Applied Evidence Based Medicine
Objectives
- Understand what PICO stands for and how it can be used to develop an answerable clinical question
- Learn how PICO can be adapted to various question types
- Become aware of databases that can help you find answers to your clinical question
Using PICO to Develop an Answerable Clinical Question
Framing your clinical question appropriately is an important precursor to a good search. PICO is a framework that can be used to make important, searchable concepts easily identifiable and help you translate your research question into an answerable clinical question.
The PICO framework can be used to break down various types of questions into their component parts:
- Introduction to PICO (video tutorial)This short podcast walks you through an example of using PICO to structure your clinical question.
- PICO WorksheetDownload and print this worksheet to map out your own clinical question.
Resources to Help Answer Your Clinical Question
Databases
- PubMed: PubMed is a database from the US National Library of Medicine covering medicine, nursing, dentistry, veterinary medicine, molecular biology, the health care system, and the preclinical sciences. You should access it through the UCalgary library website to ensure that you avoid paywalls and can link through to the university's journal subscriptions.
- TRIP Medical Database: This is a free evidence-based literature search tool that is an alternative to PubMed for all-purpose searching. Content from PubMed is typically added every two weeks while content added manually (mostly secondary evidence) is added once per month. TRIP attempts to display the most relevant results first. You can limit your results to the "top of the pyramid" synopses and there is also a PICO search tool.
- ACCESSSS: This website provides one-stop access to pre-appraised evidence to address this key question: "What is the current best evidence available to support clinical decisions?" It conducts searches simultaneously in several evidence-based information services and provides email alerts to newly published evidence in the user’s chosen area(s) of training/interest. Searching ACCESSSS yields content that is hierarchically organized. Always look first at the content available at the highest level of the hierarchy, as it is most likely to be useful for clinical purposes.
Quick Answer Clinical Tools
- DynaMed
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DynaMed is a clinical reference resource useful for getting answers to clinical questions quickly and easily. It includes overviews and recommendations for the most common conditions, as well as evidence-based recommendations for action, Micromedex® Clinical Knowledge Suite drug content, and over 2,500 medical graphics and images. Also included is a wide array of specialty topics in areas such as infectious disease and immunology, cardiology, oncology and emergency medicine. This is a competitor product to UpToDate and is also licensed by AHS for its clinicians. - ClinicalKey
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ClinicalKey provides full-text access to selected medical texts, medical journals, practice guidelines, drug information, patient handouts, and CME materials. For point-of-care questions, use the drop-down menu to select "Clinical Overviews." These overviews are easy-to-scan, clinically focused medical topic summaries designed to match the clinician workflow.
Evidence Synopses
- ACP Journal ClubACP Journal Club's general purpose is to select published articles according to explicit criteria and to abstract those studies and reviews that warrant immediate attention by physicians attempting to keep pace with important advances in the treatment, prevention, diagnosis, cause, prognosis, or economics of the disorders managed by internists. These articles are summarized in "value-added" abstracts and commented on by clinical experts. Keep your search terms fairly general, as there's not a lot of content here compared to a resource like PubMed.
- Cochrane Clinical AnswersCochrane Clinical Answers (CCA) is part of Ovid's Evidence Based Medicine Reviews collection, and are readable, digestible, clinically-focused entry points to rigorous research from Cochrane systematic reviews. Each Cochrane Clinical Answer contains a clinical question, a short answer, and an opportunity to ‘drill down’ to the evidence from relevant Cochrane reviews.