Prospective, blind controlled trial compared to gold standard
Cohort study, case control, case series/case reportMeta-Analyses, systematic reviews Randomized Controlled Trial
The following examples may help you put PICO into practice. Suggestions in the brackets are just extra ideas for what you might want to consider.
1) Isobel is a 45 year old woman who asks you for advice on natural ways of resolving her depression. She's particularly interested in whether she'd gain any benefits to her mental health from exercising.
P - 40 plus year old woman with depression (but also ask whether you need to know the severity of her depression, and whether she has any other health conditions that may suffer or benefit from exercise)
I - Exercise (but what type and how strenuous?)
C - Antidepressants (what strength and for how long?)
O - Reduced or eradicated depression.
So your question might be:
2) Fred is 72, and is undertaking therapy for recovery from a stroke which affected his mobility. His daughter is a strong advocate of acupuncture, and has suggested he ask about it at his next appointment with you.
P - Men in their 70s who have suffered from stroke
I - Acupuncture (but duration, frequency etc?)
C - Fred's current therapy
O - Higher recovery rate (in terms of time of recovery and level of improvement to mobility)
So your question could be:
Your questions might not match these exactly, but they should contain all the elements from your PICO answers, and your choice of comparison and outcome will modify your question somewhat. For example, you might modify your question to include specific brands/types of therapy such as light jogging versus a specific drug in the depression scenario.
Once you've attributed each element of your scenario to PICO, you can then start to look at formulating a list of synonyms to use in searching.
Using the depression and exercise example above, we could look at it like this (we are sure you can think of many more alternative terms though!):
|PICO answer||Synonym 1||Synonym 2|
|40 year old woman||middle aged woman||middle aged female|
|Exercise||physical therapy||physical exertion|
|Antidepressants||[name of antidepressant]||medication|
|Reduced depression||treatment of depression||management of depression|
Quantitative Evidence Pyramid
Qualitative Evidence Pyramid
It is common to confuse systematic and literature reviews as both are used to provide a summary of the existent literature or research on a specific topic. Even with this common ground, both types vary significantly. Please review the following chart (and its corresponding poster linked below) for the detailed explanation of each as well as the differences between each type of review.
|Systematic Review||Literature Review|
|Definition||High-level overview of primary research on a focused question that identifies, selects, synthesizes, and appraises all high quality research evidence relevant to that question||Qualitatively summarizes evidence on a topic using informal or subjective methods to collect and interpret studies|
|Goals||Answers a focused clinical question
|Provide summary or overview of topic|
|Question||Clearly defined and answerable clinical question
Recommend using PICO as a guide
|Can be a general topic or a specific question|
|Components||Pre-specified eligibility criteria
Systematic search strategy
Assessment of the validity of findings
Interpretation and presentation of results
|Number of Authors||Three or more||One or more|
|Timeline||Months to years
Average eighteen months
|Weeks to months|
|Requirement||Thorough knowledge of topic
Perform searches of all relevant databases
Statistical analysis resources (for meta-analysis)
Understanding of topic
|Value||Connects practicing clinicians to high quality evidence
Supports evidence-based practice
|Provides summary of literature on the topic|
Why Do I Need Journals and Databases?
As professionals you will want to use bibliographic databases such as CINAHL and PubMed (MEDLINE) to keep current with the research literature. In addition, full text databases such as the Cochrane Library (a database of systematic reviews), textbook resources such as STAT!Ref, and electronic journals such as Evidence Based Nursing can provide needed information, quickly and easily.
How the Library Can Help
While some web-based resources are free, many quality resources, such as the indexes, databases, journals, and textbooks that you need to do your job have a cost associated with them. Libraries provide access to many online resources, by paying subscription fees to publishers and vendors with the understanding that their library users can access this information from within the library, on campus, and sometimes from off-campus computers as well through proxy access.
A bibliographic database leads the user to sources of information, usually in journals, providing a citation that includes the article's author, title and source information; journal name, volume, issue and page numbers, and often an abstract of the article. As opposed to the Cochrane systematic review databases, the searcher must analyze the quality and relevance of the studies themselves when using PubMed and CINAHL.
Here are the two of the most utilized databases by nurses:
The CINAHL database (Cumulative Index to Nursing and Allied Health) covers nursing, allied health, biomedical and consumer health journals, publications of the American Nursing Association, and the National League for Nursing. Over 350,000 records and 900 journals are included. It also includes healthcare books, nursing dissertations, standards of professional practice, nurse practice acts, and educational software.
PubMed (MEDLINE) is a free resource provided by the National Library of Medicine. Anyone can access this database, which is widely recognized as the premier source for bibliographic and abstract coverage of biomedical literature.
PubMed includes citation and abstract information from Index Medicus, Index to Dental Literature, and International Nursing Index, as well as other sources in the areas of allied health, physical therapy, health education, biological and physical sciences, humanities and information science as they relate to medicine and health care, communication disorders, population biology, and reproductive biology.