Developing a PICO Question for PEN

Developed by PEN Canada Team members:Dawna Royall, Tanis Fenton, Kristyn Hall,

Jayne Thirsk and Beth Armour

EBP Information Cycle

Assess

AskAppraise

Apply

Acquire

CHE Evidence-based tutorial; 2008

AskTypes of Questions:Background

§ General knowledge, conditions, regulations etc

§ Background document template

Foreground § Specialized knowledge§ About choices / decision

making § PEN PICO question

Background or ForegroundQuestions?

1. How long does it take �food� to enter breast milk and be eliminated from it?

2. Does a breastfeeding mother’s diet contribute to infant colic?

Background Information Sources

n eMedicine (Medscape)

n Mayo Clinic

n Merck Manual Online

n Medline Plus Health Topics (NLM and NIH)

n NIDDK

n disease-related association websites

Population – how would you define your population e.g. demographics, medical condition?

Intervention or Exposure of interest – what are the intervention or prognostic factors?

Comparison – is there an alternative or standard practice to compare to? What comparison is relevant?

Outcome – what do you hope to accomplish, improve or effect? What outcome is important to you and your patients/clients?

PICO Questions

Your PICO terms form your research question

Examples:u Among hospitalized patients, do dietetic

services improve quality of life or mortality?

u Among patients with dysphagia, what is the evidence that modified consistency improves swallowing?

PICO Research Question (example)

u Among hospitalized patients, do dietetic services improve quality of life or mortality?Ø P Ø I Ø C Ø O

PICO Research Question (example)

u Among hospitalized patients, do dietetic services improve quality of life or mortality?Ø P – adults hospitalized for bariatric surgeryØ I – post-op bariatric surgery diet progressionØ C – those post-op bariatric surgery who are allowed to eat ad-libØ O – better quality of life and less incidence of vomiting

PICO Research Question (example)

u Among patients with dysphagia, what is the evidence that modified consistency improves swallowing? Ø P Ø I Ø C Ø O

PICO Research Question (example)

u Among patients with dysphagia, what is the evidence that modified consistency improves swallowing? Ø P – adults with long-term dysphagiaØ I – consuming modified consistency liquid and solid foodsØ C – consuming regular consistency foods and liquidsØ O – fewer incidences of chocking, weight maintenance

Types of inquiry in Nutrition

§ Etiology / Prevention§ Treatment / Intervention

§ Efficacy§ Harm

Ask

Ask

Map questionn Prevention / Etiology

Soy and breast cancer preventionCohort studies

nTreatment / InterventionChromium picolinate and body weightRCTs

Choosing the best study design to address your question

Questiontype Example Studytypes Appraisalissues

Etiologyandriskfactors

Arethereknownfactorsassociatedwithincreasedrisk?

Systematicreviewofcohortstudies,cohortstudies,case-controlstudy

Groupsonlydifferintheoneexposure,controlforconfounding

Intervention Whataretheoutcomesoftheintervention

SystematicreviewofRCTs,RCTs

Randomization,blinding,completefollow-up

*AdaptedfromtheNHMRC2000b,TheEndorsementProcessforEvidence,BaseClinicalPracticeGuidelines,DietitiansAssociationofAustralia2006

Are ___________________________ (P)who have______________________ (E)compared with those without / low__ (C)at ____ risk for _________________ (O)

Treatment / Intervention

Prevention / Etiology

In _____________________ (P)how does _______________ (I)compared with ___________(C)affect __________________ (O)

PICO QuestionPrevention / Etiologyu Are ___________________________(P)u who have______________________ (I)u compared with those without / low___(C)u at ____ risk for __________________(O)

uAre post-menopausal women who have a high consumption of soy products, compared to those with a low intake, at decreased risk for developing breast cancer?

PICO questionTreatment / Intervention u In _____________________ (P)u how does _______________ (I)u compared with ___________(C)u affect __________________ (O)

u In individuals who are overweight (BMI > ? ) how does a daily chromium picolinate supplement, compared with no supplement, affect ones ability to lose weight?

PEN® Training Modules

The following other PEN® Training Modules are available: • Evidence-based Process• Appraising the Literature• PubMed Module• Quick Review of Study Designs

Thank you for your time in reviewing this module.

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