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Begin with the Question, or What is a PICO?. Michael K. Gould, MD, MS Vice Chair, ATS DDIC May 13, 2011. Why PICO?. Clearly articulates questions to be addressed Facilitates literature search Defines specific components of individual recommendations

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begin with the question or what is a pico

Begin with the Question, or What is a PICO?

Michael K. Gould, MD, MS

Vice Chair, ATS DDIC

May 13, 2011

why pico
Why PICO?
  • Clearly articulates questions to be addressed
  • Facilitates literature search
  • Defines specific components of individual recommendations
    • A PICO for every recommendation and a recommendation for every PICO!
  • Helps to determine scope of document
    • Each PICO requires its own literature search!
pico question
PICO Question
  • Among patients undergoing major abdominal surgery, should LDUH versus no prophylaxis be used for VTE prevention?
  • Are we confident that the benefits of reducing fatal and non-fatal VTE exceed the harms of increasing fatal and non-fatal major bleeding?
collins meta analysis
Collins Meta-analysis

NEJM 1988;318:1162-1173.

pico question1
PICO Question
  • Among patients undergoing major abdominal surgery, should LDUH versus no prophylaxis be used for VTE prevention?
  • Are we confident that the benefits of reducing fatal and non-fatal VTE exceed the harms of increasing fatal and non-fatal major bleeding?
    • When stratified by risk for VTE?
    • When stratified by risk for major bleeding complications?
estimating baseline risk
Estimating Baseline Risk

Ann Surg 2010;251:344-50

recommendation
Recommendation

For major abdominal surgical patients at moderate risk for venous thromboembolism who are not at high risk for peri-operative bleeding, we suggest use of low-dose unfractionated heparin (Grade 2B) over no prophylaxis.

recommendation1
Recommendation

For major abdominal surgical patients at high risk for venous thromboembolism who are not at high risk for peri-operative bleeding, we recommend use of low-dose unfractionated heparin (Grade 1B) over no prophylaxis.

pico checklist
PICO Checklist
  • Are all elements of the research question described in sufficient detail?
  • Is the question important to clinicians and patients?
  • Are the outcomes important to patients?
    • For surrogate outcomes, is the link between the surrogate and the patient-important outcome clearly established?
need help
Need Help?
  • Jerry Krishnan, DDIC Chair
  • Michael Gould, DDIC Vice Chair
    • mgould@usc.edu
  • Kevin Wilson, ATS Documents Editor
  • Jan Brozek, ATS methodologist
  • Judy Corn, ATS Staff
  • Your friendly DDIC Liaison