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PubMed, PICO & Evidence-Based Medicine

Searching PubMed

Why PICO?

The PICO format helps you

  • form an appropriate, focused question
  • identify key concepts and brainstorm search terms
  • develop a strong search strategy
  • obtain a manageable number of pertinent results
  • appraise results for relevance

Adapted from Developing a PICO Question Tutorial: Part 1 of a 2 part tutorial series from Marymount Library's PICO Tutorials. 

What is PICO?

The PICO model can help you formulate a good clinical question. Sometimes it's referred to as PICO-T, containing an optional 5th factor. 

P - Patient, Population, or  Problem
  • What are the most important characteristics of the patient?
  • How would you describe a group of patients similar to   yours?
  • What is the problem to be addressed?
  • Think of this element as the dependent variable
I - Intervention
  • What is the relevant treatment or exposure? What action or change would affect the patient/problem/population?
  • What do you want to do for the patient (prescribe a  drug, order a test, etc.)?
  • Think of this element as the independent variable
C - Comparison
  • What is the main alternative to compare with the intervention? (A different intervention? The usual standard of care? Not intervening at all?)
  • Think of this element like a "control group"
O - Outcome
  • What do you hope to accomplish, measure, improve, or affect?
  • Think of this element as what is measured to show what the intervention has accomplished or improved
T - Time Factor,  Type of Study  (Optional)
  • In what time frame should the intervention achieve the outcome?
  • What would be the best study design to answer the PICO question? 
  • Think of this element as additional, optional constraints to narrow the question

Foreground and Background Questions

Clinical questions are categorized as background or foreground. Once you determine your question type you may want to use the "Asking PICOT Questions Template" document to develop your question.

Background Questions

  • Ask to obtain general knowledge about an illness, condition, or disease
  • Ask who, what, when, where, how, or why

Foreground Questions

  • Ask for specific knowledge to inform clinical decisions
  • Deal with specific patient or population; more complex than background questions

Framing a PICO Question

Foreground questions can be further classified into four groups: diagnosis, therapy, prognosis, and etiology/harm. Certain study designs are better for answering particular question types. 

  • The "Appropriate Study Types" column lists study designs best suited to each question type, in order of utility.
Question Type Definition Appropriate Study Types
Diagnosis Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation

Randomized Controlled Trial

Cohort Studies

Therapy Questions addressing how a clinical issues, illness or disability is treated

Meta or Systematic Reviews

Randomized Controlled Study

Cohort Study

Prognosis Questions addressing the prediction of the course of a disease

Cohort Study

Case Control Studies

Case Studies

Etiology/Harm Questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder

Cohort Study

Case Control Studies

Case Series

 

Getting Started With Searching!

  • Consider downloading the template above as you begin to learn to ask PICO questions. In addition to the four main types of questions, two additional types of questions listed that will help guide you in this process. The second page of the document provides short definitions for the type of questions along with samples of questions.
  • Consider using PubMed for searching. They have set up clinical queries that filter your results to aid in your searches.
  • Consider watching this video that shows how to search and limit your results in PubMed.
  • Consider watching this video that shows how to search for the full text of articles not freely available in PubMed.

Sources

Adapted from: