Introduction
In developing patient care practices, the PICO (T) study design is justified because it addresses the effectiveness of the care plan. Through this schema, patient satisfaction is improved. This paper presents a study of a practice problem related to the diagnosis of endometriosis. In addition, sources of evidence are identified, and conclusions from articles are explained to answer the research question. The PICO (T) principle was used to accomplish the task at hand.
Using the PICO (T) Framework in the Care of Patients with Endometriosis
The practical problem prepared in the study is the need to develop a general principle approach to diagnosing endometriosis in women. Diagnostic measures for endometriosis are complicated by the high variability of disease symptomatology and the complexity of data interpretation (Lamvu et al., 2020). In this regard, a research question was posed. Is symptomatic diagnosis combined with biochemical analyses of endometriosis more accurate compared to analysis of disease biomarkers alone in women?
The principles of integrative medicine were used as an approach to intervention, combining a combination of traditional and additional targeted interventions for high efficacy. The study population is female patients with symptoms of endometriosis presenting to an antenatal clinic. The study aims to determine the effectiveness of diagnostic approaches so all factors that may affect a woman’s reproductive health are considered. However, the study does not include factors related to the patient’s culture or other worldviews.
Identifying Sources of Evidence
The diagnosis of endometriosis is complicated by varying degrees of severity of clinical symptoms. The current diagnostic measures and examination for endometriosis include a routine exam and biochemical and histological parameters changed by the disease. The systematic analysis consists of a bimanual gynecological examination, which allows early detection of the presence of foci of an endometrial tissue overgrowth in the genital area (Lamvu et al., 2020). In addition, general examination data (palpation of the mammary glands, examination of postoperative scars) allow you to exclude the presence of infiltrates and endometrial implants. The doctor records the primary data in the patient’s chart during the public test (Taylor et al., 2018). At the same time, the nurse assesses the general condition and makes a clinical judgment about the impaired needs. In the case of a symptom-only approach, the nurse can determine the severity of symptoms during the woman’s stay in the hospital. For diagnosis, this is often an indicator of the degree of endometrial tissue overgrowth.
Biochemical indicators traditionally include studying the hormonal system with an assessment of changes in “reproductive” hormones during menstruation. Adhesion molecules are involved in forming adhesions and adhesions in the endometrial tissue (Parasar et al., 2017). In this regard, examining blood components such as integrins and cadherins is advisable. It is also worth taking into account immunological parameters: cytokine accumulation plays a role in pain syndrome formation (Zhao et al., 2020). Non-invasive ways of diagnosis greatly simplify patients’ perception of care. In contrast to the symptomatic approach, biochemistry is more specific and allows better contact with the patient.
Laparoscopic surgery is considered to be the standard diagnostic procedure for endometriosis. It allows quick and effective inspection of the small pelvis and determination of the presence of endometriosis with further tissue sampling for analysis. Proponents claim its high efficiency and accessibility, including the ability to take histological samples. However, laparoscopy is a surgical intervention, so the role of medical professionals, in this case, is to choose the tactics for the psychological preparation of patients (Parasar et al., 2017). There are likely difficulties with women’s readiness for pelvic surgery due to the high association of endometriosis with infertility. In contrast to other diagnostic approaches, laparoscopy is more damaging than blood draws or simple examinations.
Outcomes from the Articles
The symptomatic approach to diagnosis is the primary non-invasive method most accessible to women. The advantage of the system is its comprehensiveness: the therapist of the preliminary examination with the nurse can identify the diverse manifestations of the disease. It is taken into account because it is essential to assess the quality of life among women with a history of endometriosis (Agarwal et al., 2019). It consists of performing household activities, health care costs, limitations in social activities, and more. The symptomatic approach relies on two key attributes: pain and infertility. Both indicators directly impact the quality of life because they cause the most anxiety for patients. The medical staff tries to increase patient satisfaction and relief, so assessing symptoms (especially during menstruation) speeds up diagnosis. Moreover, unlike other diagnostic interventions, examinations solve the problem of psychological comfort and attitude toward the disease.
Nevertheless, an asymptomatic approach is not enough, so biological markers solve the problem of complete identification of the disease. Biomarkers are reliable and straightforward indicators for the early diagnosis of the disease (Zhao et al., 2020). Endometriosis is fixed as an inflammatory disease, so assessing the levels of immunological indicators allows one to judge the severity (Parasar et al., 2017). Local painful manifestations may be associated with hormonal fluctuations, so assessing estrogen levels in the blood over a certain period contributes to a comprehensive diagnosis. Semi-invasive diagnostic methods simplify diagnosis by providing an expanded patient health status database.
Relevance of the Outcomes of the Articles
A study by Agarwal et al. (2019) details the medical community’s attitudes toward clinical diagnosis. The paper provides an overview of current opinions on the extent to which an asymptomatic approach is necessary to detect endometriosis. The study also draws attention to the system’s shortcomings, allowing the reader to appreciate the complexity of the overall diagnostic process. The article relies on qualitative and quantitative statistical data, greatly facilitating the perception of the disease and guiding an in-depth approach to the evaluation of the problem (Agarwal et al., 2019). Moreover, the researchers note that the clinical approach is more patient-centered, undoubtedly affecting the interaction between the individual and the medical staff. There is also a positive dynamic in the speed of establishing a final diagnosis with an early clinical trial. The advantages of laparoscopic examination are noted, and the need to deepen clinical diagnosis is explained.
A paper by Parasar et al. (2017) was chosen because it investigated biomarkers as critical diagnostic indicators. It draws on the advantages of laparoscopy, noting its difficulties in some cases. The study provides an overview of the main endometriosis biomarkers, citing academic sources and explaining their validity and purpose (Parasar et al., 2017). The work reveals the potential of biomarkers as targets for the treatment of endometriosis. The authors draw attention to the advantages and disadvantages of biomarkers, defining their necessity for a complete diagnosis.
Conclusion
Endometriosis is a debilitating disease that requires a comprehensive diagnostic approach. There is a need to deepen the knowledge of the clinical symptoms of endometriosis with an emphasis on biomarkers because improving diagnosis and increasing its speed and reliability is achieved. The PICO (T) framework has been applied to establish that an integrated diagnostic approach using a symptom-based method and biochemical testing is more effective than biomarkers. It was proven by identifying sources of evidence and explaining the results based on their relevance. Articles Agarwal et al. (2019) and Parasar, et al. (2017) provide reliable and valid information to explore a comprehensive approach to the diagnosis of endometriosis.
References
Agarwal, S. K., Chapron, C., Giudice, L. C., Laufer, M. R., Leyland, N., Missmer, S. A., Singh S. S., & Taylor, H. S. (2019). Clinical diagnosis of endometriosis: a call to action. American Journal of Obstetrics and Gynecology, 220(4), 354-365. Web.
Lamvu, G., Antunez-Flores, O., Orady, M., & Schneider, B. (2020). Path to diagnosis and women’s perspectives on the impact of endometriosis pain. Journal of Endometriosis and Pelvic Pain Disorders, 12(1), 16-25. Web.
Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: Epidemiology, diagnosis and clinical management. Current obstetrics and gynecology reports, 6(1), 34-41. Web.
Taylor, H. S., Adamson, D. G., Diamond, M. P., Goldstein, S. R., Horne, A. W., Missmer, S. A., Snabes, M. C., Surrey, E., & Taylor, R. N. (2018). An evidence-based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis. International Journal of Gynecology & Obstetrics, 142, 131-142. Web.
Zhao, T., Xiao-Hong, C., Yan., & Hong-Lan, Z. (2020). Current biomarkers for the detection of endometriosis. Chinese Medical Journal, 133 (19), 2346-2352. Web.