Writing your clinical
question.
» The PICOT format is a formula for developing
answerable, researchable questions. Writing a
good one can make the rest of the process of
finding and evaluating evidence much easier!
Types of questions
Intervention: What tx has the best
outcome?
 Etiology: What are the greatest risk
factors or causes?
 Prognosis: What is the course/complication of a condition?
 Diagnosis: What test is most accurate/
precise?
 Meaning: What is the meaning of an
experience for an individual?

PICOT format

Patient population (i.e., age, gender, disorder)
Intervention or issue of interest (i.e., exposure,
risk behavior, prognostic factor)

Comparison intervention or group (ie., could be
placebo or usual care group)

Outcome (i.e., risk of disease, accuracy of dx, rate
or occurrence

Time frame (i.e., how long observed, time to
achieve outcome)

“Good” or “Not so good”?

Identify the “PICOT” for each question.
Is this question a well-written PICOT
question? Why or why not? How
would you make it better?
“Good” or “Not so good”?

Is there a difference in the duration of
recovery in patients receiving a total
hip replacement for those who
contracted a post-operative infection
compared to those who do not, 6 weeks
following surgery?
“Good” or “Not so good”?

Are NSAIDs effective in treating
menstrual cramps?
“Good” or “Not so good”?

What is the “quality of life” in patients
diagnosed with cancer?
“Good” or “Not so good”?

Do adolescent girls who are sexually
active and begin using DEPO, more
likely to have higher weight gain one
year later compared to users of OCPs?
“Good” or “Not so good”?

In the obese adolescent, is diet and
exercise more effective in reducing
weight compared to exercise alone?
“Good” or “Not so good”?

Does treatment with chemo drug X for
6 months change the health outcome in
patients with cancer?
“Good” or “Not so good”?

Is there a greater chance of exhibiting
more symptoms of dementia in people
with lower compared to higher serum
concentrations of serum Vitamin D?
“Good” or “Not so good”?

Are there gender differences in
mortality rates in adults who binge
drink compared to those who do not
binge drink?
Case example---what is the
PICOT?
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JG is pregnant for the 2nd time. She had her first baby when she was 33
and had amnio to find out if the baby had Down's Syndrome. The test
was negative but it was not a good experience as she did not get the
result until she was 18 weeks pregnant. She is now 35, 1 month
pregnant and asks if she can have a test that would give her an earlier
result. The local hospital offers serum biochemistry plus nuchal
translucency ultrasound as a 1st trimester test for Down's Syndrome.
You wonder if this is as reliable as conventional amniocentesis.
PICOT?--For pregnant women, is nuchal translucency ultrasound plus serum
biochemistry testing in the first trimester as accurate (ie with equal or
better sensitivity and specificity) as conventional amniocentesis for
diagnosing Down's Syndrome?’
Case example---what is the
PICOT?

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
Your next patient is a 72-year-old woman with osteoarthritis of the
knees and moderate hypertension, accompanied by her daughter. The
daughter wants you to give her mother a prescription for one of the
new COX-2 inhibitors. She has heard that they cause less GI bleeding.
Her mother is concerned that the new drugs will mean more out of
pocket costs each month.
PICOT?
In elderly women with osteoarthritis of the knee, can COX-2 Inhibitor
use decrease the risk of GI Bleeding compared with other NSAIDs?
Case example---what is the
PICOT?
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Your 60-year old female patient has been experiencing a continued
deterioration of her periodontal tissues. Her attempts to quit smoking
have been unsuccessful; otherwise she is in good health and taking no
medications. Because you are her primary care NP, she has questioned
you about her current dilemma. The periodontist has suggested a 3week course of doxycycline therapy to control her latest exacerbation
of periodontal disease, but she is concerned about reports asking for
prudent use of antibiotics. How do you advise this patient?
PICOT?
In middle-aged women with periodontal disease, how effective is the
therapeutic use of doxcyline decrease gum bleeding and recession
compared to no treatment?
Case example---what is the
PICOT?
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On morning rounds in the peds Hem/Onc unit a new NP turns to you
for consultation. She wants to discuss options for managing moderate
nausea and vomiting that result from chemo. She shares an experience
of a relative taking ginger when prochlorperazine did not provide
effective relief and asks for your input.
PICOT?
In pediatric patients receiving chemo who are experiencing moderate
nausea and vomiting is the use of ginger as effective as
prochlorperazine in reducing nausea & vomiting?
Case example---what is the
PICOT?
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

Clinicians have used a conservative approach to the diagnostic
evaluation of head injured infants, arguing that infants are at risk of
intracranial injury (ICI) and that symptoms/signs of brain injury many
not be reliably present in those with ICI. Previous studies have report
a significant fraction of ICIs in infants occur in patients with a normal
neuro status and no signs/symptoms of brain injury. You want to see
how well clinical features predict ICI in infants (Adapted from Greenes
& Schutzman; Pediatrics 1999; 104(4):861-7).
PICOT?
Among infants with a minor head injury does the use of CT scan
versus other clinical findings affect identification and diagnosis of
intracranial hemorrhage?
Case example---what is the
PICOT?
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The traditional view of withholding feeds in VLBW infants has recently
been challenged. Provision of trophic feeds has been found to result in
faster maturation of the gut, making it much more receptive for
subsequent enteral feeds. You’ve been asked to find evidence on
whether feeds should be administered fast or slow to this vulnerable
population.
PICOT?
Among very low birth weight infants, are slow vs fast enteral feeds
better tolerated (e.g., decreased episodes of regurgitation, change in
VS, etc.)?
Case example---what is the
PICOT?
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Working on the Developmental Assessment Team for school-aged
children of mothers who used cocaine during pregnancy, you are
interested in learning the developmental outcomes for these children as
they begin school compared to children not exposed to cocaine during
pregnancy.
PICOT?
Controlling for other confounding factors, do otherwise healthy
children exposed in utero to cocaine, compared those not exposed,
have increased incidence of learning disabilities at age 6?
Case example---what is the
PICOT?



On morning rounds in the peds Hem/Onc unit a new NP turns to you
for consultation. She wants to discuss options for managing moderate
nausea and vomiting that result from chemo. She shares an experience
of a relative taking ginger when prochlorperazine did not provide
effective relief and asks for your input.
PICOT?
In pediatric patients receiving chemo who are experiencing moderate
nausea and vomiting is the use of ginger as effective as
prochlorperazine in reducing nausea & vomiting?