P :children under 12

I : topical treatment regime with calcineurin inhibitors and emoillent

C: treatment with steroid and emoillent

O: reduction in frequency and severity in eczema flares in a month

In elderly patients with hypertension, does the use of a low sodium diet compared to standard dietary advice lead to better blood pressure control?

• P: Elderly patients with hypertension

• I: low sodium diet

• C: Standard dietary advice

• O: Blood pressure control

P: Pregnant women suspected of having a PE

I: CTPA

C: V/Q scan or no imaging

O: Accurate diagnosis of PE, minimising maternal and fetal risks (e.g. radiation exposure)

P: Patient with COPD exacerbation

I: Antibiotics

C: With or without Antibiotics

O: Rate of Recovery

“Is a breathing exercise intervention effective in reducing chronic pain among breast cancer survivors compared to standard care?”

PICO Framework:

• Problem (P): Breast cancer survivors with chronic pain

• Intervention (I): Evidence-based breathing exercise intervention

• Control (C): Standard care or no intervention

• Outcome (O): Reduction in chronic pain

P - pediatric (0-16yo) population with suspected appendicitis

I - USG

C - CT

O - diagnostic accuracy

P:

• Pregnant women

• Previous history of pre-eclampsia

• Currently before 12 weeks

I:

• 150 mg aspirin PO OD from 12 weeks until birth

C:

• 75 mg aspirin PO OD from 12 weeks until birth

O:

• Prevention of pre-eclampsia measured as the relative risk reduction in incidence (risk ratio)

Study Design:

• Randomized Controlled Trial

• Prospective Cohort Study

• Retrospective Cohort Study

PICO framework:

P: older patients with Alzheimer’s

I: reminiscence therapy with pharmacological treatment

C: pharmacological treatment only

O: improved quality of life

Is there any preference in choosing ACEi or ARB in treating hypertension

P: Patient above 18 y/o diagnosed with primary hypertension

I: ACEi

C: ARB

O: Target BP : 140/90

https://pmc.ncbi.nlm.nih.gov/articles/PMC10944326/

In adult male patients with a diagnosis of epilepsy, does the benefits of prescribing sodium valproate first line outweigh its risks compared to lamotrigine ?

PICO framework

P (patient) - male patients with epilepsy

I (intervention) - sodium valproate

C (comparison) - lamotrigine

O (outcome) - does the benefits outweigh the risks?

• Stratification clearly described.

• patient characteristics mentioned… confounders not statistically significant

• no blinding

• analysis does not include participants who dropped out.. no longer intention to treat analysis.. per-protocol analysis.

• data collection — home BP measurements, lack of standardization… 2 monthly follow up as oppose to recommended biweekly follow up, introduces variability — we don’t know about compliance, diet, other lifestyle factors, but they assessed other med usage. Subjective.

• initially 58, 58 -> 57, 56 — 80% power assumption (reasonable)

• Eastern India — ethnically limited, restricted generalizability

Would physiotherapy be a better initial management over medication?

Patient/problem: 60 year old woman with chronic knee arthritis

Intervention: physical therapy, including strengthening and flexibility exercises

Comparison : Medical management (NSAIDS and Steroids)

Outcome: Improvement in pain reduction and joint mobility

Patient - adolescents newly diagnosed with asthma

Intervention - steroids

Comparison - Delayed initiation of inhaled steroid on diagnosis

Outcome - Frequency of annual exacerbations

https://pubmed.ncbi.nlm.nih.gov/10195073/

Patient - 58yo Female with type 2 diabetes with uncontrolled glucose (HbA1C - 8.5%)

Intervention - low glycemic index diet

Comparison - standard balance diet

Outcome - improved glycemic control

Question: does physiotherapy alone improve symptoms in adults with severe osteoarthritis more compared with the use of NSAIDs only

P: adult patient with severe osteoarthritis

I: physiotherapy

C: pain relief with NSAIDs

O: reduced pain score, improved quality of life

https://pmc.ncbi.nlm.nih.gov/articles/PMC10423468/

P - adult with moderate to severe depression

I - CBT

C - pharmacological intervention

O - reduction in depressive symptoms assessed by BDI

Randomized control trial:

https://pubmed.ncbi.nlm.nih.gov/26224300/

P: Men with type 2 diabetes presented with symptoms of erectile dysfunction

I: lifestyle changes and glycaemic control

C: pharmacological intervention (eg. PDE5 inhibitor)

O: symptoms improve

https://pubmed.ncbi.nlm.nih.gov/15599697/

I-SGLT-2

C-Improved cardiovascular outcomes compared to ACEI

O- reduction in hospitalization due to heart failure

Clinical Question

-              In patient with heart failure, does SGLT-2 reduce the rate of hospitalisation secondary to decompensation compared to ACEI?

Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction | New England Journal of Medicine