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Clinical Question Using PICO

Here are the PICO components for this clinical question: P - Children with severe Guillain-Barré syndrome (GBS) requiring ventilator support I - IVIG therapy C - 1) Plasma exchange therapy 2) Prednisone therapy O - Survival rate, development of sequelae, length of stay in PICU, outcome scoring, recovery The research question would be: "In children with severe GBS requiring ventilator support, does IVIG therapy result in better outcomes such as survival rate, development of sequelae, length of stay in PICU, outcome scoring and recovery compared to plasma exchange therapy or prednisone therapy?"

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Krishna Bayu
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129 views30 pages

Clinical Question Using PICO

Here are the PICO components for this clinical question: P - Children with severe Guillain-Barré syndrome (GBS) requiring ventilator support I - IVIG therapy C - 1) Plasma exchange therapy 2) Prednisone therapy O - Survival rate, development of sequelae, length of stay in PICU, outcome scoring, recovery The research question would be: "In children with severe GBS requiring ventilator support, does IVIG therapy result in better outcomes such as survival rate, development of sequelae, length of stay in PICU, outcome scoring and recovery compared to plasma exchange therapy or prednisone therapy?"

Uploaded by

Krishna Bayu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Lecture 2

Dewi Sutriani Mahalini


Department of Pediatrics, Faculty of Medicine, Udayana University
Email: [email protected]
CURRICULUM VITAE

Tempat/tgl lahir: Singaraja, 27 Juni 1970


Pendidikan:
2006 ~ PPDS I Ilmu Kesehatan Anak FK Unud/ RSUP Sanglah
2010 ~ Fellowship Bagian Neurologi Anak FKUI/RSCM Jakarta
2018 ~ Program Doktor/S3 Ilmu Kedokteran, Universitas Udayana
Instansi : Divisi Neurologi Anak
Departemen Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah
Email : [email protected]
1. Understand the reasons for focused questions
(PICO)
2. Learn how to formulate clinical questions
3. Use the PICO to formulate your search strategy
4. Introduction to Boolean logic to combine your
search strategy
5. Learn how to use systematic approach to
locating the evidence

www.cebm.net
E S
B T
M E
P
S
BACKGROUND QUESTIONS;
 Ask for general knowledge about a condition, test,
or treatment.
 Have 2 essential components:
1. A question root (who, what, where, when, how, why)
2. A disorder, test, treatment, or other aspect of healthcare
 Examples:
 How does heart failure cause pleural effusions?
 What cause dengue fever?
FOREGROUND QUESTIONS;
 Ask for specific knowledge to inform clinical
decisions or actions
 Have 4 essential components:
1. P
2. I
3. C
4. O
 EBM process starts with a clinical scenario that
needs the best answer

 One of the difficult steps in practicing EBM may


be the translation of a clinical problem into an
answerable question.
 Convert the clinical problem into an
answerable question

 The key to successful searching is to


convert your clinical problem into a clear
answerable question, which should
ideally be framed in the PICO/PIO format.
Originate from
everyday clinical problem
 Clinicians have 0.7 to 18.5 questions for every 10 patients
they care for.
 However, answers to 2/3 of the questions are either not
pursued or pursued but not found.
 Subsequent analyses show that almost all unanswered
questions could be answered through improved query
formulation and better search.
Dissect what you want
to know into its
component parts

PICO is the commonly used acronym


for forming clinical questions when
practising EBM
CLINICAL PROBLEM PICO

A child, 8 years, P= Child with severe GBS


hospitalized in PICU
because severe GBS, I = IVIG
need ventilator support C= (1) Plasma exchange
(2) Prednison
The doctor want to know,
are there any other therapy O= (1) survive/death
option is better ? (2) sequele
Does IVIG therapy deliver (3) LOS in PICU
outcome better than other (4) outcome scoring
therapy? (5) Recovery
(6) etc
"PICO" is the acronym for this 4 part question
which consists of the first letters of
1. Population/ patients
2. Intervention/ Indicator/ Exposure
3. Comparison / Control
4. Outcome.
P Population The patient or problem in question
Clinical Who are the relevant people in relation to
problem clinical problem?
I Intervention The intervention/test/exposure of interest.
Indicator Management strategy, exposure or test to
Index test find out about relation to clinical problem
C Comparator Comparison interventions
Control Alternative/control strategy, exposure or
test for comparison
O Outcome The outcome of interest
What are you most concerned about
happening or stopping happening
 should be clear
 directly
 focused on the problem
 answerable by searching the medical
literature.
Assume that you are working in a Emergency Unit in
general hospital as a General Practitioner.
A eight years old boy presented with acute
diarrhea.
You want to know if combination of probiotics and
prebiotics are effective in decreasing the duration
of diarrhea compared to probiotics only.
Patient Children with acute diarrhea
P Population

Intervention Probiotic+Prebiotic therapy


I
Comparison Probiotic only
C
Outcome Decrease duration of diarrhea
O
question In children with acute diarrhea, whether giving
? combination probiotics+prebiotics more
effective compared with probiotic for decreasing
duration of diarrhea
 Who are you intersted in?
 How would you describe the patients or
population of interest?
Patients or population
Which is referred to the specific group the
patient or population belong to ?
 Diabetes mellitus type 1
 Infant with acute diarrhea
 Adult with chronic kidney disease
 Epilepsy in adult/children/ neonates
 Low birth weight infant
 Children with dermatitis atopic
 Pregnant woman
 Patient epilepsy with phenobarbital
 Cause
 Risk Factor
 Prognostic Factor
 Treatment/intervention
Intervention
Which is the kind of treatment or procedure we
want to know its efficacy ?.
RISK FACTOR PROGNOSTIC FACTOR

 Family with epilepsy  Control of blood


 Social economy pressure
 Low protein intake  HbA1C
 Obese  Hb concentration
 Less execise  Regular exercise
 Age  MRI result
 High blood pressure  CRP
 HDL/LDL ratio
INTERVENTION TREATMENT

 Plasma exchange  Amphicillin


 V-P shunt  Carbamazepin
 Certain Procedure  Paracetamol
 Elastic bandage  Ibuprofen
 Elastic stocking  High protein intake
 Catheterization  Hiperosmoler fluid
 What is the alternative to the
intervention?
 May not always be necessary

Comparison
Which is the standard treatment for
comparing the effect of Intervention ?
 What do I hope to accomplish?
 What could this exposure really affect?

Outcome
Which is the intended outcome we
expected to have by our intervention ?
 Length of stay
 Duration of diarrhea
 Duration of fever
 Accuracy
 Life expected
 Survival rate
 Creates a clear focused question !
 Defines the important outcomes !
 Structures your search !
 Saves you time!
Formulate an answerable question
Write here the clinical issue that you wrote down earlier

Identify what sort of question it is


 Intervention

 Etiology

 Diagnosis

 Prognosis/prediction

 Frequency/rate

 Phenomenon
Now built up a research question using PICO

P population =

I intervention =

C comparator =

O outcome =
RESEARCH QUESTION
CLINICAL PROBLEM/ PICO ANSWERABLE/
SCENARIOS RESEARCH QUESTION
The doctor want to P=child with severe GBS 1. In child with severe
know, are there any GBS, does IVIG
other therapy option is I /C = therapy deliver survival
better for child 1. Plasma rate better than plasma
hospitalized with GBS exchange exchange therapy?
& need ventilator 2. Prednisone 2. In child with severe
supports? 3. IVIG GBS, does IVIG
O= therapy deliver
1. Survive/Death sequalae less than
Does IVIG therapy 2. Sequalae plasma exchange
deliver outcome better 3. LOS in PICU therapy?
than other therapy? 4. Outcome scoring 3. In child with severe
5. Recovery GBS, does IVIG
6. Etc. therapy deliver
sequalae less than
Prednisone ?

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