PICO: Form a Focused Clinical Question

Example 1: Atrial Fibrillation 

A previously healthy 41-year-old African American man woke up feeling his heart racing. He also had 7 out of 10 chest tightness and shortness of breath. Heart rate is 90 beats per minute and blood pressure is 130/72 mm Hg. An electrocardiogram (ECG) shows atrial fibrillation. You wonder if this patient is a candidate for direct current cardioversion.

Initial Question: Is this patient a candidate for direct current cardioversion?

Open to check your PICO analysis of the scenario for cardiology.

Adapted from Bayefsky, S. & McDonald, M. (2019). Atrial Fibrillation. In El-Sourady, M. (Ed.), Vanderbilt Internal Medicine and Pediatrics Curriculum. AccessMedicine, McGraw Hill Medical. https://accessmedicine-mhmedical-com.proxy.lib.fsu.edu/cases.aspx?groupid=1344

Example 2: Clostridioides Difficile

An 80-year-old female fell, broke her hip, and underwent intraoperative repair with pinning of the fracture. She developed a local infection at the site of the repair and was treated with a 10-day course of oral clindamycin. She was transferred to the nursing home for rehabilitation and has developed loose, watery stools. Today when you visit her, she reports feeling diffuse abdominal discomfort and has had 10 bowel movements. She is very concerned because she cannot work with the therapist and risks losing her Medicare benefit for skilled nursing. You suspect Clostridioides difficile (Clostridium difficile or C. difficile or C. diff.) may be the cause, but you aren’t sure whether you should begin as needed to prevent diarrhea during the therapy sessions before confirmation of C. difficile.

Initial Question: Should you prescribe loperamide (Imodium) before confirmation of C. difficile?

Open to check your PICO analysis of the scenario for infection control.

Adapted from Appenheimer, A.B. (2020). Infectious Diseases Case 8.02. Wilbur, J. K., Graber, M., & Ray, B. (Eds.), Graber and Wilbur's Family Medicine Examination and Board Review, 5th ed. McGraw Hill Professional. https://accessmedicine-mhmedical-com.proxy.lib.fsu.edu/CaseContent.aspx?gbosContainerID=231&gbosID=531397&viewByNumber=false#248072642

Example 3: Gastroesophageal Reflux Disease

A 39-year-old man presents for evaluation of burning epigastric pain and substernal pain that has occurred frequently over the past 6 months. He indicates that the symptoms generally occur after meals and especially when he is lying down. The patient has been prescribed a proton pump inhibitor (PPI) and has taken it regularly for the past 3 months with significant symptomatic improvement. He has no other major medical problems and denies any recent weight loss. He reports moderate consumption of tobacco and alcohol. On examination, he is moderately obese but without any cardiopulmonary or abdominal findings. The main reason for his visit at this time is to inquire how long he will need to continue his medication and whether there are other therapeutic options. You believe the most likely diagnosis is gastroesophageal reflux disease (GERD) and wonder if the patient will be a good candidate for a complete (360°) fundoplication procedure (Nissen fundoplication) performed by the laparoscopic approach.

Initial Question: Is surgery a good treatment for this patient? 

Open to check your PICO analysis of the scenario in surgery.

Adapted from Toy, E. C., Liu, T. H., Campbell, A. R., & Palmer, B. J. A. (2016). Gastroesophageal Reflux Disease. Case Files: Surgery, 5th ed. McGraw Hill Medical. https://accessmedicine-mhmedical-com.proxy.lib.fsu.edu/CaseContent.aspx?gbosID=246077&gbosContainerID=92&viewByNumber=false&groupid=373#130867604

Refine your skills in locating evidence for the purpose of patient care by practicing with these learning modules.