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Evidence-Based Practice : What is “PICO” ?

Evidence-Based Practice : What is "PICO" ?
Hi everyone the topic of this course is Pico evidence-based practice. My name is Yen Ying Lee. I’m the clinical pharmacy coordinator at Shanghai hospital and also an adjunct assistant professor at college of pharmacy taipei medical university. These are the learning objectives. After completing this course you should be able to formulate a Pico question under a given scenario preform a literature search using appropriate resource and apply Pico process in the real practice. And I’m assuming some of you have never heard of the term Pico before. So let me explain what a Pico process is first.
It is a technique that we used in evidence-based decision making process when we encounters a clinical question and we want to answer it with the systematic way. It is a mnemonic that will help us to remember the four important parts to form and insert a clinical question. And this is what a Pico stands for. P is patient, problem or population. So it could be either your patient or the problem that you have at your work. I is intervention. So that was the intervention that you are interested in. It could be the treatment that you wanted to give to your patient C means comparison. So it could be control like placebo or comparison intervention.
So it could be like the treatment other treatments that you also can give to your patients to treat the same disease. And O is the outcome. So that’s would be the outcome that you want to look at. So here is an example. Say if you are a hospital pharmacist and you have a patient Mr. A. He is a 60 year old male, presented to ER with acute dystonia due to acute decompensated heart failure. So clearly you know your patient is diuretics. The question you have is that you want to know whether continuous infused loop diuretics can provide more benefits than the transitional boluses of loop diuretics. So we can start to formulate your Pico here. He is the patient.
So that will be adult patients with acute decompensated heart failure. I is the intervention that you are interested in. In this case, it is continuous infuse loop diuretics. C will be the comparison treatment. So it is the transitional intermittent boluses of loop diuretics. So O is the outcome that you’re interested in because you want to know if continuous infused loop diuretics can provide more benefits of then looked at bolus of loop diuretics. So the outcome you want to look at will be the efficacy and safety of the two regiments of loop diuretics. So once you have formulate your PICO, the next step is try to do a literature search. Here is the evidence-based medicine pyramid.
I’m assuming some of you are familiar with it. It shows the hierarchy of evidence sources, At the top is systematic reviews which are considered to be the highest level of evidence and the next level is randomized controlled trial. As you go down the level of evidence decreases. And at the bottom it is the aspirate opinion. It is the background information but because it is highly influenced by one’s belief that’s why it’s at a button of this pyramid. And there a lot of different electronic databases that you can use for a literature search. And today I’m going to introduce Pubmed. The reason I chose Pubmed is because it’s free and it’s easy for you to access.
So you go to the front page of PubMed. And you can see the quick search box. Basically with the quick search box, you can enter whatever it turns were keywords how you want to search. And if you click the advanced under the quick search box, you will go into the Advanced Search web page. So here you can see all your search history and then you can easily combine different search outcomes together. And you can also go to the match database. When you click the match database at the front page of PubMed, you will enter this web page. A match is actually the medical subject headings that is from the US national library of medicine.
They have a controlled vocabulary and they use the mesh database to help them to index articles. So with this mesh database, you are able to make your search more precisem, and you can also use the PubMed clinical queries. It is an online search filters. The reason for using this clinical queries is because it can make your literature search more clinical relevant and there are three different options here. One is the clinical study categories. The other is systematic reviews and medical genetics. You can choose either options by looking at what kind of article types you want to have.

In this video, Dr. Yen-Ying Lee clarifies the definition and the appropriate use of “PICO”.

To begin with, we should be able to formulate a PICO question under a given scenario, perform a literature search using the appropriate source(s), and apply PICO process in real practice to answer clinical questions when we complete this lesson.

Besides, we need to know the definition of “PICO”. P means a patient’s problem, I means the intervention, C means comparison, and finally, O represents the outcome.

Given a practice example, we can learn to recognize how to apply PICO in clinical cases.

From an evidence-based medicine pyramid, we can see the top of it is systematic reviews, which are considered to be the highest level of evidence. The next level is randomized controlled trials. As you go down, the level of evidence decreases. Finally, she lists several databases and elaborates on MeSH in Pubmed, which is essential for literature evaluating.

Have you used these sources before? Please share your experience below.

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Evidence-Based Medicine in Clinical Pharmacy Practice

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