Converting an information need into a clinical question
Check before beginning: is your question a foreground question? Background questions such as broad information on a disorder or a treatment are best answered in textbooks and in online clinical tools such as UpToDate. Foreground questions are very specific - such as the adverse effects of a particular drug, or the comparable effectiveness of different treatments.
A foreground question requires a search for evidence in a citation database.
Formulating a precise and answerable clinical question is critical for translating the question into searchable concepts.
PICO
PICO is a mnemonic framework for the four elements of a clinical foreground question. The patient or population, the intervention or treatment we are considering, the comparison of one intervention to another - if this is applicable - and the outcome we are interested in. PICO is just one tool that is particularly suitable for looking at interventions.
Once a well-structured question is formulated, you will be in a better position to effectively search the literature.
The PICO elements only inform the search - not all the elements of the PICO are used in the search. While it's important to consider the outcome in developing an answerable clinical question, we want to undertake a discovery process and so the Outcome element is not used in the search strategy.
Identify the PICO elements in these clinical questions
- In individuals with psychotic disorders (including schizophrenia) who require long term antipsychotic treatment, are anticholinergic medications more effective in preventing or reducing extrapyramidal side-effects and/or improving treatment adherence than placebo/treatment as usual?
- In children and adolescents with anxiety disorders, what is the effectiveness and safety, considering system issues in low- and middle-income countries, of using pharmacological interventions in non-specialist settings?
- Is removing means for self-harm better than no intervention for persons with thoughts or plans of self-harm in the last month or acts of self-harm in the last year?
- Is hospitalization better than no hospitalization for persons with self-harm?
- In individuals with a first psychotic episode with full remission, how long should antipsychotic drug treatment be continued after remission in order to allow for the best outcomes?
- What are the effective maternal mental health interventions to prevent developmental problems in early infancy?
- For people with dementia, which cognitive/psychosocial interventions (such as cognitive stimulation, cognitive rehabilitation, reality orientation, reminiscence therapy) when compared to placebo/comparator produce benefits/harm in the specified outcomes?
- In people with depressive symptoms (in absence of depressive episode/disorder) - who are in distress or have some degree of impaired functioning - is a problem-solving approach better (more effective in symptom reduction) than treatment as usual?
- In individuals with psychotic disorders (including schizophrenia), is the use of two or more antipsychotic medications concurrently more effective and safer than the use of one antipsychotic only?
- In individuals with psychotic disorders (including schizophrenia) and bipolar disorders are psychoeducation, family interventions and cognitive-behavioural therapy feasible and effective?
- In children and adolescents with anxiety disorders, what is the effectiveness and safety, considering system issues in low- and middle-income countries, of using pharmacological interventions in non-specialist settings?