22(2), 74–79. Web.
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