Part 1: Develop a searchable question using the PICOT format. (The question is a single statement identifying the components of PICOT.
For patients undergoing Statin Therapy to control cholesterol levels in order to reduce risk of Cardio Vascular disease, are Statins responsible for increased Liver diseases?
Statins are effective drugs used to inhibit biochemical synthesis necessary for production of cholesterol in the Liver. However, recent incidents have prompted Interventional studies to be conducted in order to establish whether Statins and other Statin drug interactions are responsible for increased Liver diseases (Argo et al, 2008). Cholesterol is synthesized within cells from its simple molecular form and plays a vital role in maintaining cellular function and homeostasis. Cell membranes are made of cholesterol and its lipid structure bonds to ensure that the membrane is permeable to allow flow of substances in and out the cell. In addition, cholesterol is a vital precursor molecule in some important biochemical pathways; excess cholesterol is converted to bile salts which help absorption of fat and vitamins, A, D, E and K in the intestines. However, cholesterol is hardly soluble in water; therefore it is esterified so as to bond with Lipoproteins for increased transport. Low density Lipoprotein (LDL) particles transport cholesterol from the liver to blood vessels and cells while High density Lipoprotein (HDL) particles transport Cholesterol to the liver. There is significant scientific evidence that increased LDL particles contribute to progression of Cardio vascular disease (Cromwell et.al, 2007). In a previous study, patients suffering from cardio vascular related diseases have relatively high Total and LDL Cholesterol implicating cholesterol as a risk factor of increased mortality (Pekkanen et.al, 1990). Serum cholesterol can be controlled by maintaining a healthy diet, physical exercise and taking medication. Smokers and elderly people aged 40 years and above are more vulnerable to heart diseases resulting from increased serum cholesterol. Healthcare organisations are therefore monitoring Liver Function Tests (LFTs) regularly in patients undergoing Statin Therapy.
NICE recommends Statin therapy as a vital preventive measure to manage and reduce mortality in adults with a higher risk of developing CVD. Also, it recommends regular progressive monitoring of LFTs in all patients. LFTs monitoring in patients undergoing Statin therapy can prove to be difficult before establishing a significant result. Statins induce liver enzymes and therefore in the early weeks Aspartate transaminase (AST) and Alanine transaminase (ALT) are significantly high and to yield a significant result it would require the next testing to be done after several months. Other complications are, some patients can develop drug-induced toxicity and obesity can influence liver function. Therefore it is necessary to measure a patient’s Baseline LFTs and consider all other factors that may influence LFTs abnormalities before establishing the probability of Statins influence on Liver Disease. Also, it is vital to include Histological techniques in addition to regular LFTs monitoring (Argo et.al, 2008).
Perform a rapid appraisal of each article by answering the following questions (one to two sentences are sufficient to answer each question)
1. How does each article describe the nature of the problem, issue, or deficit you have identified?
Statin effect on causing Liver toxicity is considered possible and potent in most articles. However, in some articles it is relatively considered unlikely unless different tests to support the hypothesis are performed and yield a significant result.
2. Does each article provide statistical information to demonstrate the gravity of the issue,
problem or deficit?
Each article has a done a done a study to demonstrate an aspect or other of the issue. The articles have therefore provided empirical evidence on the issue, giving numbers of the people that were studied who have the issue of interest.
3. What are example(s) of morbidity, mortality, and rate of incidence or rate of occurrence in the general population?
Diseases associated with Liver diseases such as Jaundice and Cirrhosis are evident and common in the elderly. About 20,000 deaths a year are associated with Liver diseases.
4. Does each article support your proposed change?
Although not every article supports mentions introduction of other techniques, some articles encourage use of Histological techniques in monitoring influence of Statins on normal Liver function. Most articles even if they do not offer a solution assert that there is need for change.
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