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Evidence-Based Practice

This guide will help you work through the process of Evidence-Based Practice.

Creating a Clinical Question: PICO / PICOTS

PICO is an acronym that can help you create a well-built clinical question by identifying the key aspects of a complex patient presentation. In addition to the four main concepts of a clinical questions (PICO), there are two additional factors that you can also include in your question:

  • Patient of Population or Problem: The disease or condition you are investigating, and the particular demographic you are wanting to learn about (if applicable)
  • Intervention or Indicator: Primary treatment option
  • Comparison or Control: Comparison treatment (if applicable)
  • Outcome: What you you expect to see?

 

In addition to the major PICO components, there are two additional factors you may want to include in your question:

 

  • Timeline**: Time it takes to demonstrate a clinical outcome or how long patients are observed.
  • Study Type: What kind of study would best answer this question (i.e., RCT, Case Series, etc.). Rather than using keywords in your search strategy, you can often use filters to limit to specific study types / designs.

    ** Note that the timeframe does not always show up in the abstract. If you aren't getting enough results, you may need to remove this from your search, and just eliminate results that don't fit your preferred timeframe in the Prisma screening section.

PICOT Example

Does telemonitoring blood pressure (I) in patients with hypertension (P) affect blood pressure control (O) within one year of initiation of the medication (T)?

 

Patient or Problem = hypertension

KEYWORDS: hypertension, high blood pressure, hypertensive

Intervention = telemonitoring blood pressure

KEYWORDS: telemonitor, telemedicine, MeSH term is “Blood Pressure Monitoring, Ambulatory”

Comparison = n/a

Outcome = improve blood pressure

MeSH term is “Blood Pressure” (but if you are using terms for “telemonitoring blood pressure,” this is unnecessary).

Timeframe = within one year

one year, twelve months (searching for timeframes can be tricky -- this won't find studies that were less than 12 months! If your results are too limited, you can try removing this from your search).

 

Potential search strategy:

hypertension OR hypertensive OR high blood pressure  AND
telemonitor OR telemedicine OR "Blood Pressure Monitoring, Ambulatory"[Mesh]  AND
one year OR twelve months


or if you search everything in a single line:

(hypertension OR hypertensive OR high blood pressure) AND (telemonitor OR telemedicine OR "Blood Pressure Monitoring, Ambulatory"[Mesh]) AND (one year OR twelve months)


Want to see an example in action? Check out the video below.

PICOT example begins at the 3:00 mark.

"Table 1" is from:

Gallagher Ford, L., & Melnyk, B. M. (2019). The Underappreciated and Misunderstood PICOT Question: A Critical Step in the EBP Process. Worldviews on Evidence-Based Nursing, 16(6), 422–423. https://doi.org/10.1111/wvn.12408

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