Question

Assignment 1: Application – PICO Analysis Depression

A PICO analysis is used to pose a focused clinical question to which you find appropriate evidence-based answers. The PICO question should include the patient or population (P), anticipated intervention (I), comparison group or current standard (C), and outcome desired (O). In this Assignment, you develop a question related to dementia, delirium, or depression. Through your PICO analysis, you explore various resources and examine current evidence to answer the question you develop.

To prepare:

Select depression.

Review the guidelines in the “Literature Review Matrix” document in this week’s Learning Resources.

Think about a research question around your issue as indicated in Part I: PICO Analysis of Research Topic.

Consider the resources you will use, search terms and criteria, and Boolean search strings as indicated in Part II: Search Strategy.

Using the Walden Library and other appropriate databases, locate five articles related to your PICO question. At least one article must be a systematic review. All of the articles should be primary sources.

Reflect on the five articles you selected as indicated in Part III: Analysis of Literature. Consider the conceptual framework/theory, main finding, research method, strengths of study, weaknesses, and level of evidence for each article.

Consider how to use the summaries in Part III to create an evidence table. Use this evidence table to determine appropriate treatment options for patients who present with the disorder you selected as your topic.

To complete:

Formulate a question around the disorder you selected as indicated in Part I: PICO Analysis of Research Topic.

Identify the resources you will use, search terms and criteria, and Boolean search strings as indicated in Part II: Search Strategy.

Summarize the five articles you selected as indicated in Part III: Analysis of Literature. Describe the conceptual framework/theory, main finding, research method, strengths of study, weaknesses, and level of evidence for each article.

Create an evidence table based on the article summaries in Part III. Describe appropriate treatment options for patients based on this evidence table.

Answer 1

Part I:PICO question

Population: Depressive patients

Intervention: Selective serotonin reuptake inhibitors

Comparison: Tricyclic antidepressants

Outcome: improved prognosis

Does selective serotonin reuptake inhibitors improves prognosis better than tricyclic antidepressants in patients suffering from depression.

Part II: Search Strategy

The databases that are used are TRIP DATABASE for systemic reviews and PUBMED for articles form primary resources

The search terms used are Depression, selective serotonin reuptake inhibitors, tricyclic antidepressants and improved prognosis for TRIP database. The systemic review option was selected

The PUBMED database was browsed. There will be an advanced search option down th dialogue box. Click on it. Then we have to select MeSH terms and enter the following terms in the same order below

Depression AND selective serotonin reuptake inhibitors AND antidepressive agents, tricyclic AND prognosis. Now select systematic reviews, observational studies, journal article .

Part III:Evidence table

Evidence based table on depression treatment

Author name	Conceptual or theoretical framework	Findings	Research Method	Strenghts of study	Weakness	Level of Evidence
Ackermann and Williams	effectiveness of treatments used in the management of minor depression and premenstrual dysmorphic disorder PMDD	Sertraline andFluoxetine are beneficial in carefully selected patients, for the treatment of severe psychological or physical symptoms causing functional impairment in women with PMDD	Systematic review	Data base selection, Inclusion of only RAndomized control trail data	authors did not stated validity, they did not stated how many reviewers performed the selection	Level 1
Forder, Kavanagh and Fenyo	Sertraline versus conventional tricyclic antidepressants in treating depression	Treatment with sertraline appears to be successful in reducing the symptoms of depression	Systematic review	multicenter study	sensitivity analysis was not performed, retrospective design	Level II
Souery D, 2011	Evidence in favour of switching between SSRI and TCA in treatment resistant depression	switching from SSRI to TCA in non-responders to a 4 week trail of SSRI/TCA was not associated with improved response	Randomized open study	randomization, clinical rating scales	open label study	Level I
Qin, Zhang	efficacy and acceptability of SSRi and TCA in depressed children, adolescents and adults	SSRI therapy has a superior efficacy and is better tolerated than TCA therapy in young patients	Meta Analysis	database selection, risk ratio calculation	validity	Level 1
Wijkstra, 2010	Treatment of unipolar depression with antidepressant and antipsyhcotic vs antidepressant alone	unippolar psychotic depression should be treated with combination of antidepressant and antipsychotic combination	Randomized double blind study	randomization, no researcher bias	age selection	Level I

Selective serotonin reuptake inhibitors may be preferred over tricyclic antidepressants