the pyramid sometimes.
Okay, now we're going to ask the research question.
This seems like it should be a straightforward
easy thing to do, but professionals who conduct
systematic reviews or do EBM searches will
spend a great amount of time focusing on phrasing
the question as precisely as possible. The
more focused and precise the phraseology,
the more correct and targeted the result of
the search will be. There are many ways to
phrase a research question correctly, I like
to use a method called the PICO method, and those
letters stand for certain things. The P stands
for patient population, so who's your patient
population, who is your patient, what are
his or her needs or cohorts? The I stands for
interventions, what action are you considering?
The C stands for a comparison or a control
group, what are you comparing them to?
And lastly the O is outcome, what is it that you're
trying to change or accomplish? What's the
disease state you're measuring? So there are
many different kinds of questions we can be
asking as well, there are at least four, one
of them is therapeutic. Maybe you want to
know what treatments are available that lead
to certain kinds of outcomes for your patient.
Maybe you want to know about how best diagnose
a patient's condition. Maybe you want to know
about how likely is the patient going to have
certain kinds of outcomes, their prognosis
or maybe you want to know what's the relationship
between the disease and its possible cause,
in other words a measurement of harm. So let's
do an example, a doctor wants to research
the effects of dietary fat on breast cancer
risk, maybe this doctor has a middle-aged
female patient who has a family history of
breast cancer and she wants to minimize her
risk in all possible ways going forward, because
she knows it's in her family history, so she
knows about the genetic portion of breast
cancer, now she wants to know a little bit
more about the behavioral aspects of breast
cancer and she wants to know whether removing
dietary fat from her behavior will gain her
any kind of advantage going forward in not
acquiring breast cancer like her mother did.
So what do you do? You're going to search
the literature; you're going to employ EBM
methods to do so. You do so by phrasing an
appropriate question. Let's use the PICO method.
Patient population, well it's going to be
adult woman, because your patient is an
adult woman, the intervention you care about
is dietary fat, that's the thing that's going
to make the change. The comparison group you
care about, well there isn't really one, we're
comparing adult women to themselves really
and the outcome we care about is breast cancer.
Note that the comparison group here is empty,
that's quite common, the PICO method has some
flexibility to it. The type of question you
are asking is an etiologic one, you're looking
for relationships between exposures and outcomes,
that's relevant when you're looking through
the studies that you find to see what their
focus is, is your focus a description, is
it etiologic, is it behavioral, is it opinion?
And you will take any kind of study at this
point, even though you know, at the end of
the day, you are going to apply the evidence
pyramid and try to pick the best quality evidence.
So here's your question then, 'In adult women,
is dietary fat a risk factor for breast cancer?”
That's the PICO outcome. Now you may think
that you could've gotten that answer yourself
without going through the PICO process and
that's fine, but some people need a framework
to help them phrase these kinds of questions.
So what do you do now? You actually apply
the search. There are lots of search engines
you could go to, so one of them is pub med
and that's a free search engine run by the
American government, that you can type in
the appropriate keywords, 'dietary fat treatment'.
You can go to Google scholar and type in keywords
as well, there are literally scores of possible
search engines to try, world science for example.
So at the end of all this, what you will find