Utilization of the PICO framework to improve searching PubMed for clinical questions
TL;DR: There was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results, and this pilot study could not demonstrate a statistically significant difference between the search protocols.
Abstract: Supporting 21st century health care and the practice of evidence-based medicine (EBM) requires ubiquitous access to clinical information and to knowledge-based resources to answer clinical questions. Many questions go unanswered, however, due to lack of skills in formulating questions, crafting effective search strategies, and accessing databases to identify best levels of evidence. This randomized trial was designed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system. Two of the search interfaces utilized a specific framework called PICO, which was designed to focus clinical questions and to prompt for publication type or type of question asked. The third interface was the standard PubMed interface readily available on the Web. Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US. Thirty-one subjects were randomized to one of the three interfaces, given 3 clinical questions, and asked to search PubMed for a set of relevant articles that would provide an answer for each question. The success of the search results was determined by a precision score, which compared the number of relevant or gold standard articles retrieved in a result set to the total number of articles retrieved in that set. Participants using the PICO templates (Protocol A or Protocol B) had higher precision scores for each question than the participants who used Protocol C, the standard PubMed Web interface. (Question 1: A = 35%, B = 28%, C = 20%; Question 2: A = 5%, B = 6%, C = 4%; Question 3: A = 1%, B = 0%, C = 0%) 95% confidence intervals were calculated for the precision for each question using a lower boundary of zero. However, the 95% confidence limits were overlapping, suggesting no statistical difference between the groups. Due to the small number of searches for each arm, this pilot study could not demonstrate a statistically significant difference between the search protocols. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results.
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TL;DR: The findings continue to support the importance of at least 60 min/day of MVPA for disease prevention and health promotion in children and youth, but also highlight the potential benefits of LPA and total PA.
Abstract: Moderate-to-vigorous physical activity (MVPA) is essential for disease prevention and health promotion. Emerging evidence suggests other intensities of physical activity (PA), including light-intensity activity (LPA), may also be important, but there has been no rigorous evaluation of the evidence. The purpose of this systematic review was to examine the relationships between objectively measured PA (total and all intensities) and health indicators in school-aged children and youth. Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, aged 5–17 years), intervention/exposure/comparator (volumes, durations, frequencies, intensities, and patterns of objectively measured PA), and outcome (body composition, cardiometabolic biomarkers, physical fitness, behavioural conduct/pro-social behaviour, cognition/academic achievement, quality of life/well-being, harms, bone health, motor skill development, psychological distress, self-esteem)....
1,259 citations
Cites methods from "Utilization of the PICO framework t..."
...The participants, interventions, comparisons, outcomes and study design (PICOS) framework (Schardt et al. 2007) was followed to identify key study concepts in the research question a priori and to facilitate the searching process....
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...Eligibility criteria The participants, interventions, comparisons, outcomes and study design (PICOS) framework (Schardt et al. 2007) was followed to identify key study concepts in the research question a priori and to facilitate the searching process....
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University of Ottawa1, Children's Hospital of Eastern Ontario2, University of Alberta3, Public Health Agency of Canada4, Conference Board of Canada5, University of British Columbia6, Douglas Mental Health University Institute7, Queen's University8, Pennington Biomedical Research Center9, McMaster University10, McGill University11, University of Wollongong12, University of South Australia13, University of South Carolina14, University of Prince Edward Island15, University of Calgary16, Swansea University17, University of Toronto18, Camosun College19
TL;DR: The Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep provide evidence-informed recommendations for a healthy day (24 h), comprising a combination of sleep, sedentary behaviours, light-, moderate-, and vigorous-intensity physical activity.
Abstract: Leaders from the Canadian Society for Exercise Physiology convened representatives of national organizations, content experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children and youth aged 5-17 years respect the natural and intuitive integration of movement behaviours across the whole day (24-h period). The development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and systematic reviews of evidence informing the guidelines were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Four systematic reviews (physical activity, sedentary behaviour, sleep, integrated behaviours) examining the relationships between and among movement behaviours and several health indicators were completed and interpreted by expert consensus. Complementary compositional analyses were performed using Canadian Health Measures Survey data to examine the relationships between movement behaviours and health indicators. A stakeholder survey was employed (n = 590) and 28 focus groups/stakeholder interviews (n = 104) were completed to gather feedback on draft guidelines. Following an introductory preamble, the guidelines provide evidence-informed recommendations for a healthy day (24 h), comprising a combination of sleep, sedentary behaviours, light-, moderate-, and vigorous-intensity physical activity. Proactive dissemination, promotion, implementation, and evaluation plans have been prepared in an effort to optimize uptake and activation of the new guidelines. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed.
1,114 citations
TL;DR: The SPIDER tool is used to advance thinking beyond PICO in its suitable application to qualitative and mixed methods research, however, the need for improved indexing of qualitative articles in databases is highlighted.
Abstract: Standardized systematic search strategies facilitate rigor in research. Current search tools focus on retrieval of quantitative research. In this article we address issues relating to using existing search strategy tools, most typically the PICO (Population, Intervention, Comparison, Outcome) formulation for defining key elements of a review question, when searching for qualitative and mixed methods research studies. An alternative search strategy tool for qualitative/mixed methods research is outlined: SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). We used both the SPIDER and PICO search strategy tools with a qualitative research question. We have used the SPIDER tool to advance thinking beyond PICO in its suitable application to qualitative and mixed methods research. However, we have highlighted once more the need for improved indexing of qualitative articles in databases. To constitute a viable alternative to PICO, SPIDER needs to be refined and tested on a wider range of topics.
959 citations
TL;DR: This systematic review is an update examining the relationships between objectively and subjectively measured sedentary behaviour and health indicators in children and youth aged 5-17 years and found higher durations/frequencies of screen time and television viewing were associated with unfavourable body composition.
Abstract: Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a metaanalysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.
819 citations
TL;DR: Results indicate that smartphone devices are a promising self‐management tool for depression, and future research should aim to distil which aspects of these technologies produce beneficial effects, and for which populations.
590 citations
References
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Book•
14 Mar 2000
TL;DR: This chapter discusses how to ask clinical questions you can answer and critically assess the evidence for evidence-based medicine, as well as 7 Rapid Reference Cards used in clinical practice.
Abstract: Introduction: On the Need for Evidence-Based Medicine 1. How to Ask Clinical Questions You Can Answer 2. Searching for the Best Evidence 3. Critically Appraising the Evidence 4. Can You Apply This Valid, Important Evidence in Caring for Your Patient? 5. Evaluation Appendix: Confidence Intervals Also Included Are 7 Rapid Reference Cards
6,019 citations
TL;DR: Evidence-based Healthcare: How to Make Health Policy and Management Decisions, by J. A. Muir Gray is a guide to applying valid evidence and data to a specific clinical question engendered during patient care.
Abstract: Evidence-based Healthcare: How to Make Health Policy and Management Decisions, by J. A. Muir Gray, 270 pp, with illus, paper, $29.95, ISBN 0-443-05721-4, New York, NY, Churchill Livingstone, 1997. We develop clinical expertise with bedside training and experience. How well do we integrate this experience with the best available external evidence for the purpose of direct patient care? I suspect that we do not carry out this function very well. Evidence-based Medicine (EBM) is the practice of applying valid evidence and data to a specific clinical question engendered during patient care. Lately, EBM has been on the lips and pen tips of clinicians, perhaps as a close runner-up to the other shibboleths managed care, gag clause, and networking. Is EBM then another mere mantra, a novel paradigm, or a practicable concept to help with ordinary, day-to-day clinical care? I believe it is the last, but you should be
3,136 citations
"Utilization of the PICO framework t..." refers background in this paper
...Background Practicing evidence-based medicine (EBM) requires integration of clinical experience, the best available research evidence, and the values and preferences of the patient into the clinical decision-making process [1]....
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Book•
01 Jan 2005
TL;DR: Appraising the evidence Therapy Diagnosis and screening Prognosis Harm Evaluation Teaching EBM Appendix: Glossary Index Ready reference cards.
Abstract: Asking answerable clinical questions Acquiring the evidence: How to find current best evidence and have current best evidence find us Appraising the evidence Therapy Diagnosis and screening Prognosis Harm Evaluation Teaching EBM Appendix: Glossary Index Ready reference cards
1,667 citations
TL;DR: For clinicians to make explicit and systematic use of the best available evidence when teaching and practicing clinical medicine, they must start by using an additional fundamental skill for evidence-based medicine: asking well-built clinical questions.
Abstract: What do these scenarios have in common? Among other things, they are all opportunities to make explicit and systematic use of the best available evidence when teaching and practicing clinical medicine. In other words, they are moments of opportunity for evidence-based medicine (1, 2). Many readers of ACP Journal Club are already recognizing and capitalizing on these moments in their daily work. In so doing, these clinicians are using their searching skills to track down published evidence; they are using their critical appraisal skills to judge the scientific validity and clinical usefulness of that evidence; and they are using their clinical judgment to decide with their patients how best to put the evidence into practice. For these steps to be efficient and effective, they must start by using an additional fundamental skill for evidence-based medicine: asking well-built clinical questions.
1,648 citations
"Utilization of the PICO framework t..." refers methods in this paper
...[ 9 ] The PICO framework can be expanded to PICOTT, adding information about the Type of question being asked (therapy, diagnosis, prognosis, harm, etc.) and the best Type of study design for that particular question....
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Proceedings Article•
01 Jan 2006TL;DR: The PICO framework is primarily centered on therapy questions, and is less suitable for representing other types of clinical information needs, and its value as a tool to assist physicians practicing EBM is reaffirmed.
Abstract: The paradigm of evidence-based medicine (EBM) recommends that physicians formulate clinical questions in terms of the problem/population, intervention, comparison, and outcome. Together, these elements comprise a PICO frame. Although this framework was developed to facilitate the formulation of clinical queries, the ability of PICO structures to represent physicians’ information needs has not been empirically investigated. This paper evaluates the adequacy and suitability of PICO frames as a knowledge representation by analyzing 59 real-world primary-care clinical questions. We discovered that only two questions in our corpus contain all four PICO elements, and that 37% of questions contain both intervention and outcome. Our study reveals prevalent structural patterns for the four types of clinical questions: therapy, diagnosis, prognosis, and etiology. We found that the PICO framework is primarily centered on therapy questions, and is less suitable for representing other types of clinical information needs. Challenges in mapping natural language questions into PICO structures are also discussed. Although we point out limitations of the PICO framework, our work as a whole reaffirms its value as a tool to assist physicians practicing EBM.
638 citations