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PICOT Question Patients with Stroke Care

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PICOT Question
20.04.2021
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Introduction

Stroke is a medical condition that is caused by the interruption or reduction of blood supply to the brain. This deprives the affected part of brain nutrients and oxygen supply. The biochemical processes are hence stopped, interrupted, or impaired; the brain cells can even die. Further, the condition can also be caused by bursting or leakage of a blood vessel (causing a hemorrhagic stroke) or by blockage of vessels or arteries (causing an ischemic stroke). It can also manifest when the said cells experience a temporary interruption of blood flow, resulting in a transient ischemic attack. All instances of stroke require effective systematic management to alleviate symptoms, accompanying pain, and bodily failings. Patients with stroke have different care and management options that mostly include usual care therapy and rehabilitation impairment-based therapy. Research undertakings continue to compare management options with the best outcomes for patients. In this study, the PICOT statement helped to frame a research question. Indeed, the PICOT statement is used to systematically analyze the research questions in a bid to test the hypothesis.

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Problem Statement

The PICOT question will be:

”In stroke patients older than 60 years old, which management intervention: early rehabilitation impairment-based therapy or the usual care (UC) therapy produces the best outcome, alleviating the pain and putting them back on the track of recovery?”

The Research Critique, the PICOT Statement, and the Research Articles

To build formidable and actionable research, the above components become essential operatives. The research publications authoritatively assert that improper or mismanagement of stroke incidents quickly lead to mortalities. This process can be very rapid, and that is why the intervention must be timous and effective. In choosing the best management method, many considerations are put in place; among these considerations is the cost of the said intervention, the degree of the vessel blockage, and the duration it has taken. The duration in this context has a direct relation to the degree because the longer the stroke has taken, the more critical is the state of the patient.

In particular, the research conducted by Rangel-Castilla et al. (2017) observes that in occlusion cases, the blockage of cervical vessels accounts for 15% of mortality cases among ischemic stroke patients. Further, to depict the wide research areas to be exploited in the management of stroke incidents, the researcher in the cited work concludes that management of Tandem Occlusion cases requires more pragmatic improvements to tie loose ends. For example, it holds that the prognosis of these cases has been poor. It is in this regard that no particular intervention by way of management method has been singled out to give the best outcome. Hence, the analysis of topic 3 has demarcated the research gap and the amount of work that is outstanding in zeroing in on the management methods to be used. Some researchers have suggested the ways, such as managing external and intracranial lesions, as a part of the interventions with a caveat that no single method can be prioritized over the other, in order to produce the best outcome in managing it. Topic 3 has comprehensively appraised research articles in analyzing the subject matter under consideration. It has highlighted the research gaps, the challenges in research, and the possible grounds to be covered in future undertakings in uncovering the best management options for this condition.

Topic 2 regards stroke and rehabilitation. Collectively, it relates to better interventions in managing the conditions. Medical rehabilitation has been highlighted as the move to alleviate any pathological process that can lead to a persistent or just a temporal state of physical disability. The rehabilitation methods often include psychological, emotional, and physical therapy. As explained in the discussion, the rehabilitation interventions for persons with stroke tends to be holistic, touching on the physical state of body, psychological and emotional therapy, and socio-economic support, among others. The physical approaches tend to include the use of physical exercises to reactivate joints, muscles, and body parts. The activation would increase the work of muscles, improving the blood flow. Indeed, besides the medical administrations, the psychological therapies help to integrate the patient back to society (Rice et al., 2017). A patient might need to accept the new state, as he/she- may be in a state of disability and appreciate the new physical state and new potentials.

Rice et al. (2017) demonstrate these fundamentals by explaining that the role of family and close associates of a patient is critical in this socialization endeavor. The stroke patient needs socialization and activation of cognitive abilities, as a method of rehabilitation. They are also coached into mortal skills. They are helpful in understanding how to balance their body parts and weight throughout the recovery process. This is a methodical undertaking that is systematic. The researcher holds that the rehabilitation approaches have different objectives, depending on the severity of the stroke conditions. The objective of recovery and restoration is essentially targeted if the condition is not a server and has not taken longer. In this case, full recovery from dysfunctions and impairment is pursued. Rather, integration of a patient in the society and sensitize them on new potentials.

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The full social, physical, emotional, and psychological potential of the patient is pursued, so that disabled is not confined in a state of sorry and or a state of despair. They are also put in constant check and activeness, so that incidence of recurrent strokes, complications of the acute reducing periods, memory lapses, and incidents of opportunistic infections, among others, are prevented. Rehabilitation, therefore, seeks to prevent and manage or treat the complications that are associated with stroke and reduce the main disease symptoms. Among other things, the focus of the rehabilitation approaches, include the motor activity of patients, helping them to adapt to the new neurological deficiencies, correction of functional disorders, increased tolerance to physical loads, improving the quality of life, increasing social activity, as well as slowing down the pathological process.

Moreover, ethical considerations must be appreciated, when carrying out the rehabilitation measures. Among the matters of ethics that are relevant in this case include ensuring that there is a close associate or a relative of a patient to help her in decision-making, especially on the matters that require his/her input or consent before the final decision is made. Needless to say that there are instances during therapeutic interventions, where the consent of the patient is mandatory, as a matter of ethical requirement. When the patient is in a state of unconsciousness or unable to productively consider the matters at hand, aid must be consulted. Other considerations, in this regard, are applying early rehabilitation interventions in order to alleviate the pain and suffering of the patient. This is grounded on earlier highlighted the fact that the stroke conditions worsen as time passes. It is, therefore, only ethically right to almost immediately place the patient on a rehabilitation regimen almost immediately.

The best way is to ensure that the rehabilitators are of different profiles, experience, and diverse knowledge to ensure that the patient has more individualized experience of the process. The diversity of specialty of rehabilitators is helpful in ensuring that different approaches are used. However, the bottom line is that whatever approach is applied, it must be systematic and stage-wise, so that the patient’s body system is activated and effectively handled (Rice et al., 2017). The process can be lengthy but humane and considerate, not compounding the pain on patients’ bodies. The patient’s participation also needs to be harnessed and encouraged to be active and effective. Often, when family members tend to be more sympathetic, caring, and warning the patient, whenever he/she makes any moves, to make sure he/she does not incur any bodily harm. While it is not bad, it often discourages the patient, making him/her extra careful and cautious. This has a dampening effect on one’s self-esteem and level of confidence.

Literature Research

Six literary research journal articles were consulted in preparing two write-ups critiqued and discussed above. This subject is widely researched in different dimensions. Mbabuike, Gassie, Brown, Miller, and Tawk (2017) explain the best methodology for managing tandem occlusions in patients with stroke issues. It presents the anterograde approach with proximal to distal revascularization and retrograde approach with distal to proximal revascularization. These approaches present a holistic handling of patients with stroke, so that the wholesome outcome is attained. This affirms the above discussions.

Rangel-Castilla et al. (2017), investigating the best management options for acute ischemic stroke due to tandem occlusion, seeks to uncover the best intervention in this regard at first instance. It provides empirical information on the outcome for approaches that patients underwent and the effect they had on them. This article is relevant, especially regards to the concept of evidence-based decision-making. The data generated hereupon is useful in evaluating the output of every management options adoptable under the various circumstances. The article is hence important in testing research hypothesis and answering the PICOT question in this research.

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Further, Dababneh, Guerrero, Khanna, Hoh, and Mocco (2012) engender the evidence-based decision, making principle in its analysis of issues. It also tests various options for managing the tandem occlusion stroke. In particular, the research tests the efficacy of endovascular therapy. The outcome will be used or otherwise avoided, depending on the outcome. Indeed, the researchers explain their experiences, when handling the acute ischemic stroke patients, focusing on tandem occlusions and they later went through intravenous thrombolysis. They were then taken through extracranial ICA angioplasty and intracranial MCA mechanical thrombectomy.

Furthermore, the input of Rice et al. (2017), as it has been explicated above, cannot be underemphasized. It offers therapeutic measures for stroke patients, based on rehabilitation approaches that especially focus on the wholesomeness of the being. It explains that their spiritual, emotional, psychological, social, physical, among others aspects, must be brought to par to integrate them back into society. This management approach is called goal-setting therapy, and it is often confined within a timeframe.

Moreover, Dyakova et al. (2016) explore the different methods to assess the risk predisposition of every person with regard to cardiovascular infections. This is preventative in nature. As such, the journal evaluates the systematic, on the one hand, and opportunistic risk assessment, on another hand, to prevent these kinds of diseases. It highlights the screening options to prevent stroke symptoms. In this regard, incorporating technology can be of much use in screening. Laver et al. (2013) explore the extent to which technology can be used in the prevention of stroke symptoms. Taking proactive measures to prevent cardiovascular diseases can be effective and cheaper than treating them. This article introduces telerehabilitation, as one of the ways. Telerehabilitation avails the services closer to the patient without much hustle of movement.

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