Answer

Introduction

This presentation discusses the solution to the clinical problem of stroke recurrence using the EBP process. The areas covered in this presentation are description of the selected EBP problem, PICOT question, high-level overview of the articles found on the EBP problem, summary of the search strategy employed in locating the articles, changes that could be made owing to the findings of the articles, strategies and resources that would be employed in implementing a change based on these findings, opportunity areas for future research and EBP associated with the issue of stroke recurrence, conclusion, and discussion of next steps.

Description of the Selected Evidence-Based Practice Problem

The Evidence-based problem is associated with stroke recurrence for smokers and non-smokers. Patients who have recovered from stroke have a tendency of going back to their former habit of smoking as they are unaware of the higher risk that smoking exposes them to in relation to developing stroke again (Chen et al., 2019). According to Gray et al. (2017), clinical problems required evidence-based research solutions. Since stroke recurrence for patients presents a clinical problem, there is significant need for finding an EBP solution for stroke recurrence

PICOT Question

MY PICTO question was as follows:

In patients who have experienced stroke(P), how does being a smoker (I) compared to a nonsmoker (C)developed higher risk of recurrence (O) during the first 1 year after stroke?

Overview of the Articles Found: Article 1

The quantitative article by Chen et al. (2019) focused on the investigation of the effect of smoking status in the recurrence of stroke. Patients that have experienced stroke for the first time were enrolled in the study. The data was collected using a face-to-face questionnaire. The researchers analyzed the subjects’ smoking status, and the primary endpoint was established as nonfatal or fatal recurrent stroke. The risk of stroke recurrence was examined using a multivariate Cox regression model. The findings revealed that even after the first stroke, individuals who were persistent in smoking had increased chances of experiencing stroke recurrences.

Overview of the Articles Found: Article 2

In the quantitative article by Matsuo et al. (2020), the authors focused on the clarification of the correlation between smoking status and clinical development after acute ischemic stroke. The method used involved a multicenter clinic-based stroke case in Japan. The researchers analyzed 1082 patients diagnosed with acute ischemic stroke. Data was collected using a questionnaire developed in specific health checkups and specific health guidance across Japan. The findings of the study showed that habitual smoking is linked to an increased risk of unfavorable clinical outcomes at the third month of being diagnosed with ischemic stroke.

Overview of the Articles Found: Article 3

Qualitative article by Epstein et al. (2017) focused on analyzing whether cessation of smoking after an ischemic stroke or TIA enhances outcomes of an individual’s health compared to those who continued smoking. The method used was a prospective observational group analysis of 3,876 nondiabetic men and women enrolled in the Insulin Resistance Intervention After Stroke (IRIS) through randomization to placebo and pioglitazone within six months of a qualifying TIA or stroke and made a follow up for a median of 4.8 years. Annual face-to-face interviews were undertaken between the researchers and the subjects.  The findings revealed that ceasing cigarette smoking after a TIA or ischemic stroke was linked to significant health benefits above 4.8 years in the IRIS trial process.

Conclusion and Discussion of Next Steps

The next step should involve the execution of evidence-based research on the effectiveness of various smoking cessation interventions such as exercise, medication, and education. This step should then be followed by the execution of evidence-based research that compares the effectiveness of different smoking cessation interventions including exercise verses education, education versus medication, and exercise versus meducation.