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Evidence-based Practice: Forming Clinical Questions

In this guide:

Formulate the clinical questions in the PICO framework

P stands for Patient/Problem, Disease, Condition. It's about who and what.

I stands for Intervention, Exposure. It's about how.

C stands for Comparison(e.g. placebo, no teatment, alternative teatments).

O stands for Outcome.

Type of Scenario (Question):Therapy/Prevention, Diagnosis, Etiology, Prognosis, others

Create search queries from PICO question

  • Identify terms to fit the PICO question:keywords and their synonyms or alternative keywords
  • Keyword Search: keywords are natural words used by authors
    • Connect synonyms with OR and put them in the brackets, then connect brackets /keywords with AND
  • Subject Heading Search: Controlled vocabulary. Mesh is used in Medline, and Emtree is used in Embase.
    • Using a keyword to map the subject heading, then conduct subject heading search
    • Doing other subject heading searches with different keywords from PICO question
    • Connect subject heading search results with AND

Sample Scenario:

One of your regular patients asks to see you about a new herb called saw palmetto. He says that he has heard that it is good for prostate problems and as it is “natural”, has no side effects. You know that he is being treated for benign prostatic hypertrophy (BPH) with finasteride. What evidence can you find of the safety and efficacy of saw palmetto for BPH and what would you recommend to this patient?

P I C O Framework

P

I

C

O

Definition

Patient/Problem, Disease, Condition

Intervention, Exposure

Comparison

Outcome (clinical)

Example Scenario

benign prostatic hypertrophy (BPH)

saw palmetto

No comparison

 OR finasteride

safety and efficacy of saw palmetto for BPH

Clinical Question

For a patient with benign prostatic hypertrophy (BPH), is saw palmetto safe and effective?

How effective is saw palmetto in benign prostatic hypertrophy (BPH) compared to finasteride?

Type of Question

Therapy

Search terms:

keywords and their synonyms

benign prostatic hypertrophy, BPH, Benign prostatic
  hyperplasia

saw palmetto, dwarf
palm plant, Serenoa repens, SR, Sabal

finasteride

No

Keyword Search

(benign prostatic hypertrophy or BPH or Benign prostatic hyperplasia) and (saw palmetto or dwarf palm plant or serenoa repens or SR or Sabal)

OR

(benign prostatic hypertrophy or BPH or Benign prostatic hyperplasia) and (saw palmetto or dwarf palm plant or serenoa repens or SR or Sabal) and finasteride

Subject Heading Search

Mesh

Prostatic Hyperplasia/

Serenoa/

 Finasteride/

No

Emtree

prostate hypertrophy/

exp sabal/ or exp sabal extract/

finasteride/

No