Beruflich Dokumente
Kultur Dokumente
MUHAMMAD ALI
FM USU
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And this question...
“Is vitamin C more effective than echinacea in
preventing the common cold in adult?”
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Characteristics of Good Question
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THE FIVE STEP EBM MODEL
•Patient
•Patient
•Hierarchy •Intervention
•Hierarchyofofevidence
evidence •Intervention
•Pre •Comparison
•Preappraised resources
appraised resources Searching the •Comparison
•Outcome
•Outcome
Evidence
(Lang,
(Lang,2000)
2000) 6
P I C O: Formulate an Answerable Question
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• PICO is a method of putting together a search strategy that allows
you to take a more evidence based approach to your literature
searching when you are searching bibliographic databases like
Medline (OVID), PubMed and Embase
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Remember the PICO Principle
P Population / problem
I Intervention
C Comparator / control
O Outcome
Diagnosis
how to select and interpret diagnostic tests
Therapy
how to select treatments to offer patients that do more good than harm
and that are worth the efforts and costs of using them
Prognosis
how to estimate the patient's likely clinical course over time and
anticipate likely complications of disease
Harm/Etiology
how to identify causes for disease (including iatrogenic forms)
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Anatomy of a Good Clinical Question: PICO
P = Patient or problem
How would you describe a group of patients similar to
yours?
What are the most important characteristics of the
patient?
Sex, age or race of a patient?
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I = Intervention, prognostic factor, or exposure
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C = Comparison
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O = Outcomes
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'P I C O' examples
1. Interventions
- Cover a wide range of activities from drug treatments and other clinical therapies,
to lifestyle changes and social activities
- Can include individual patient care or population health activities
A 28-year-old male presents with recurrent furunculosis (skin boils) for past 8
months; these episodes have been treated with drainage and several courses of
antibiotics but keep recurring. He asks if recurrences can be prevented.
Vit C
Adult with a cold
Prevention of the cold
echinacea
Patient /
Problem / Intervention Comparison Outcome
Population
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P is for Patient
Patient
Who is your patient?
A clinical question must identify a patient or patient group. Additionally
a clinical question should include any information that is relevant to the Intervention
treatment or diagnosis or the patient . For example, you might include
the patient's:
Comparison
• Sex, age or race
• Disease History
• Primary Complaint Outcome
Case:
A mother came to your clinic bringing her son, Charly, a ten-year old boy. She would like to know of
your opinion about the best option for her son’s Atrial Septal Defect/ASD closure, whether the
transcatheter closure with Amplatzer device is better than that with open heart surgery.
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I is for Intervention
The intervention is what you plan to do for your patient or patient group.
For example, you might: Intervention
• Run tests
• Prescribe drug treatment Comparison
• Refer to a specialist
• Schedule surgery/other intervention
Outcome
Case:
A mother came to your clinic bringing her son, Charly, a ten-year old boy. She would like
to know of your opinion about the best option for her son’s Atrial Septal Defect/ASD
closure, whether the transcatheter closure with Amplatzer device is better than that
with open heart surgery.
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C is for Comparison
Patient
What is the Comparison
• In general most, but not all, clinical questions have a comparison. Intervention
A comparison is the alternative that you want to compare to
your intervention.
Comparison
For example:
• Is aspirin as effective in preventing
strokes as warfarin? Outcome
• Is chicken soup as effective as
bed rest in treating a cold?
Case:
A mother came to your clinic bringing her son, Charly, a ten-year old boy. She would like to know of your
opinion about the best option for her son’s Atrial Septal Defect/ASD closure, whether the transcatheter
closure with Amplatzer device is better than that with open heart surgery.
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O is for Outcome
Patient
What is the Outcome?
Intervention
The outcome is the hoped for effect of the intervention
Case:
A mother came to your clinic bringing her son, Charly, a ten-year old boy. She would like
to know of your opinion about the best option for her son’s Atrial Septal Defect/ASD
closure, whether the transcatheter closure with Amplatzer device is better than that
with open heart surgery.
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PICO
You determined the following were important factors for our case.
Case:
A mother came to your clinic bringing her son, Charly, a ten-year old boy. She would like
to know of your opinion about the best option for her son’s Atrial Septal Defect/ASD
closure, whether the transcatheter closure with Amplatzer device is better than that
with open heart surgery.
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Your Clinical Question
Case:
A mother came to your clinic bringing her son, Charly, a ten-year old boy. She would like
to know of your opinion about the best option for her son’s Atrial Septal Defect/ASD
closure, whether the transcatheter closure with Amplatzer device is better than that
with open heart surgery.
Is transcatheter closure more effective than surgical closure in child with ASD?
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2. Aetiology and risk factors
- Relate to questions that probe possible causes of a disease or illness
- Deal with the harmful outcomes of an activity or exposure
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3. Frequency or rate
- Questions of FREQUENCY (prevalence) are about how many people in
the population have a disease or health problem
- If the question also includes a time period, it becomes a question of
rate (incidence)
Julie is pregnant for the second time. She had her first baby when she was 33 and
had amniocentesis to find out if the baby had Down's Syndrome. The test was
negative but it was not a good experience as she did not get the result until she
was 18 weeks pregnant. She is now 35, one month pregnant and asks if she can
have a test that would give her an earlier result. The local hospital offers serum
biochemistry plus nuchal translucency ultrasound as a first trimester test for
Down's Syndrome. You wonder if this is as reliable as conventional amniocentesis.
• For an intervention/therapy:
In _______(P), what is the effect of _______(I) on ______(O) compared with
_______(C)
• For etiology:
Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk
for/of_______ (O) compared with ______ (P) with/without ______ (C)
• Prevention:
For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O)
compared with _________ (C)?
• Prognosis/Predictions
Does __________ (I) influence ________ (O) in patients who have _______ (P)
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The Clinical Question
Your clinical question will impact the entire EBM research process.
Evidence Based
Clinical Question Search terms Literature search
Answer
• Note: Your clinical situation may raise more than one question. Don't try to
squeeze multiple topics into one clinical research question.
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The ‘PICO’ Principle
Population and This shows who the relevant people are in ralation to the clinical
clinical problem problem that you have in mind
Intervention (or This shows the management strategy, exposure or test that you want
indicator or indext find out about in relation to the clinical problem. This might be:
text) • a procedure, such as a drug treatment, surgery or diet
(intervention)
• Exposure to an environmental chemical or other hazard a physical
feature (such as being overweight) or a factor that might affect a
health outcome (indicator)
• a diagnostic test, such as a blood test or brain scan (index test)
Comparator This shown an alternative or control strategy exposure or test for
comparison with the one you are interested
We call these four parts of a clinical question ‘PICO’ pronounced ‘pee-co’) which makes them easy
to remember. A timeframe (T) is usually implicit in every question, but it is some time useful to add
this component explicitly (ie PICOT) 30
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THANK YOU
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