The first step in formulating a clinical question in the PICO format is to consider the clinical problem you face. Your key clinical challenge is to manage the problem affecting your patient or group of patients, and to identify evidence to support the best approach, you need to clearly define the problem.
It is helpful to think in terms of the population you are dealing with and to characterise your patient in general terms (e.g. ‘A 14-year-old cat’ with ‘a diagnosis of chronic kidney disease’).
In simple terms, you are looking to identify a group of patients similar to the one you are concerned about. At this stage, it can be difficult to decide how specific to be in terms of defining the population and problem. A sensible guideline is to be reasonably specific at first, while being prepared to loosen your definition of the patient if the definition does not yield sufficient evidence in a literature search.
You also need to use your clinical common sense; you are likely to find studies that include evidence regarding the management of geriatric cats in chronic renal failure, while you are unlikely to find many (if any!) studies on specific breeds at precise ages.
|Which diet is best to feed to cats with chronic renal disease?||Cats with chronic renal disease|
|Which diagnostic test is most reliable for diagnosing fascioliasis in lactating dairy cattle?||Lactating dairy cattle|
|Does sex affect survival in flat-coat retrievers with cancer?||Flat-coated retrievers with cutaneous lymphoma|
|What are the risks of general anaesthesia in ferrets?||Ferrets|
|What is the prevalence of cardiac disorders in Welsh Section A mountain ponies?||Horses|