AUC Library: Evidence Based Medicine: Clinical Questions

PICOTT - Building a Good Clinical Question

A clinical question needs to be directly relevant to the patient or problem at hand and phrased in such a way as to facilitate the search for an answer. PICO(TT) makes this process easier. It is a mnemonic for the important parts of a well-built clinical question. It also helps formulate the search strategy by identifying the key concepts that need to be in the article that can answer the question.

Population	What specific population are you interested in?
Intervention	What main intervention are you considering? What do you want to do with this patient?
Comparison Group	What is the main alternative being considered, if any?
Outcome of Interest	What are you trying to accomplish, measure, improve or affect?
Time Frame	What is the appropriate follow-up time to assess outcome?
Type of Study	What is the best study type to answer you question?

ADDITIONAL INFORMATiON

Answering the Clinical Question With PICO
The Maguire Medical Library's short interactive tutorial for developing clinical queries.
Clinical Question Worksheet (pdf)
Worksheet developed by Dartmouth Biomedical Libraries.
TRIP Medical Database
Trip is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care.
As well as research evidence it also allow clinicians to search across other content types including images, videos, patient information leaflets, educational courses and news.
Well Built Clinical Question (PICO)
Worksheet developed by Duke University Medical Center Library.

Types of Clinical Questions

Therapy Question - A question concerning the effectiveness of a treatment or preventative measure

Prognosis Question - A question concerning outcome of a patient with a particular condition

Diagnosis Question - A question concerning the ability of a test to predict the likelihood of a disease

Harm Question - question concerning the likelihood of an intervention to cause harm

Type of Question	Type of Study
Therapy	Double Blind Study; Randomized Controlled Trial (RCT)
Diagnosis	Randomized Controlled Trial (RCT)
Prognosis	Cohort Study; Case Study
Etiology/Harm	Cohort Study
Prevention	Randomized Controlled Trial (RCT); Prospective Study
Quality Improvement	Randomized Controlled Trial (RCT)

Types of Studies Used to Answer Clinical Questions

These are a few of the publication types associated with evidence-based practice taken from the Glossary of EBM Terms from the Centre for Evidence-Based Medicine Toronto. Closer to the top of the pyramid, the study designs are more rigorous and allow for less bias or systematic error. A more detailed list can be found in the Parab, S., & Bhalerao, S. (2010). Study designs. International journal of Ayurveda research, 1(2), 128–131.

Meta-analysis: A systematic review that uses quantitative methods to synthesize and summarize results of studies.
- Answers Questions About: Treatment, Prevention, Harm
Systematic Review: A summary of the medical literature that uses explicit methods to perform a comprehensive literature search and critical appraisal of individual studies and that uses appropriate statistical techniques fo combine these valid studies.
- Answers Questions About: Treatment, Prevention, Harm
Randomized Controlled Trial: A study in which participants are randomly allocated into an experimental group or control group and followed over time for the variables/outcomes of interest.
- Answers Questions About: Treatment, Prevention, Harm
Cohort Study: Involves identification of two groups (cohorts) of patients, one which received the exposure and one which did not, and following these cohorts forward for the outcome of interest.
- Answers Questions About: Incidence Risk or Preventive Factors, Prognosis
Case Control Study: A study which involves identifying patients who have the outcome of interest (cases) and patients without the same outcome (controls), and looking back to see if they had the exposure of interest.
- Answers Questions About: Risk or Preventive Factors
Case Series: A report on a series of patients with an outcome of interest. No control group is involved.
- Answers Questions About: Unique or rare conditions, New treatment regimes

Image courtesy of Duke University Medical Center Library and the Health Sciences Library at the University of North Carolina at Chapel Hill's Introduction to Evidence-based Medicine Tutorial.

Study Design 101

Study Design 101
This tutorial is designed to give you:
An understanding of different types of clinical medical studies and how they relate to each other.
An overview of important formulas relevant to these study types.
The ability to locate articles using each of the different study types.
A glossary of terms related to clinical medical studies.

Study Design 101 by Himmelfarb Health Science Library is licensed under a Creative Commons Attribution-Non Commercial-NoDerivs 30 Unported License