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Evidence-Based Practice

Searching for the Evidence

  1. Start with the patient: clinical problems and questions arise out of patient care

  2. Translate the clinical questions into a searchable question using PICO

  3. Decide on the best type of study to address the question

  4. Perform a literature search in the appropriate source(s)

PICO

  • Patient, Population or Problem

    • What are the characteristics of the patient or population?

    • What is the condition or disease you are interested in?

  • Intervention or exposure

    • What do you want to do with this patient (e.g. treat, diagnose, observe)?

  • Comparison

    • What is the alternative to the intervention (e.g. placebo, different drug, surgery)?

  • Outcome

    • What are the relevant outcomes (e.g. morbidity, death, complications)?

Examples

Example 1

Your next patient is a 72-year-old woman with osteoarthritis of the knees and moderate hypertension, accompanied by her daughter, a lab tech from the hospital. The daughter wants you to give her mother a prescription for one of the new COX-2 inhibitors. She has heard that they cause less GI bleeding. Her mother is concerned that the new drugs will mean more out of pocket costs each month.

Patient/Problem Intervention Comparison Intervention Outcome
72 year old woman with osteoarthritis of the knee and moderate hypertension COX-2 Inhibitor other NSAIDS
  • less GI bleeding
  • pain control

Specific Question

In a 72 year old woman with osteoarthritis of the knee, can COX-2 Inhibitor use decrease the risk of GI Bleeding compared with other NSAIDs?

 


 

Example 2

You have been treating a 54-year old woman for many years and despite the excellence of your fixed partial denture restorations, the intense routine maintenance by her periodontist, and good homecare, she has been experiencing a continued deterioration of her periodontal tissues. Her attempts to quit smoking have been unsuccessful; otherwise she is in good health and taking no medications. Because you are her primary care dentist, she has questioned you about her current dilemma. The periodontist has suggested a 3-week course of doxycycline therapy to control her latest exacerbation of periodontal disease, but she is concerned about Food and Drug Administration (FDA) reports asking for prudent use of antibiotics. How do you advise this patient?

Patient/Problem Intervention Comparison Intervention Outcome
54 year old woman with exacerbation of periodontal disease doxycyline no treatment
  • less gum bleeding
  • stop recession

Specific Question

For a 54 year old woman with periodontal disease, how effective is the therapeutic use of doxcyline decrease gum bleeding and recession compared to no treatment?

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