Clinical Research Using PICO Framework
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What does the 'I' in the PICO framework represent?

  • Investigator's hypothesis
  • Indicator of outcome measures
  • Intervention being studied (correct)
  • Inclusion criteria for study participants

    • Which of the following is a suitable comparison intervention in a PICO question?

  • A new medication being tested
  • Patient demographic information
  • Symptoms experienced by the patient
  • A placebo or standard treatment (correct)

    • In writing a clinical question using PICO, what does 'O' refer to?

  • Options available to the patient
  • Objectives of the study
  • Outcomes of the intervention (correct)
  • Observational parameters

    • What is primarily assessed by the 'P' in the PICO framework?

    <p>Patient population characteristics (A)</p> Signup and view all the answers

    What type of intervention might be considered under the 'I' section for a patient with myopia?

    <p>Antimuscarinic medications (C)</p> Signup and view all the answers

    When writing a clinical question, it is important to distinguish between the outcome relevant to the patient and what?

    <p>Outcome measures in studies (D)</p> Signup and view all the answers

    When comparing an intervention, which of the following would NOT qualify as a comparison intervention?

    <p>Patient self-reported outcomes (C)</p> Signup and view all the answers

    What is an example of an environmental factor that may be considered in writing a clinical question?

    <p>Access to therapeutic sessions (A)</p> Signup and view all the answers

    What does the 'Measurable' aspect of SMART criteria emphasize?

    <p>Identifying how success will be evaluated. (A)</p> Signup and view all the answers

    Which of the following is a clear distinction between aims and objectives?

    <p>Aims are general statements of intention, while objectives specify the means to achieve them. (D)</p> Signup and view all the answers

    What is a common mistake when formulating research aims?

    <p>Having multiple aims that lack focus. (B)</p> Signup and view all the answers

    What aspect of SMART criteria addresses the feasibility of a research aim?

    <p>Achievable (B)</p> Signup and view all the answers

    Which of the following illustrates a well-structured objective?

    <p>Interview stakeholders to gather distinct perspectives. (D)</p> Signup and view all the answers

    What does having 'realistic' aims and objectives imply in research planning?

    <p>They need to consider time and resource limitations. (C)</p> Signup and view all the answers

    Why should aims and objectives avoid redundancy in their definitions?

    <p>Redundant definitions can confuse the reader. (D)</p> Signup and view all the answers

    What is a suggested way to express objectives in research?

    <p>Specific stages outlining how each aim will be executed. (C)</p> Signup and view all the answers

    What is a potential benefit of antioxidant supplements for older adults with age-related diseases?

    <p>They may slow down the progression of the disease. (D)</p> Signup and view all the answers

    Which of the following is NOT a synonym for 'older-age adults' as presented?

    <p>Younger adults (A)</p> Signup and view all the answers

    In the context of the provided information, what is the primary type of study being referenced?

    <p>A clinical trial comparing interventions. (C)</p> Signup and view all the answers

    What could be a misleading assumption about antioxidant supplements?

    <p>They provide immediate results in disease management. (C)</p> Signup and view all the answers

    Which nutrient is specifically associated with antioxidants as mentioned?

    <p>Ascorbic acid (D)</p> Signup and view all the answers

    What is a critical consideration when assessing the effectiveness of antioxidant supplements?

    <p>The age of individuals taking the supplements. (A)</p> Signup and view all the answers

    What type of publication is considered credible for information regarding treatment methods?

    <p>A peer-reviewed article. (A)</p> Signup and view all the answers

    What should patients avoid using while searching for health information?

    <p>Online search engines like Google and Bing. (A)</p> Signup and view all the answers

    Which publication database is known for covering primarily nursing literature?

    <p>CINAHL (D)</p> Signup and view all the answers

    What is a common colloquial term for 'myopia'?

    <p>Near-sightedness (D)</p> Signup and view all the answers

    What type of terms does Embase particularly emphasize?

    <p>Evidence-based medicine terminology (D)</p> Signup and view all the answers

    Which of the following age ranges is classified as 'infant' in MEDLINE terms?

    <p>0 to 23 months (B)</p> Signup and view all the answers

    What year did CINAHL start indexing relevant literature?

    <p>1982 (C)</p> Signup and view all the answers

    Which resource would be best for confirming medical synonyms?

    <p>Medical encyclopedias/dictionaries (A)</p> Signup and view all the answers

    Which of the following is NOT a function of truncation in database searches?

    <p>To specify exact phrases (D)</p> Signup and view all the answers

    What retrieval method classifies a patient as 'aged' in MEDLINE terminology?

    <p>65 years and older (A)</p> Signup and view all the answers

    Which indexing term does not pertain to Embase?

    <p>Dietetics (D)</p> Signup and view all the answers

    What type of databases does the Cochrane Library primarily contain?

    <p>High-quality healthcare decision-making evidence (B)</p> Signup and view all the answers

    Which database covers the greatest number of journals?

    <p>MEDLINE (C)</p> Signup and view all the answers

    Which of the following terms does NOT classify in the age category of an adolescent in EMBAS?

    <p>19 years (B)</p> Signup and view all the answers

    Which tactic is most effective for refining search results?

    <p>Applying filters related to publication date (D)</p> Signup and view all the answers

    What best describes a synonym as defined in medical terminology?

    <p>A medical term with similar or identical meanings (B)</p> Signup and view all the answers

    What is the most appropriate action to take if a patient diagnosed as an alcoholic wishes to self-discharge against medical advice?

    <p>Attempt to persuade the patient to stay by discussing potential risks. (A)</p> Signup and view all the answers

    When assessing diabetic patients, what type of evidence should you prioritize to determine the effectiveness of an intervention?

    <p>Randomized controlled trials (RCTs) and systematic reviews. (A)</p> Signup and view all the answers

    What is a primary concern when interpreting research conducted outside your specific patient group?

    <p>The results may not be applicable to your patient population. (D)</p> Signup and view all the answers

    Which type of evidence is best suited to understand the patient's experience while undergoing treatment?

    <p>Qualitative research using interviews and personal accounts. (C)</p> Signup and view all the answers

    If the intraocular pressure (IOP) values of a patient with glaucoma fluctuate significantly over three months, what is a critical consideration regarding their treatment?

    <p>Monitor the patient closely before deciding on any medication change. (A)</p> Signup and view all the answers

    What type of evidence should you review when examining the compliance of patients with prescribed medications?

    <p>Observational studies and surveys specifically targeting medication adherence. (D)</p> Signup and view all the answers

    What is a significant limitation of research conducted in laboratory settings when applied to clinical scenarios?

    <p>Laboratory findings may not accurately mimic real-life patient responses. (B)</p> Signup and view all the answers

    Which reason justifies caution when a manufacturer claims that a product is effective?

    <p>Positive results might not be supported by high-quality evidence such as RCTs. (A)</p> Signup and view all the answers

    Which of the following statements correctly assesses the relevance of the objectives listed?

    <p>The objectives are crucial for the overall research aim. (B)</p> Signup and view all the answers

    Which aspect is missing in the objectives for assessing their timebound characteristic?

    <p>It is unclear which methods will be used to evaluate them. (C)</p> Signup and view all the answers

    Which of the following statements describes how objectives should be framed?

    <p>They should initiate with a verb to clarify intent. (B)</p> Signup and view all the answers

    What characteristic indicates that the objectives are measurable?

    <p>The research objectives specify clear assessments. (B)</p> Signup and view all the answers

    Why are the provided objectives considered achievable?

    <p>It’s stated how the objectives will be conducted. (C)</p> Signup and view all the answers

    Which of the following is true regarding the objectives' enumeration?

    <p>Each objective is clearly numbered for organization. (A)</p> Signup and view all the answers

    Which aspect of an objective would enhance its specificity?

    <p>Including specific target populations or conditions. (B)</p> Signup and view all the answers

    What is the primary focus of the aim stated in the example research study?

    <p>Factors affecting the acceptability of VCT services. (A)</p> Signup and view all the answers

    Study Notes

    Lecture 03: Defining your research questions SoHP503 Project studies

    • This lecture discusses defining research questions for SoHP503 project studies.
    • The agenda covers using evidence for decision-making, formulating searchable questions, and finding relevant evidence.
    • Intended learning outcomes include explaining PICO and PICOTE, applying the framework, formulating clinical questions, identifying research components, and creating viable research questions.
    • Virtual meeting etiquette guidelines were mentioned, relating to phone use, keyboard, appropriate attire, awareness of surroundings, microphone use, and camera positioning.
    • The anatomy of the research process was described, illustrating the journey from choosing a topic to developing a research project proposal and data collection/conclusion.

    Decision Making Process

    • According to Hastie and Dawes (2010), decision-making involves three parts:
      • Multiple courses of action
      • Consideration of outcomes/consequences
      • Assessment of consequences based on personal beliefs & goals

    Use of Evidence to Decide

    • Thomson & Stapley (2011) presented different types of decisions in clinical practice:
      • Decisions about interventions
      • Decisions on optimal patient selection for interventions
      • Decisions on timing of interventions
      • Decisions relating to delivery of information
      • Decisions on managing services and care delivery
      • Decisions on reassurance of patients

    Consequences and Implications of Decisions

    • Some decisions are more important than others based on potential for patient harm and costs.
    • Clinicians need to identify areas of higher risk in their practice and assess the evidence base for treatments used in those high-risk areas.
    • Practical consideration: Lack of research evidence for a specific treatment or area of concern

    Types of Evidence

    • Most appropriate evidence for general practice should be adopted and justified.
    • Types include primary research, reviews of research, policy/guidelines/care pathways, clinical judgment, and patient experience/expertise.
    • Additional types: statistical, testimonial, anecdotal, and analogical evidence.
    • Anecdotal evidence shouldn't be relied upon unless absolutely necessary.

    Examples - Evidence for Decisions

    • Examples of clinical scenarios requiring evidence-based decisions were presented.
      • Patient with alcohol issues seeking self-discharge from hospital
      • Student colleague struggling emotionally
      • Patient seeking advice on vision therapy for a child
      • Patient with diabetes requiring specific treatment

    Which Type of Evidence Do I Need?

    • Evidence of effectiveness, patient experience, and practical application are important considerations for making decisions

    Research that has not been conducted in your particular setting or patient group

    • In some cases, there might not exist research for a particular set of patients or setting.
    • Research that's conducted in related areas should be considered as a start
    • Research from other disciplines could be a viable source of evidence.

    Where can I get this from?

    • List of resources to obtain high-quality information regarding drug, health services, and health statistics.
      • Clinical Trials.gov, Cochrane Library, NHS evidence, Google Scholar, MEDLINE, MedicalStudent.com, Merriam-Webster, NICE
      • Public Library of Science (PLOS), Plymouth Primo, PubMed, ScienceDirect, The British Library, Zetoc.
      • British National Formulary (bnf.org) and US Food and Drug Administration (fda.gov) for drug info
      • Medicines and Healthcare Products Regulatory Agency (mhra.gov.uk) etc for safety info

    Key points

    • Every decision demands evidence consideration.
    • Various decision types and evidence types exist.
    • Use research papers initially, and other rationales (like ethical considerations & clinical judgment) when no study exists
    • Anecdotal evidence is a last resort.
    • Always use the best available evidence.

    Formulating Searchable Questions

    • Searching for evidence begins with formulating clear questions.
    • Questions can pertain to treatment methods, guidelines, policies, or research
    • The structure of the question should be considered.
    • Bad questions include those that are unanswerable or poorly focused.

    Types of questions

    • Clinical questions are categorized as background or foreground questions.
    • Background questions address general knowledge. (Who, What, When)
    • Foreground questions pertain to specific patient problems or scenarios.
      • Examples include interventions for myopia prevention in children, or the effectiveness of treatment based on patient demographics.

    Type of foreground question

    • Aetiology (cause of disease)
    • Diagnosis (methods and interpretation of test results)
    • Therapy (best interventions and harm reduction)
    • Prognosis (likely outcome of disease and possibilities of complications)
    • Magnitude (size of health problem in terms of patient numbers/costs)

    Outlook: Research question and research design

    • Research question types include descriptive, relational, and causal analyses.
    • Descriptive research focuses on characteristics of a population/phenomenon
    • Relational research examines relationships, or correlation, between variables.
    • Causal research attempts to establish cause-and-effect relationships among variables.

    Breaking down the clinical scenario

    • The PICO framework provides a structure to phrase clinical questions.
    • P = Patient/Population, I = Intervention, C = Comparison (interventions/placebos), O = Outcome

    PICO Example 1

    • Does hand washing reduce hospital-acquired infections in healthcare workers?

    Identifying keywords

    • Examples provided relating to patient scenarios.
    • Example: A 72-year-old woman, with age-related macular disease, wants to know if antioxidant pills may slow down the progression of the disease, and the best ones to use

    PICO Example 3

    • 10-year-old patient with myopia, seeks to prevent further progression

    Tips for writing a clinical question in practice

    • Defining the person, patient, population, or problem (P). This involves listing specific qualities and characteristics for the patient or participant group.
    • Identifying the intervention (I). Listing the procedure, treatment, or substance being used.
    • Identifying the comparison intervention (C). Listing the alternative procedure, treatment, or substance to compare the intervention to.
    • Identifying the outcome (O). Listing the result the study aims to achieve.

    PICO Example 4

    • For patient care workers, it relates to what method of hand-washing (medicated soap, alcohol-based solution) is most effective from an infection control perspective.

    Common search frameworks

    • PICO(S), PEO, SPIDER, ECLISSE, and SPICE are frameworks to guide searching, depending on the area under investigation

    Finding evidence

    • The phrasing of the question directly impacts the relevance and volume of search results.

    How questions influence search results:

    • Broad questions yield many results (often irrelevant)
    • Narrow questions yield fewer results (often highly relevant)

    Building a search strategy

    • Identify the PICO, synonyms, resources.
    • Apply truncations & wildcards in searches.
    • Combine terms using Boolean operators (AND, OR, NOT).
    • Combine terms using nesting.
    • Refine search results using filters.

    Identify synonyms

    • Consider possible alternative terms for keywords to broaden and refine search.
    • Recognize differences in spelling and terminology (UK vs US).

    Terminology (database indexes, filters)

    • Database-specific terms and filters should be considered while searching for evidence.
    • (Database examples include Medline, CINAHL, Embase, PsychINFO, and the Cochrane library; their differences in content and terms)

    Sources for synonyms

    • Use medical encyclopaedia, dictionaries, and colleague’s expertise.

    Identify Synonyms (Example)

    • Example presented for an individual patient and potential use of the PICO framework

    Combining final search strategy (example)

    • Example of combining components for a complex search

    Refine the search strategy - Filters

    • Types of Evidence, background/foreground questions, along with patient/problem, intervention, comparison (interventions/ placebos), outcome.

    Comparison - Answer

    • Comparing common search strategies and EBP search strategies.

    Summary search strategy

    • Steps on how to proceed with a summary search strategy

    Phrase your aims and objectives

    • How to create clear aims & objectives for a research study

    Terminology

    • Definitions of research question, aim, objectives, and hypothesis

    Research Aim

    • Overview of the overall intention/goal of the research

    Research Objectives

    • How to formulate tangible and specific steps towards your research aim
    • Steps must be SMART (Specific, Measurable, Achievable, Realistic, Time-constrained)

    What is the difference between research aims and objectives?

    • Explanation of the difference between aims & objectives

    What not to do

    • Mistakes to avoid when formulating aims & objectives

    Table of words to be used

    • Table providing terms related to understanding, applying, analysing, synthesising, and evaluating different types of research information

    Example (Voluntary Counselling and Testing)

    • Example provided to structure clinical research question, including aim, objectives

    Example - SoHP503

    • Example used to present research questions, aim, and objectives for a specific study

    Please use the discussion board in case of questions. Thank you!

    • Concluding remarks for the lecture

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    Lecture 03: Defining Your Research Questions (SoHP503) PDF

    Description

    This quiz explores key components of the PICO framework used in formulating clinical questions. Test your understanding of the elements involved in writing effective clinical questions and distinguishing between various types of interventions and outcomes. Suitable for students and professionals in healthcare research.

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