Although the PICO formulation should apply easily to the majority of effectiveness questions and a great number besides you may encounter questions that are not easily accommodated within this particular framework. Below you will find a number of acceptable alternatives:

Q. What if I have not identified an Intervention? A. PECO

For non-intervention studies we suggest that you may find it helpful to replace Intervention (a planned procedure) with Exposure (an unintentional occurrence or happening).

Q. What if I am interested in a social intervention? A. PICOC

For interventions that are heavily dependent on context for their effectiveness we suggest the addition of C for Context to the standard PICO formulation.

Q. What if I have not identified a comparison? A. PIE

Q. What if I am interested in a Qualitative question? A. SPICE or ProPheT

Q. What other variations on PICO are there? A. PICOS and PICOT

And some variations you definitely won’t have heard of!:

PEAHEN (Population, Exposure, Adverse Health Effects, Negative reactions; as alternative to PICOC)

SugABABes (Suggested Approach, Best Alternative, Best compromise; as alternative to SPICE)

PEAS (Problem, Experiment, Alternative, Setting; as alternative to PIE)

SAPO (Setting, Approach, Primary Outcomes; as alternative to PICO)

There are 4 messages totalling 985 lines in this issue. Topics of the day: 1. SV: Qualitative research and PICO 2. R: Basic question about diagnostic versus prognostic studies 3. SV: SV: Qualitative research and PICO 4. Basic question about diagnostic versus prognostic studies ---------------------------------------------------------------------- Date: Mon, 23 Feb 2009 00:52:13 -0600 From: "Dr. Carlos Cuello" <[log in to unmask]> Subject: Re: SV: Qualitative research and PICO --00032557570240316e046390713d Content-Type: text/plain; charset=ISO-8859-1 Content-Transfer-Encoding: quoted-printable Greetings wouldn't be better to consider the question into the frame of background vs foreground questions? If so, this would obviously be a background question. Presuming qualitative research is often use to explore topics or questions that usually cannot be answered by quantitative methods, for example, what are the reasons doctors prescribe more x therapy? Or which are the reasons patients do not take x drug, etc? Regards Carlos A. Cuello-Garc=EDa, MD Director, Centre for Evidence-Based Practice-Tecnologico de Monterrey Cochrane-ITESM coordinator. Professor of Paediatrics and Clinical Research Avda. Morones Prieto 3000 pte. Col. Doctores. CITES 3er. piso,Monterrey NL, M=E9xico. CP64710 Phone. +52(81)88882154 & 2141. Fax: +52(81)88882019 www.cmbe.net The content of this data transmission must not be considered an offer, proposal, understanding or agreement unless it is confirmed in a document signed by a legal representative of ITESM. The content of this data transmission is confidential and is intended to be delivered only to the addressees. Therefore, it shall not be distributed and/or disclosed through any means without the authorization of the original sender. If you are not the addressee, you are forbidden from using it, either totally or partially= , for any purpose --00032557570240316e046390713d Content-Type: text/html; charset=ISO-8859-1 Content-Transfer-Encoding: quoted-printable <div>Greetings wouldn't be better to consider the question into = the frame of background vs foreground questions?</div><div> </div><div>I= f so, this would obviously be a background question. Presuming qualitati= ve research is often use to explore topics or questions that usually cannot be answered by quantitative methods, for example, what  are the reasons doctors prescribe more x therapy? Or wh= ich are the reasons patients do not take x drug, etc? Regards <br=

idence-Based Practice-Tecnologico de Monterrey Cochrane-ITESM coordinator. Professor of Paediatrics and Clinical Research = Avda. Morones Prieto 3000 pte. Col. Doctores. CITES 3er. piso,Monterrey= NL, M=E9xico. CP64710 Phone. +52(81)88882154 & 2141. Fax: +52(81)8= 8882019 <a href=3D"http://www.cmbe.net">www.cmbe.net</a>   The content = of this data transmission must not be considered an offer, proposal, unders= tanding or agreement unless it is confirmed in a document signed by a legal= representative of ITESM. The content of this data transmission is confiden= tial and is intended to be delivered only to the addressees. Therefore, it = shall not be distributed and/or disclosed through any means without the aut= horization of the original sender. If you are not the addressee, you are fo= rbidden from using it, either totally or partially, for any purpose --00032557570240316e046390713d-- ------------------------------ Date: Mon, 23 Feb 2009 08:46:10 +0100 From: Barbani Federico <[log in to unmask]> Subject: R: Basic question about diagnostic versus prognostic studies Hi Simon. I heard a beautiful sentence about this matter: "the diagnosis (..) is = only a mental resting place for prognostic considerations and therapeutic decisions". (Wulff HR. Rational diagnosis and treatment. Oxford: Blackwell = Scientific Publications, 2nd Editions. 1981: 80, cited in: Alessandro Liberati, A. Addis, Luciana Ballini, Marco Bobbio, Massimo Brunetti, and Vittorio = Caimi. Etica, conoscenza e sanit=E0. Evidence-based medicine fra ragione e = passione, Roma:Il Pensiero Scientifico, 2005) I have long thought about this fascinating question. I came to the conclusion that substantially diagnosis and prognosis have = in deep the same meaning. Academically you can say that diagnosis is a wider concept and = encompasses symptoms, signs and test results, while prognosis is limited to how and = how long will be the life of the patient; so it is somewhat a part of = diagnosis. But for a patient's perspective to have a diagnosis is actually to have = a prognosis if no intervention is made and you let natural history go on. Simply in clinical practice prognosis is often placed in a following = time than diagnosis. Kind regrds dott. Federico Barbani Healthcare Purchasing Unit Health Authority Modena via San Giovanni del Cantone 23 41100 MODENA, Italy tel 059/435813 - 435731 -----Messaggio originale----- Da: Evidence based health (EBH) [mailto:[log in to unmask]] Per conto di Steve Simon Inviato: venerd=EC 20 febbraio 2009 20.21 A: [log in to unmask] Oggetto: Basic question about diagnostic versus prognostic studies Maybe this is a stupid question, but here goes. What is the difference between a diagnostic study and a prognostic=20 study? Is it that diagnostic study examines one of more factors that can = help identify an already existing condition whereas a prognostic study=20 examines one of more factors that can predict a future condition? Is it=20 that diagnosis is targeted towards something bad (disease) while=20 prognosis is targeted towards something good (recovery)? Or is it=20 something else? --=20 Steve Simon, Standard Disclaimer. Sign up for my brand new newsletter, The Monthly Mean, at www.pmean.com/news ------------------------------ Date: Mon, 23 Feb 2009 09:51:20 +0100 From: Janet Harris <[log in to unmask]> Subject: SV: SV: Qualitative research and PICO This is a multi-part message in MIME format. ------_=_NextPart_001_01C99593.E6111D7A Content-Type: multipart/alternative; boundary="----_=_NextPart_002_01C99593.E6111D7A" ------_=_NextPart_002_01C99593.E6111D7A Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Kev, Craig and Carlos =20 Thanks for the points. =20 Re: Kev's point that Evaluation should be the results: The results = contained two headings: Perceived threat of the illness and Personal = control exercised by parents in response to the threat. I lumped these = under the term coping but it's probably better to keep the headings from = the article for accuracy. We also use Craig's PIC model, but have found that the different = definitions need some reinforcing. When people are accustomed to working = with RCTs and the traditional PICO, they tend to confuse Interventions = with Interest until they have had some practice.=20 Craig, where do you place the FIndings in your acronym? Carlos asked 'wouldn't be better to consider the question into the frame = of background vs foreground questions? If so, this would obviously be a = background question.' Sackett et al (2000) characterizes background questions as 'who, what, = where, when, why and how' questions. This fits with qualitative = questions. And qualitative research can provide good background = information to inform systematic reveiw protocols.The Cochrane = Qualitative Research Methods Group is working on this now.=20 =20 Best wishes Janet=20 ________________________________ Fra: Evidence based health (EBH) p=E5 vegne av Craig Lockwood Sendt: s=F8 22.02.2009 23:33 Til: [log in to unmask] Emne: Re: SV: Qualitative research and PICO Dear All, I have some affinity with the PICO format, its great in that existing = familiarity can assist with the teaching process, and with some = adaptation, I use the same approach for qualitative reviews.=20 In usage, PICO becomes P Population I phenomena of Interest Co Context The phenomena of interest being (in a phenomenological example) the = lived experience. =20 The question in action might look like "What is the lived experience of younger, disabled people residing in = long term care environments for older adults?" The population being younger people with a disability, the phenomena of = interest being their experiences and the context being that they are = living in an environment designed for older adults not living = independently. =20 This is the format I use for teaching question development for = qualitative systematic review titles also; although I don't know of any = published reviews that describe their process of question development = that report using this approach. Kind regards Craig Craig Lockwood Associate Director / Research & Innovation The Joanna Briggs Institute Royal Adelaide Hospital North Terrace Adelaide, South Australia 5000 p: +61 8 8303 4880 =20 f: +61 8 8303 8280=20 =20 ________________________________ From: Ornissa Naidoo <[log in to unmask]> Reply-To: Ornissa Naidoo <[log in to unmask]> Date: Mon, 23 Feb 2009 08:16:43 +1000 To: "[log in to unmask]" = <[log in to unmask]> Subject: Re: SV: Qualitative research and PICO Greetings Very interesting debate, Yes I tend to use PICO, I agree with Janet: P: Parents I: Is not a manipulated intervention, but rather an event that occurs=20 Hence I would use it as follows: P- Parents of preschool children who are acutely ill I- Parents beliefs/concerns C- Nil O- ( Not sure what you would eventually hope to achieve with the = information for eg:) - Less stressed patients of acutely ill preschool children .... =20 Hope this helps Kind regards=20 Ornissa Naidoo=20

Hello Janet, Thanks for that. Yes, Booth and Brice?s SPICE structure does seem well = suited although it was developed with information services/librarians? = situation in mind. May I bounce back a few things for you to consider? 1 In teaching, it is good to have consistency so before accepting a new = tool, I would want to be sure that the old one has more disadvantages = than advantages (your ref to shoe horning points to a disadvantage). 2 PICO of course is not just for interventions, it works with diagnostic = and prognostic questions too (its suitability as an acronym has been = debated here before) 3 I think the Evaluation in SPICE as used below should actually be the = parents? beliefs and concerns about children becoming ill ? these are = the results.=20 Kev Dr Kev (Kevork) Hopayian MD FRCGP GP Tutor Postgraduate Medical Centre Ipswich Hospital Ipswich Suffolk -------on 22/02/2009 17:59, Janet Harris at [log in to unmask] = [log in to unmask]"><about:[log in to unmask]> wrote: Hi Kev =09 PICO is good when you want to compare interventions and outcomes but = it's difficult to shoehorn qulaitative questions into this format.. = Qualitative questions explore perceptions of health issues, attitudes = toward interventions, experiences with interventions, and acceptability = of outcomes. They may compare diverse views and experiences across = different people but the comparison isn't manipulated by putting people = into different groups.=20 =09 An alternative format suggested b Booth & Brice (2003) is SPICE=20 Setting: of the research Perspective: of those who are experiencing the intervention or the = situation of interest Intervention/Phenomena of Interest: the intervention or the phenomenon = that is being experienced Comparison: may be with those who do not receive the intervention or = experience the phenomenon Evaluation. What is being explored or evaluated in the study =09 Going back to your article, it could be formatted like this:=20 =09 =09 S: Disadvantaged inner city community P: Parents =20 I: Acutely ill preschool children=20 C: None E: .Coping when young children become acutely ill =20 All elements are not always present - it depends on the question. =20 =20 You could alternatively formulate it as a PO, PI or PIO keeping in mind = that your definitions for PIO are a bit different e.g. P: Parents I: Is not a manipulated intervention, but rather an event that occurs = - acute illness in preschool children =20 Hope that helps. =20 Best wishes Janet =20 Janet Harris Associate Professor University College Bergen Centre for Evidence Based Practice M?llandahlsveien 6 Bergen 5009 Norway =20 =09 =09 ________________________________ Fra: Evidence based health (EBH) p? vegne av Padmanabhan badrinath Sendt: s? 22.02.2009 16:17 Til: [log in to unmask] = [log in to unmask]"><about:[log in to unmask]>=20 Emne: Qualitative research and PICO or PECOT & CASP checklists =09 Dear Kev, =09 A very good afternoon and early spring greetings from the East of = Englnd. =09 A quick look at the CASP worksheets for the RCT and qualitative = desingns shows that first question is very different.=20 CASP checklist for RCT available at http://www.phru.nhs.uk/Doc_Links/rct appraisal tool.pdf=20 =09 The first question is:=20 =09 Did the study ask a clearly-focused question?=20 =09 Consider if the question is ?focused? in terms of:=20 ? the population studied=20 ? the intervention given=20 ? the outcomes considered =09 CASP checklist for qualitative study available at=20 http://www.phru.nhs.uk/Doc_Links/Qualitative Appraisal Tool.pdf=20 =09 The first question is: =09 Was there a clear statement of the aims of the research?=20 =09 Consider:=20 ? what the goal of the research was=20 ? why it is important=20 ? its relevance =09 It appears that the PICO format is more suited for therapy questions.=20 =09 You might also find this paper by Huang et al of interest.=20 =09 Evaluation of PICO as a Knowledge Representation for Clinical Questions http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3D1839740=20 =09 "Our study shows that the PICO framework is best suited for = representing therapy questions, and considerably less-suited for = diagnosis, etiology, and prognosis questions. In some cases, it is = difficult to encode certain question classes without modifying the = existing PICO structure or introducing counterintuitive elements. Given = that the PICO framework is a well-established tool for formulating = clinical queries, any limitations of the framework itself could = potentially impact the quality of clinical evidence retrieved under its = guidance. This study reveals a number of challenges associated with PICO = analysis, which will serve as a basis for refining the principles of = clinical query formulation". =09 Warm regards & very best wishes, =09 Badri =09 Dr P Badrinath MD BS M.Phil MPH FFPH PhD (Cantab) Consultant in Public = Health Medicine & Affiliated Clinical Lecturer Suffolk PCT & University = of Cambridge Rushbrook house, Paper mill lane, Bramford, Ipswich, IP8 = 4DE, Suffolk, UK http://myprofile.cos.com/badrishanthi=20 =09 =09 =20 > Date: Sun, 22 Feb 2009 10:08:25 +0000 > From: [log in to unmask] = [log in to unmask]"><about:[log in to unmask]>=20 > Subject: Qualitative research and PICO or PECOT > To: [log in to unmask] = [log in to unmask]"><about:[log in to unmask]>=20 >=20 > Does anyone have experience of setting the research question in a > qualitative study into the PIO or PICO or PECOT format? It seems = possible to > do so but I have not seen it done. > P is easy to identify but the E or I and O less so. There is = sometimes a C > but more often not. > For example, in a study "To identify and explore parents' concerns = when > preschool children become acutely ill." > http://www.bmj.com/cgi/content/full/313/7063/983 > P =3D parents' of preschool children > E or I =3D children develop an acute illness (note - this does not = imply the > children have acute illness during the study, rather the parents = consider > their experience) > O =3D their beliefs and concerns. > So it can be done but my questions to the group are: > 1 Any views on using PIO/PICO in this situation? Does it add anything = of > value to our appreciation of the paper over and above a narrative = expression > of the research question (as in the title above)? > 2 Do you have experience of doing so? Could you tell us more? > --=20 > B/W, Kev Hopayian =09 =09 --=20 *************************************************************************= ******* This email, including any attachments sent with it, is confidential and = for the sole use of the intended recipient(s). This confidentiality is = not waived or lost, if you receive it and you are not the intended = recipient(s), or if it is transmitted/received in error. Any unauthorised use, alteration, disclosure, distribution or review of = this email is strictly prohibited. The information contained in this = email, including any attachment sent with it, may be subject to a = statutory duty of confidentiality if it relates to health service = matters. If you are not the intended recipient(s), or if you have received this = email in error, you are asked to immediately notify the sender by = telephone collect on Australia +61 1800 198 175 or by return email. You = should also delete this email, and any copies, from your computer system = network and destroy any hard copies produced. If not an intended recipient of this email, you must not copy, = distribute or take any action(s) that relies on it; any form of = disclosure, modification, distribution and/or publication of this email = is also prohibited. Although Queensland Health takes all reasonable steps to ensure this = email does not contain malicious software, Queensland Health does not = accept responsibility for the consequences if any person's computer = inadvertently suffers any disruption to services, loss of information, = harm or is infected with a virus, other malicious computer programme or = code that may occur as a consequence of receiving this email. Unless stated otherwise, this email represents only the views of the = sender and not the views of the Queensland Government. *************************************************************************= ********* ------_=_NextPart_002_01C99593.E6111D7A Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <HTML dir=3Dltr><HEAD><TITLE>Re: SV: Qualitative research and = PICO</TITLE>=0A= <META http-equiv=3DContent-Type content=3D"text/html; charset=3Dunicode">=0A= <META content=3D"MSHTML 6.00.2900.3492" name=3DGENERATOR></HEAD>=0A= <BODY>=0A= <DIV id=3DidOWAReplyText53613 dir=3Dltr>=0A= <DIV dir=3Dltr>Kev, Craig and Carlos</DIV>=0A= <DIV dir=3Dltr> </DIV>=0A= <DIV dir=3Dltr>Thanks for the = points.</DIV>=0A= <DIV dir=3Dltr> </DIV>=0A= <DIV dir=3Dltr>Re: Kev's point that = Evaluation should be the results: The results contained two = headings: Perceived threat of the illness and Personal control = exercised by parents in response to the threat. I lumped these under the = term coping but it's probably better to keep the headings from the = article for accuracy.</DIV></DIV>=0A= We also use Craig's PIC model, but have = found that the different definitions need some reinforcing. When = people are accustomed to working with RCTs and the traditional PICO, = they tend to confuse Interventions with Interest until they have had = some practice. =0A= Craig, where do you place the FIndings in = your acronym?=0A= <DIV>Carlos asked 'wouldn't be better = to consider the question into the frame of background vs foreground = questions? If so, this would obviously be a background = question.' </DIV>=0A= <DIV>Sackett et al = (2000) characterizes background questions as ‘who, what, = where, when, why and how’ questions. This fits = with qualitative questions. And qualitative research can provide = good background information to inform systematic reveiw protocols.The =  Cochrane Qualitative Research Methods Group is working on this = now. </DIV>=0A= <DIV> </DIV>=0A= <DIV>Best = wishes</DIV>=0A= <DIV>Janet  </DIV>=0A= <DIV dir=3Dltr> </DIV>=0A= <DIV dir=3Dltr>=0A= <HR tabIndex=3D-1>=0A= </DIV>=0A= <DIV dir=3Dltr>Fra: Evidence based = health (EBH) p=E5 vegne av Craig Lockwood Sendt: s=F8 = 22.02.2009 23:33 Til: = [log in to unmask] Emne: Re: SV: Qualitative = research and PICO </DIV>=0A= <DIV>Dear = All, I have some affinity with the PICO format, its great in that = existing familiarity can assist with the teaching process, and with some = adaptation, I use the same approach for qualitative reviews. In = usage, PICO becomes P     Population I =       phenomena of Interest Co =  Context The phenomena of interest being (in a = phenomenological example) the lived experience.   The = question in action might look like “What is the lived = experience of younger, disabled people residing in long term care = environments for older adults?” The population being = younger people with a  disability, the phenomena of interest being = their experiences and the context being that they are living in an = environment  designed for older adults not living independently. =   This is the format I use for teaching question development = for qualitative systematic review titles also; although I don’t = know of any published reviews that describe their process of question = development that report using this approach. Kind = regards Craig Craig Lockwood Associate = Director / Research & Innovation The Joanna Briggs = Institute Royal Adelaide Hospital North Terrace Adelaide, South = Australia 5000 p: +61 8 8303 4880 =         f:  +61 8 8303 8280 = <IMG src=3D"image.jpg"> =0A= <HR align=3Dcenter width=3D"95%" SIZE=3D3>=0A= From: Ornissa Naidoo = <[log in to unmask]> Reply-To: Ornissa = Naidoo <[log in to unmask]> Date: Mon, 23 = Feb 2009 08:16:43 +1000 To: = "[log in to unmask]" = <[log in to unmask]> Subject: Re: SV: = Qualitative research and PICO Greetings Very interesting = debate, Yes I tend to use PICO, I agree with = Janet: P: Parents I:  Is not a manipulated intervention, = but rather an event that occurs Hence I would use it as follows: P- Parents of preschool = children who are acutely ill I- Parents beliefs/concerns C- = Nil O- ( Not sure what you would eventually hope to achieve with the = information for eg:)   - Less stressed patients of acutely = ill preschool children ....   Hope this helps Kind regards = Ornissa Naidoo >>> "k.hopayian" = <[log in to unmask]> 23/02/2009 7:15 am = >>> Hello Janet, Thanks for = that. Yes, Booth and Brice�s SPICE structure does seem well = suited although it was developed with information = services/librarians� situation in mind. May I bounce back a few = things for you to consider? 1 In teaching, it is good to have = consistency so before accepting a new tool, I would want to be sure that = the old one has more disadvantages than advantages (your ref to shoe = horning points to a disadvantage). 2 PICO of course is not just for = interventions, it works with diagnostic and prognostic questions too = (its suitability as an acronym has been debated here before) 3 I = think the Evaluation in SPICE as used below should actually be the = parents� beliefs and concerns about children becoming ill = � these are the results. Kev Dr Kev (Kevork) = Hopayian MD FRCGP GP Tutor Postgraduate Medical Centre Ipswich = Hospital Ipswich Suffolk -------on 22/02/2009 17:59, Janet = Harris at [log in to unmask] <[log in to unmask]>">about:[log in to unmask]> =  wrote: =0A= <BLOCKQUOTE>Hi Kev PICO is good when you want to compare interventions and = outcomes but it's difficult to shoehorn qulaitative questions into this = format.. Qualitative questions explore perceptions of health issues, = attitudes toward interventions, experiences with interventions, and = acceptability of outcomes. They may compare diverse views and = experiences across different people but the comparison isn't manipulated = by putting people into different groups. An = alternative format suggested b  Booth & Brice (2003)  is = SPICE Setting: of the = research Perspective: of those who are experiencing the intervention = or the situation of interest Intervention/Phenomena of Interest: the = intervention or the phenomenon that is being experienced Comparison: = may be with those who do not receive the intervention or experience the = phenomenon Evaluation. What is being explored or evaluated in the = study Going back to your article, = it could be formatted like this: S: =  Disadvantaged inner city community P: Parents   I: =  Acutely ill preschool children C:  None E: .Coping = when young children become acutely ill   All elements are not = always present - it depends on the question. =      You could alternatively formulate it as a PO, = PI or PIO keeping in mind that your definitions for PIO are a bit = different e.g. P: Parents I:  Is not a manipulated = intervention, but rather an event that occurs - acute illness in = preschool children   Hope that helps.   Best = wishes Janet   Janet Harris Associate = Professor University College Bergen Centre for Evidence Based = Practice M�llandahlsveien 6 Bergen = 5009 Norway          &= nbsp;      =0A= <HR align=3Dcenter width=3D"100%" SIZE=3D3>=0A= Fra: Evidence = based health (EBH) p� vegne av Padmanabhan = badrinath Sendt: s� 22.02.2009 16:17 Til: = [log in to unmask] = <[log in to unmask]>">about:[log in to unmask]> Emne: = Qualitative research and PICO or PECOT & CASP = checklists Dear Kev, A very = good afternoon and early spring greetings from the East of = Englnd. A quick look at the CASP worksheets = for the RCT and qualitative desingns shows that first question is very = different. CASP checklist for RCT available at <A = href=3D"http://www.phru.nhs.uk/Doc_Links/rct">http://www.phru.nhs.uk/Doc_= Links/rct</A> appraisal tool.pdf The first question is: = Did the study ask a clearly-focused question? = Consider if the question is �focused� in = terms of: � the population studied � the = intervention given � the outcomes = considered CASP checklist for qualitative = study available at <A = href=3D"http://www.phru.nhs.uk/Doc_Links/Qualitative">http://www.phru.nhs= .uk/Doc_Links/Qualitative</A> Appraisal Tool.pdf The = first question is: Was there a clear statement of the = aims of the research? Consider: � what the = goal of the research was � why it is important � = its relevance It appears that the PICO format is = more suited for therapy questions. You might also find this = paper by Huang et al of interest. Evaluation of PICO as a = Knowledge Representation for Clinical Questions <A = href=3D"http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3D18397= 40">http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3D1839740</= A> "Our study shows that the PICO framework is best suited for = representing therapy questions, and considerably less-suited for = diagnosis, etiology, and prognosis questions. In some cases, it is = difficult to encode certain question classes without modifying the = existing PICO structure or introducing counterintuitive elements. Given = that the PICO framework is a well-established tool for formulating = clinical queries, any limitations of the framework itself could = potentially impact the quality of clinical evidence retrieved under its = guidance. This study reveals a number of challenges associated with PICO = analysis, which will serve as a basis for refining the principles of = clinical query formulation". Warm regards & very best = wishes, Badri Dr P Badrinath MD BS M.Phil MPH = FFPH PhD (Cantab) Consultant in Public Health Medicine & Affiliated = Clinical Lecturer Suffolk PCT & University of Cambridge Rushbrook = house, Paper mill lane, Bramford, Ipswich, IP8 4DE, Suffolk, UK <A = href=3D"http://myprofile.cos.com/badrishanthi">http://myprofile.cos.com/b= adrishanthi</A>   > Date: Sun, 22 Feb 2009 = 10:08:25 +0000 > From: [log in to unmask] = <[log in to unmask]>">about:[log in to unmask]> > Subject: = Qualitative research and PICO or PECOT > To: = [log in to unmask] = <[log in to unmask]>">about:[log in to unmask]> > = > Does anyone have experience of setting the research question in = a > qualitative study into the PIO or PICO or PECOT format? It = seems possible to > do so but I have not seen it done. > P = is easy to identify but the E or I and O less so. There is sometimes a = C > but more often not. > For example, in a study "To = identify and explore parents' concerns when > preschool children = become acutely ill." > <A = href=3D"http://www.bmj.com/cgi/content/full/313/7063/983">http://www.bmj.= com/cgi/content/full/313/7063/983</A> > P =3D parents' of = preschool children > E or I =3D children develop an acute illness = (note - this does not imply the > children have acute illness = during the study, rather the parents consider > their = experience) > O =3D their beliefs and concerns. > So it can = be done but my questions to the group are: > 1 Any views on using = PIO/PICO in this situation? Does it add anything of > value to our = appreciation of the paper over and above a narrative expression > = of the research question (as in the title above)? > 2 Do you have = experience of doing so? Could you tell us more? > -- > B/W, = Kev Hopayian </BLOCKQUOTE> -- *******************************************************************= ************* This = email, including any attachments sent with it, is confidential and for = the sole use of the intended recipient(s). This confidentiality is not = waived or lost, if you receive it and you are not the intended = recipient(s), or if it is transmitted/received in = error. Any unauthorised use, = alteration, disclosure, distribution or review of this email is strictly = prohibited.  The information contained in this email, including any = attachment sent with it, may be subject to a statutory duty of = confidentiality if it relates to health service = matters. If you = are not the intended recipient(s), or if you have received this email in = error, you are asked to immediately notify the sender by telephone = collect on Australia +61 1800 198 175 or by return email.  You = should also delete this email, and any copies, from your computer system = network and destroy any hard copies produced. If not an intended recipient of this email, = you must not copy, distribute or take any action(s) that relies on it; = any form of disclosure, modification, distribution and/or publication of = this email is also prohibited. Although Queensland Health takes all = reasonable steps to ensure this email does not contain malicious = software, Queensland Health does not accept responsibility for the = consequences if any person's computer inadvertently suffers any = disruption to services, loss of information, harm or is infected with a = virus, other malicious computer programme or code that may occur as a = consequence of receiving this email. 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A prognostic test is ordered to establish the probabilities of candidate = courses of the disease process. Many tests satisfy both intentions and may be ordered with either single = intention or combining the two. Jim James M. Walker, MD, FACP Chief Health Information Officer Geisinger Health System =20 =20 If the human mind was simple enough to understand, we'd be too simple to = understand it. - Emerson Pugh=20

Maybe this is a stupid question, but here goes. What is the difference between a diagnostic study and a prognostic=20 study? Is it that diagnostic study examines one of more factors that can=20 help identify an already existing condition whereas a prognostic study=20 examines one of more factors that can predict a future condition? Is it=20 that diagnosis is targeted towards something bad (disease) while=20 prognosis is targeted towards something good (recovery)? Or is it=20 something else? --=20 Steve Simon, Standard Disclaimer. Sign up for my brand new newsletter, The Monthly Mean, at www.pmean.com/news IMPORTANT WARNING: The information in this message (and the documents att= ached to it, if any) is confidential and may be legally privileged. It is= intended solely for the addressee. Access to this message by anyone else= is unauthorized. If you are not the intended recipient, any disclosure, = copying, distribution or any action taken, or omitted to be taken, in rel= iance on it is prohibited and may be unlawful. If you have received this = message in error, please delete all electronic copies of this message (an= d the documents attached to it, if any), destroy any hard copies you may = have created and notify me immediately by replying to this email. Thank y= ou. ------------------------------ End of EVIDENCE-BASED-HEALTH Digest - 22 Feb 2009 to 23 Feb 2009 (#2009-45) ***************************************************************************

Formulating non-PICO questions

Q. What if I have not identified an Intervention? A. PECO

Q. What if I am interested in a social intervention? A. PICOC

Q. What if I have not identified a comparison? A. PIE

Q. What if I am interested in a Qualitative question? A. SPICE or ProPheT

Q. What other variations on PICO are there? A. PICOS and PICOT

And some variations you definitely won’t have heard of!: