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Activity Objectives:
1. apply the PICO -TT framework to any situation you see in your
practice ( clinical work, public health work)
Clinical Scenario #2
• Traditionally, clinicians have used a conservative approach
to the diagnostic evaluation of head-injured infants, arguing
that infants are at increased risk of intracranial injury (ICI)
and that symptoms or signs of brain injury may not be
reliably present in those with ICI. A number of previous
studies have reported that a significant fraction of ICIs in
infants occur in patients with a normal neurological status
and with no signs or symptoms of brain injury. You want to
see how well clinical features predict ICI in infants.
Clinical Scenario #4
Clinical Scenario #6
Clinical Scenario #8
• You are visiting the Cath Lab, your friend works there. She
is wearing her iPod listening some music and she seems
quite in a good mood. You noticed that the patient’s family
members are looking very scared and nervous. This
contrast makes you say:” hey, why don’t you put your music
on speakers for the family members in the waiting room?”
She says: “oh, that’s so silly”. Just to contradict her, you
are determined now to figure whether tranquil music will
make the family feel better. Somebody should have
published something on this.
Clinical Scenario #2
Answerable Clinical Question
• PICO:
• P – Among children with minor head injury
• I – does the use of CT scan
• C – versus other clinical findings
• O – affect identification and diagnosis of
intracranial hemorrhage?
• Type of Question: Diagnosis
• Type of Study/Methodology: Controlled
Studies; Systematic Review/Meta Analysis of
Controlled Studies
Clinical Scenario #3
Answerable Clinical Question
• Type of Question: Prognosis
• Type of Study/Methodology: Cohort Studies
• PICO:
• • P – Among toddlers with recurrent nasal
discharge
• • I – does the use of antibiotics
• •C–
• • O – affect the probability of recurrence?
Clinical Scenario #4
Answerable Clinical Question
• Type of Question: Therapy/Treatment
• Type of Study/Methodology: Systematic
Review/Meta Analysis of Double-Blind
Randomized Controlled Trials
• PICO:
• P – Among very low birth weight infants,
• I – are slow enteral feeds
• C – vs. fast enteral feeds
• O – better tolerated
Clinical Scenario #5
Answerable Clinical Question
• PICO
• P – (controlling for ‘nuisance‘ factors) Do
otherwise healthy children
• I – exposed in utero to cocaine,
• C – compared to children not exposed to
cocaine
• O – have increased incidence of learning
disabilities at the age of six years?
• Type of Question: Harm/Etiology
• Type of Study/Methodology: Cohort Studies
Clinical Scenario #6
Answerable Clinical Question
• Type of Question: Therapy/Treatment
• Type of Study/Methodology: Double-Blind
Randomized Controlled Trial
• PICO:
• P – Among children receiving PT/OT for the
management of hemiparesis associated with
cerebral palsy
• I – does constraint induced therapy
• C – compared to conventional PT/OT therapy
• O – improve outcomes (motor skills / function)?
Clinical Scenario #8
• You are visiting the Cath Lab, your friend works there. She
is wearing her iPod listening some music and she seems
quite in a good mood. You noticed that the patient’s family
members are looking very scared and nervous. This
contrast makes you say:” hey, why don’t you put your music
on speakers for the family members in the waiting room?”
She says: “oh, that’s so silly”. Just to contradict her, you
are determined now to figure whether tranquil music will
make the family feel better. Somebody should have
published something on this.
Clinical Scenario #7
Answerable Clinical Question
• Type of Question: Therapy/Treatment
• Type of Study/Methodology: Double-
Blind Randomized Controlled Trial
• PICO:
• In patients with acute bronchitis, do
antibiotics( vs. none) reduce sputum
production, cough or days off?
Clinical Scenario #9
Answerable Clinical Question
• Type of Question: Therapy/Treatment
• Type of Study/Methodology: Double-
Blind Randomized Controlled Trial
• PICO:
• In a 56 year old man with post-op delirium
and agitation, does treatment with
haloperidol vs. lorazepam result in greater
improvement in agitation?