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Evidence Pyramid

EBM Pyramid and EBM Page Generator, copyright 2008 Trustees of Dartmouth College and Yale University. All Rights Reserved.Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang.

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Clinical Questions

Clinical questions are sorted into two different types: Background or Foreground
Background questions are concerned with general knowledge.  They are questions about the Who, What, Where, When, or Why of disorders, tests, treatments, and other aspects of health care.  These questions can be answered by medical textbooks, or point-of-care tools such as DynaMed, or Nursing Reference Center.
Some examples of background questions are:
  • What causes migraines?
  • What does melanoma look like on darker skin tones?
  • How often should women over 40 have a mammogram?
Foreground questions are concerned with specific knowledge to make informed clinical decisions.  These questions deal with specific types of patients of populations, and are more complex than background questions.  Foreground questions are best suited to the PICO(T) format, and can be answered best by consulting medical databases such as those listed in the Resources box.
Some examples of foreground questions are:
  • In patients above 65 years (P), can using an influenza vaccine (I) compared to not using the vaccine (C) reduce the risk of contracting pneumonia (O) during cold seasons (T)?
  • Is skin-to-skin contact (I) between mother and newborn (P) during the first three months (T) effective in preventing neonatal deaths (O) compared to drying and wrapping (C)?
You can also find some templates for asking PICO(T) questions below ↓

What is PICO(T)?

P - Population or Problem

  • The description of the population with a similar problem or complaint, or a demographic description.

I - Intervention

  • The planned treatment, or other intervention.

C - Comparison

  • The primary alternative you are considering, or lack thereof.

O - Outcome

  • The measurable result of the proposed treatment.

T - Time

  • If applicable; the timeframe of the treatment or measurable outcome.

Question Templates for Asking PICOT Questions

Intervention:

In _______(P), how does _______(I) compared with _______(C) affect ______(O) within ________ (T)?

Prognosis/Predictions:

In _______(P), how does _______(I) compared with _______(C) influence/predict _______(O) over _______(T)?

Diagnosis or Diagnostic Test:

In _______(P) are/is _______(I) compared with _______(C) more accurate in diagnosing _______(O)?

Etiology:

Are ____ (P) who have _______ (I) compared with those without ______(C) at _______ risk for/of _______(O) over _____ (T)?

Meaning:

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

Prevention:

For ________ (P) does the use of ______(I) reduce the risk of ________ (O) compared with _________ (C)?

Melnyk, Bernadette Mazurek. (2019). Evidence-based practice in nursing & healthcare: a guide to best practice. Wolters Kluwer Health.