Associate Professor Dr Moy Foong Ming

Department of Social & Preventive Medicine

Faculty of Medicine

University of Malaya

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Question Question type

What should I do about this

condition or problem?

Intervention /

Therapeutic

What causes the problem? Aetiology

Does this person have the

condition of problem?

Diagnosis

Who will get the condition or

problem?

Prognosis

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*P opulation or clinical problem

*I ntervention or index test

*C omparison

*O utcome

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*D omain – population

*D eterminant

* intervention, comparison, tests

*O utcome

*Similar to PICO

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*Jean is a 55 year old woman who often crosses the

Atlantic to visit her elderly mother. She tends to get

swollen legs on these flights and is worried about

her risk of developing deep vein thrombosis (DVT),

because she has read a bit about this in the

newspaper lately. She asks you (as a doctor) if she

should wear elastic stockings on her next trip to

reduce her risk

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Population/problem

Intervention

Comparison/ control

Outcome

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Population/problem Passengers on long haul flights

InterventionWearing elastic compression stockings

Comparison/ control No elastic stockings

OutcomeDevelopment of DVT

Question In passengers on long haul flights, does wearing elastic compression stockings, compared with not wearing elastic stockings, prevent DVT?

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*George has come to your surgery to discuss the

possibility of getting a vasectomy. He says he has

heard something about vasectomy causing an

increase in testicular cancer later in life. You

know that the risk of this is very low but want to

give him a more precise answer.

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Population/problem

Intervention

Comparison/ control

Outcome

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Population/problem Adult males

InterventionVasectomy

Comparison/ control No vasectomy

OutcomeTesticular cancer

Question In men, does having a vasectomy (compared with not having one), increase the risk of getting testicular cancer in the future?

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*Julie is pregnant for the second time. She had her

first baby when she was 33 and had amniocentesis

to find out if the baby had Down Syndrome. She

didn’t have a good experience as she didn’t get her

results until 18 weeks pregnant. She is now 35 and

one month pregnant. She asks if she can have a

test that will give her an earlier result. The

hospital offers serum biochemistry plus nuchal

translucency ultrasound screening for Down

Syndrome. You wonder if this combination of tests

is as reliable as the conventional method.

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Population/problem

Intervention

Comparison/ control

Outcome

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Population/problem Pregnant woman (first trimester)

InterventionNuchal translucency ultrasound screening plus serum biochemistry

Comparison/ control Conventional amniocentesis

OutcomeAccurate diagnosis of Down syndrome (measured by sensitivity and specificity)

Question For pregnant women, is nuchal translucency ultrasound screening plus serum biochemistry in the first trimester as accurate (with equal or better sensitivity and specificity) as conventional amniocentesis for diagnosing Down Syndrome?

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*Childhood seizures are common and frightening for

the parents, and the decision to initiate

prophylactic treatment after a first fit is a difficult

one. To help parents make their decision, you

need to explain the risk of further occurrences

following a single seizure of unknown cause.

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Population/problem

Intervention

Comparison/ control

Outcome

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Population/problem Children who have had one siezure of

unknown cause

IndicatorFebrile

Comparison/ control Non-febrile

OutcomeFurther seizure

Question In children who have had one seizure of unknown cause (either associated with a fever or not),what is the long term risk of further seizures?

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Population/problem Children who have had one siezure of unknown

cause

Indicator-

Comparison/ control -

OutcomeFurther seizure

Question In children who have had one seizure of unknown cause, what is the long term risk of further seizures?

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*What is your clinical question?