Appendix B: PICO Worksheet and Search Strategy
PREFACE: In one to three sentences of common prose, describe the patient concern that made you interested in pursuing this PICO process. Must be documented
A 17-year-old male presents with findings of latent pulmonary tuberculosis. He had not been vaccinated with BCG as a child, and his father had been diagnosed with pulmonary tuberculosis 4 months ago. The patient had started a prophylactic regime of Isoniazid (INH) 300mg daily, but he missed several doses. He asks if there is a shorter and more effective prophylactic regime, so that his younger teenager siblings reduce the risk of acquiring the disease.
1. Develop your PICO question by defining the elements, and then state the full question. Patient / Problem: Non-vaccinated individuals aged 13 to 17 years, direct contact of a TB patient ( / 5 points)
Intervention: INH 900mg + Rifapentine 900mg once a week for 3 months ( / 5 points) Comparison: INH 300mg daily for 6 months ( / 5 points) Outcome: Findings of latent tuberculosis ( / 5 points)
What is your PICO question? ( / 10points)
Among individuals aged 13 to 17 years, previously non-vaccinated with BCG, and who are in direct contact with TB, is the combination therapy of INH 900mg + Rifapentine 900mg once a week for 3 months as effective as the gold prophylactic standard of INH 300mg daily for 6 months in preventing latent tuberculosis?
2. Type of question/problem: ( / 5 points)
Check one: ____Diagnosis __√_Therapy (prophylactic)
3. Further describe your “patient” and the concern behind this PICO. ( / 20 points)
M. is a 17-year-old male who was not vaccinated with BCG as a child. His parents did not want to comply with the vaccination scheme because of personal beliefs. His father had not been vaccinated either. 6 months ago, his father was diagnosed with latent pulmonary tuberculosis, but M. and his siblings resulted negative at the time. A prophylactic scheme of INH once daily for 6 months was initiated, but M. confesses that between school, extracurricular activities, family, and friends, it was hard to remember to take it daily.
Latent tuberculosis involves infection with the microorganism Mycobacterium tuberculosis, or other tuberculosis-causing organisms, but without any symptoms or signs of disease. In 2013, the United States reported 9,588 new tuberculosis cases. This study will involve populations aged 13 years to 17 years who are at direct risk of infection with Mycobacterium tuberculosis. Latent tuberculosis is diagnose by tuberculin skin test (TST) or interferon gamma release assays (IGRA). In the latent phase infected individuals do not present with any signs and symptoms. Once the condition becomes active however, they begin to show symptoms including a persistent cough, blood in the sputum and fever. In the active phase the microorganism is airborne and can infect others, thus the need for treatment and prophylaxis. Vaccination with BCG is the first and more important prophylactic measure worldwide. Nevertheless, for the purposes of this study, only patients without previous vaccination with BCG will be considered. Although BCG is a mandatory vaccine included in the vaccination scheme of many countries, some individuals reject having their children vaccinated due to personal beliefs. Vaccination with BCG is not useful in adolescents and adults. Furthermore, preventing tuberculosis in non-vaccinated subjects at a young age is difficult to manage, because the gold standard involves daily doses of INH for a long time (6 months). Therefore, rates of compliance are not as high as needed.
STRATEGY DESCRIPTION: In brief general terms, describe the strategy you will use to find literature supporting your investigation. Identify the types of studies and study characteristics you feel will be most useful and likely to be available and why. Must be documented
My literature search will make use of peer-reviewed scholarly articles available in databases (PubMed, CENTRAL, MEDLINE, EMBASE, CINAHL, Science Direct). It will include preferably Randomized Controlled Trials (RCT). However, since it could be difficult to find RCTs with large samples of subject not-previously vaccinated with BCG that are in direct contact with TB, it could be useful to include case-control studies and case series or case reports. It must be taken into account though, that these latter types of studies provide a lesser degree of evidence for causal inference than RCTs.
4. Type of study to include in the search: Check all that apply: ( / 5 points)
_√_ Randomized Controlled Trial __ Cohort Study
_√_ Case series or Case Report _√_ Case Control Study
__ Other: _________________________________________
5. List main terms and alternate terms (synonyms) for your search ( / 5points)
a. Latent tuberculosis or latent tuberculosis infection (LTBI)
b. Latent tuberculosis prophylaxis or LTBI prophylaxis adolescent
c. Isoniazid/INH
d. INH children
e. INH adolescent administration
f. TB prophylaxis
g. Rifapentine
6. List your inclusion criteria for your search (such as age, language, publication dates, etc.) ( / 5points)
a. Study population between 13-17 years of age, non-vaccinated with BCG, and in direct contact with TB.
b. Studies involving both male and non-pregnant female patients.
c. Published between 2009-2014.
d. Articles in English (and those translated to English).
7. List a minimum of three databases where you plan to search. ( / 5 points)
a. PubMed
b. CENTRAL
c. EMBASE
d. CINAHL
e. Science Direct
__ Approved __ Not Approved, rewrite required (maximum 70%)
*Please note: This worksheet must be approved prior to moving forward on your paper. Submissions beyond the designated time frame outlined in the Syllabus will receive a zero.
Adapted from Syrene A. Miller, PICO Worksheet and Search Strategy National Center for Dental Hygiene Research
