The first step to finding relevant information for your clinical scenario is to ask a searchable question. You may have several questions depending on your clinical scenario.
Background questions: general questions intended to identify general knowledge about a condition, test, or treatment.
Example: what are the clinical manifestations of anxiety in animals?
Foreground questions: specific questions intended to identify information about a specific patient, situation, or condition.
Example: Is Sertraline (Zoloft) effective in treating anxiety symptoms triggered by thunderstorms in a large breed dog?
| Type | Explanation | Types of evidence to answer questions |
|---|---|---|
| Therapy/Treatment | Questions about the effectiveness of interventions to improve the outcome of patients experiencing a medical condition. Treatments offered can include medications, surgical procedures, lifestyle changes, and more. | Randomized Controlled Trial |
| Prevention | Questions about the effectiveness of an intervention to prevent morbidity (disease) or mortality (death). | Randomized Controlled Trial/Clinical Trial, Prospective Study |
| Diagnosis | Questions about the ability of a test/procedure to differentiate between a patient with and without a condition. How do we confirm whether a patient has a condition or disease? | Randomized Controlled Trial/Clinical Trial, Cohort Study |
| Prognosis | Questions related to the forecast of the likely course of a disease or condition. What can the patient expect going forward? | Cohort Study, Case Control Studies |
| Etiology/Causation | Questions about the origin of the condition. What is the cause of the disease/condition? | Cohort Study |
| Meaning | Questions related to patients experiences, concerns, background information. | Meta-Analysis, Systematic Review, Qualitative Studies |
Table based off off University of Canberra Library Guide - Evidence Based Practice in Health
In order to create a searchable question, it is important to break them down into discrete terms and ideas that can be used to search databases. A common framework to help guide this process is the PICO framework or the PEO framework.
PICO - Patient, Intervention, Comparison, Outcome
PICO questions are typically used to explore interventions and their outcomes.
| Patient/Population | Who is the patient or population? Be as specific as possible. Example: elderly dogs, pregnant dogs, Golden Retrievers, Cats, foals, etc. |
|---|---|
| Intervention | How? What is the intervention? Example: medication, testing, surgical procedure, diet, etc. |
| Comparison/Control | What is the alternative? Are we comparing another type of intervention? Do we want to know if an intervention will have a better outcome than doing nothing (no intervention)? |
| Outcome | What are you trying to achieve? Example: pain management, lifestyle changes, improved mobility, etc.? |
| Patient Population | 9 year old German Shepard experiencing arthritis and stiff mobility, patient is already taking prescribed NSAIDs (anti-inflammatory) |
|---|---|
| Intervention | Therapeutic exercise and joint mobilization |
| Comparison | NSAIDs alone |
| Outcome | Increased mobility - less stiffness when walking, increased quality of life/comfort |
PICO Question: Would therapeutic exercise affect mobility in a 9 year old German Shepard with arthritis when combined with NSAIDs compared to NSAID treatment alone?
The outcome is not always used in the actual search, but it can be used to help frame your review of results from the research literature. You may not always have a comparison in your question. This is usually used when looking to determine an appropriate course of action for the patient's needs and compare different options.
We can then use our PICO assessment to help identify main idea search terms like:
A PEO question focuses on non-numerical, or qualitative data. Relationships & associations are explored. PEO is commonly used for etiology (causation), harm, and prognosis questions.
| Patient/Population | Who is the patient or population? Be as specific as possible. Example: elderly dogs, pregnant dogs, Golden Retrievers, cats, foals, etc. |
|---|---|
| Exposure | What is your population exposed to? Example: snake bite, medications, environment, etc. |
| Outcome | What is the result of the exposure on your population? Example: lower risk for cancer, weight loss/gain, hormone regulation, etc. |
| Patient/Population | young cat with hyperthyroidism experiencing weight loss and increased thirst and urination |
|---|---|
| Exposure | Anti-thyroid drugs |
| Outcome | control of hyperthyroidism, weight regulation |
Question: Will anti-thyroid drugs help control the weight loss and other symptoms experienced by a young cat with hyperthyroidism?
We can use our PEO chart and question to help identify main ideas for our search: