Session I: Evidence Based Medicine
and PICO Clinical Question
Mercer University School of Medicine
Medical Library & Peyton T. Anderson
Learning Resources Center
Macon, GA
Memorial University Medical Center
Health Sciences Library
Savannah, GA
reference.ill@gain.mercer.edu
library@memorialhealth.com
Session I Objectives:
Participants will:
 Identify key elements of the EBM process, including:
 formulating a clinical question
 locating the best evidence
 evaluating the evidence for validity
 Describe the elements of a PICO clinical question
 Identify and locate online EBM resources
Session I Objectives (Cont.):
 Work in groups to evaluate online EBM resources,
including:
 Dynamed
 Cochrane Database of Systematic Reviews
 National Guideline Clearinghouse
 Present their group evaluations of the EBM resources
to the class
 Learn the basic PubMed searches and also utilize
advanced features of PubMed
Your Patient:
 Shannon, a 19-year-old African
American female, visits her local
health clinic for her annual STD
screening. Shannon is asymptomatic
but tests positive for Syphilis. Testing
also reveals Shannon is 3-weeks
pregnant. She is concerned for the
health of her baby. As a physician,
what do you do to help Shannon and
get her the treatment she needs?
What is Evidence-based Medicine (EBM)?
Steps in the EBM Process:
Formulate a Clinical Question
Use EBM resources to find evidence
Evaluate evidence for validity
Apply evidence to your patient
What is PICO?
 A PICO is a well-built clinical question that
seeks a specific answer based on the best
evidence available. A well-constructed and
thoughtful question makes the search for
evidence easier.
PICO =
Patient or Population – Sex, age, race? Primary complaint? Disease
History?
Intervention – What do you want to do for them? Prescribe a drug?
Order a test?
Comparison – What alternatives do you want to compare the
intervention to?
Outcome – What do you hope to accomplish, improve or affect? Relieve
or reduce symptoms? Improve function or improve test
scores?
Our Patient’s PICO:
 P (atient) = 19-year-old African American female
with secondary syphilis and in 1st trimester of
pregnancy
 I (ntervention) = treatment with Penicillin
 C (omparison) = alternative treatments
 O (utcome) = a healthy pregnancy and delivery for
mom and baby; prevention of congenital syphilis in
baby
Locating the Best Evidence:
• Medical literature is immense
• Only a small portion is immediately useful in
answering clinical questions
• Literature reports the whole spectrum of the
scientific research process
Pyramid of Evidence:
Levels of Evidence (LOE):
• Rules of evidence have been established to
grade evidence according to its strength
• Several dozen of these hierarchies exist
• Some systems comprise three levels and
others eight or more
Group Assignment
http://med.mercer.edu/lib/
 Group 1: Dynamed
 Group 2: Cochrane Database of Systematic Reviews
 Group 3: National Guideline Clearinghouse
 10 minutes prep, 5 minutes per group for presentations
 Things to consider while searching:
Where is the information coming from? Is the source reliable?
How current is the information? When was it last updated?
What level(s) of evidence does this resource contain?
How is the information presented? Would it be useful as a point-ofcare resource?
 Was it easy to search for/find the information?
 What did you particularly like/dislike about the resource?
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Your Patient:
 Shannon, a 19-year-old African
American female, visits her local
health clinic for her annual STD
screening. Shannon is asymptomatic
but tests positive for Syphilis. Testing
also reveals Shannon is 3-weeks
pregnant. She is concerned for the
health of her baby. As a physician,
what do you do to help Shannon and
get her the treatment she needs?
Group Reports
Dynamed:
 Point-of-care medical information database
 Includes content of 3,200+ clinical evidence-based topics
 Draws from 500+ medical journals
 Each article is evaluated for clinical relevance and scientific
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validity
Conclusions based on evidence systematically identified,
selected and evaluated from the literature
Updated daily
Peer reviewed
Levels of evidence included in descending order
Cochrane Systematic Reviews:
• Part of the Cochrane Library, a collection of 6 EBM databases
• Methodology considered to be the “gold standard” for
•
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•
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systematic reviews
Reviews address specific questions about the effects of clinical
interventions, including treatments, prevention, screening and
rehabilitation. Meta-analysis may be performed.
Full-text and plain language summaries available
Updated daily
Abstracts can also be found in other resources (i.e. PubMed,
DynaMed, etc.)
National Guideline Clearinghouse:
 Initiative of the Agency for Healthcare Research and
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Quality (AHRQ)
Includes evidence-based clinical practice guidelines
Provides a mechanism for obtaining objective, detailed
information on recommendations for practice
Expert commentaries included
Guideline Syntheses address similar topic areas
Full-text and summaries available
Ability to compare two or more guidelines side-by-side
PubMed Basics:
Searching PubMed at Mercer
Boolean Terms
=
Syphilis AND Pregnancy
SYPHILIS
Syphilis OR OR
Pregnancy
PREGNANCY
Syphilis
Syphilis
Pregnancy
Pregnancy
Searching PubMed at Mercer