1. ANALYZING CLINICAL QUESTIONS Turning Your PICO into a search strategy
Shelly Warwick, MLS, Ph.D.
2013 – Permission is granted to reproduce and edit this work for non-commercial educational use as long as attribution is provided and the edited work is also available under the same terms of license.

2. After This Unit You Should be Able to:
State what does PICO and PICO(TT) stand for?
Explain how a PICO helps you create a search strategy?
Develop a PICO statement
Develop a search strategy to answer the question posed by the PICO

3. What is a “good” question ?
The key components of a good clinical question are:
Patient/Population/Problem
Intervention/Exposure
Comparison
Outcome
How do we look for answers?
Selecting the key components of a good question will help you develop an efficient and effective search strategy
Richardson et al. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club 1995;A-12
Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380-7.

4. The Well-Built Question: “P.I.C.O.” Model
Patient/Population/Problem ( Among….)
Intervention/Exposure ( does….)
Comparison (versus….)
Outcomes ( affect…)
Example: Among pre-menopausal, minority women with hypertension living in New York City, does a program of regular exercise versus no regular exercise have a measurable affect in reducing hypertension?
Richardson et al. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club 1995;A-12
Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380-7.

5. Structure of a focused question, 1:
Patient/Population/Problem:
Demographic characteristics (age, gender, etc.)
Disease or condition
Stage, Severity
Intervention:
Type of intervention or exposure:
Exposure to a risk factor
New Diagnostic test
Treatment
Health care services, management strategies
Dose, duration, timing, route, etc.
Richardson et al. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club 1995;A-12
Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380-7.

6. Structure of a focused question, 2:
Comparison:
Another risk factor (or the absence of),
a current standard of care,
a new type of treatment/intervention,
an alternative therapy,
placebo, or no intervention at all
Outcome:
Defined and measurable - test result or physiological number
Risk or protective
Impacts mortality, morbidity, quality of life, etc.
Richardson et al. The well-built clinical question: a key to evidence-based decisions. ACP Journal Club 1995;A-12
Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997;127:380-7.

7. PICO + What type of question are you asking and what is the best study design to answer it?

8. Limits of PICO (TT) model
This model works best for Therapy/Treatment & Diagnosis questions.
Remember: PICO (TT) is a model, not a rigid structure.

9. Think Synonyms
While some conditions or interventions can be described with a single well-recognized term others cannot, or you can improve your search results by using more terms.
Such as:
“Learning OR Cognition”
“Diet or nutrition”

10. Exercise – Translate Clinical Scenario into PICO format
On morning rounds in the Hematology/Oncology unit, s patient says she wants to discuss options for managing moderate nausea and vomiting that result following her chemotherapy. She shares an experience a relative had taking ginger when Prochlorperazine didn’t provide effective relief and asks for your input.

11. PICO Breakdown of Question
Patient/Population/Problem = chemotherapy patients/experiencing adverse effects of nausea & vomiting
Intervention/Exposure = Ginger
Comparison = Prochlorperazine
Outcomes = relief/reduction of nausea & vomiting due to chemotherapy

12. Search Strategy Terms Possible Search Terms: Ginger Prochlorperazine
(Class = Antiemetics)
Chemotherapy
(Chemotherapy, Adjuvant)
nausea and/or vomiting, reduced incidence