Research Guides: Evidence-Based Clinical Practice Resources: ASK

Tutorials & Modules

Asking the Question

To find information to meet the clinical need you first need to ask a clear and answerable clinical question.

Background Questions - seek to find answers to general questions. For example: when should the HPV vaccine be given? what causes ocular migraines?
- Answers for this type of questions are typically found in textbooks or in resources like DynaMed Plus.

Foreground Questions - seek to find answers to specific questions that will influence clinical decisions. These questions are best formatted using PICO or similar format.
- Answers for foreground questions are found in the medical literature. The best resources therefore are databases like PubMed or Embase.

PICO

PICO is a mnemonic device to help clarify the information need into a clear clinical question.

PICO description
PICO Format	Definition & Questions to Consider
P	Patient, Population, or Problem What are the characteristics of the patient or population? What is the condition or disease in which you are interested?
I	Intervention or Exposure What do you want to do with this patient (e.g., treat, diagnose, observe)?
C	Comparison or Intervention (if appropriate) What is the alternative to the intervention (e.g., placebo, different drug, surgery)?
O	O = Outcome What are the relevant outcomes (e.g., morbidity, death, complications)?
T	Type of Clinical Question Diagnosis, Etiology/Harm, Therapy, Prognosis, Prevention
T	Type of Study Design to Answer the Question What would be the best study design/methodology (Systematic review, RCT, cohort study, case control, etc.)

*Descriptions from the University of Washington Evidence-Based Practice LibGuide at http://libguides.hsl.washington.edu/content.php?pid=231619&sid=1931590

Types of Clinical Questions

Knowing the Type of Clinical Question will help you determine the best type of study design. The table* below demonstrates the types of studies generally recommended to answer particular types of clinical questions.

Clinical Question Types
Type of Question	Type of Study/Methodology
Diagnosis	controlled trial
Therapy	double-blind RCT, Systematic review / meta-analysis
Prognosis	cohort studies, case control, case series
Harm/Etiology	cohort studies, case control, case series
Prevention	randomized controlled trial, cohort studies
Quality improvement	Randomized controlled trials

*Table adapted from http://researchguides.uic.edu/content/php?pid=47981&sid=353409

Evidence Pyramid

It is important to remember that when seeking evidence that not all evidence is equal. It is important to seek out the recommended study level but move up or down the pyramid as necessary.

Pyramid adapted from Duke University Medical Center Library: https://guides.mclibrary.duke.edu/ebm/studydesign