Hello everyone, today we are going to talk about welcome all of you to this online course on Evidence Based Medicine. Today we are going to talk about different steps of EBM. Of which first thing is evaluating a research question. Research question as you know is the most important part of any scientific research and to pick up research questions for Evidence Based Medicine. We need to go to the clinical practices. As it is happening in the ward or in the emergency and this to take an example this morning as I was looking at a patient suffering from acute bronchiolitis. The resident asked the question whether or not to give this child hypertonic saline in place of normal saline nebulisation which were continuing on that particular child. Now this child is two years old and is suffering from acute condition called bronchiolitis. So we have to first decide what is known as the PICO of this research question. Now to PICO, P for patient or population or problem, It is for intervention there would be control group or something which is already being in practice.

Good morning everyone, welcome to this online course on Evidence Based Medicine. To start with evidence based medicine we have to first look at the research question. As you research question is the most important part of the research therefore it should be something answer to which not yet know therefore if you already know the answer to the particular

research question then there is not point doing research on that particular topic. So evidence based medicine starts with formation of research question or research query which usually come from patients from the wards or from the emergency room. For example this morning I saw a patient whose six month old child suffering from acute bronchiolitis. Which is being managed in pediatric emergency. Now this particular child the resident asked here to give this patient besides oxygen or other therapy like intravenous fluids whether we should also start this child on hypertonic saline nebulisation, This child as was already getting some nebulisation of normal saline. Now we have to formulate this as a questions so the question here could be whether in a case of acute bronchiolitis giving hypertonic saline novelization can be beneficial in comparison to the normal saline novelization. Now in evidence based medicine we actually break up a question into four or five components and which is known by acronym which is called PICO and in PICO P stands for population or for patient or problem. I stands for intervention which we are tried to addressed, C is for comparison and O  are the outcomes which we trying to measure and another dimensions which can sometimes be added in PICO is time and in those cases this PICO becomes PICOT. Now in this particular question where we have this child suffering from bronchiolitis. Let us see what is the population or what is the P of this question. The P of this question is actually children or infants suffering from acute bronchiolitis. So that is the population which we are addressing so these are children who are presented to emergency room with the problem of bronchiolitis which is diagnosis of brochealitos is already being made in these patient based on some set diagnostic criteria. For example these criteria could be patient presented with fever and cough or wheeze coming to emergency having  increased respiratory rate. There may be subcostal retraction and when you do chest X-ray on these patients. You may find there is bilateral hyper inflation. So this will be the definition of population which we are addressing today in this question. The next part is the intervention. Now the intervention in which the resident asking about is hypertonic saline. Now hypertonic saline can be of different concentrations and but let us take here as 3% hypertonic saline as a test intervention and then there would be a certain dose, there would be certain duration, there would be certain frequency of administration of this intervention to see what effect is going to have and child performance as a patient and then what would be the prognosis of this patient. Now see for this example, now we have done P, we have done I, we have done, we are now going to do what we have C-comparator and comparator here is something which is already going or which is an existing practice for  something which has control and that is normal saline.That means these patient were otherwise or this particular patient otherwise getting normal saline. And now we want to try whether going hypertonic saline would make this patient better earlier or faster in the emergency room. So then that suddenly we come to the outcomes. Now outcomes here is performance of patients whether he getting better fast. Now shall we know these outcome would have to be decided a priory. For example in a child in a respiratory distress there may be certain scores which are used to assess the severity of respiratory distress which can be measured by independent observer. So a change in that particular score that means if a particular score  decrease then we may say that patient is getting better. And another outcome could be weather this patient can be discharge earlier. That means he starts getting better faster and is in fit position to be discharge or earlier from the ER. And would not require any admission to the wards so that could be another outcome which can be assessed. Although in large series where there is a possibility of mortality one may even see whether there would be mortality related to this acute respiratory distress syndrome or patient of bronchiolitis because he may be suffering from . Though most relevant outcomes here would be the

clinical improvement in the patient in terms of clinical scores or in terms of respiratory distress or in term of requirement for supplement oxygen. So these factor can be used as outcome in this particular patient. So now we have done PICO. That means where we know the population ,we know the intervention, we know the comparator and we know what outcomes that going to address. The next would be time that means how long an intervention could be administered to a particular patient. For example in case of hypertonic saline whether we going to see the effects over a period of 24 hrs. or we going to take see effects over 48 hrs. so this we you added dimension of time to this may become PICOT and such that how we break every question which comes to us for doing systematic analysis or the next step that means doing a systematic search for literature which is already existing in this particular field.