Research guides: Optometry and Vision Science Research Guide: Asking and answering clinical questions

Tools and guides

Cochrane PICO search [beta]
PICO searchBETA allows you to use PICO (Population, Intervention, Comparison, and Outcome) terms to find the Cochrane Reviews most relevant to your healthcare question. In particular, it allows you to find reviews in which a term is used specifically as a population, an intervention, a comparison, or an outcome.
Develop a research question
A guide for how to develop an effective research question, from the University of Waterloo's Writing and Communications Centre

Answering clinical questions with evidence

Clinical questions can fall into two categories; (1) background questions, and (2) foreground questions. To examine how these questions can arise, let's consider the following patient encounter:

Clinical Scenario
	A 4-year-old patient with amblyopia is in your office with his Dad. Treatment plan: corrective lenses and schedule a follow-up at which point you may prescribe an eyepatch. You now have some additional questions that you would like answered by the evidence, prior to the follow-up appointment. These clinical questions are background and foreground questions.

Background questions help us improve our understanding of a topic. These types of questions ask for general knowledge about a condition or a thing.

Examples:

Does amblyopia present different in pediatric patients?
After successful treatment, can amblyopia reoccur? What is the likelihood of this happening?

Foreground questions "ask for specific knowledge to inform clinical decisions or actions."²

These questions are usually more complex as they contain several concepts such as a specific population, intervention, comparison and outcome. The organization of these concepts in a clinical questions, is referred to as PICO. For example:

P	Population	Pediatric patient presenting with amblyopia
I	Intervention	Eye-patch
C	Comparison	Glasses
O	Outcome	Improvement of condition

Example of a PICO-structured foreground question:

Is an eyepatch recommended for the treatment of a child with amblyopia who is already being treated with glasses?

Formulating complex PICO questions takes practice. If you need help, please contact the Optometry and Vision Science Librarian.

What information are we looking for?

The 4s's: Studies (unfiltered information), and Syntheses, Synopses, and Summaries (filtered information)

Filtered Information

Filtered information, in this context, is pre-appraised evidence.

To get filtered or “secondary” information, evidence from our primary literature is synthesized and evaluated. Those processes of evaluation, synthesizing data, and synopses take time and a lot work.

Filtered literature will often provide a more definitive answer than individual research reports.

Sources containing filtered information
Based on analysis of synopses	Summaries and systems: Point-of-care tools
Based on analysis of syntheses	Synopses: Clinical practice guidelines, evidence-based textbooks.
Based on analysis of original research studies	Syntheses: systematic reviews, meta-analyses, and literature and scoping reviews.

Unfiltered Information

Unfiltered information includes original research studies that have not yet been synthesized or aggregated. As such, they can be more difficult to read, interpret, and apply to practice.

Unfiltered does NOT mean that the research has not been peer-reviewed. This term refers to study design, not quality.

Studies, original research
	Randomized Controlled Trials (RCTs):
	Cohort studies: Prospective and retrospective cohort studies.
	Case-controlled studies: case reports and case series
	Laboratory studies: in-vitro trials