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Developing PICCO topics and questions



Developing PICCO topics and questions

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One of the most extraordinary stimulating tasks a researcher may chance meeting while initiating a project is developing a researchable question. Unreciprocated issues in existing clinical practice or case involvements define alternative therapies that may result in a researcher formulating a clinical research question or topic. The article comprises of step to step strategies of developing and preparing a research question. The paper has also described PICO (population, intervention, control, as well as outcomes. It is a criterion utilized in enclosing a research question. It is also crucial to evaluate the research features questioning the context of starting the research project.

Also read: Nursing written assignment


  1. abstract
  2. Introduction to formulating PICCO question.
  3. Method
  4. Formulating PICCO question
  5. Assessing the question
  6. Literature review
  7. Search databases
  8. Recommendation and limitation
  9. Summary of other articles
  10. references
Key research paperdiscussion
AbstractThe section contains a summary of the research paper. It also involves proceedings, review, thesis, and in-depth.
MethodsThe section of methods in the research paper offers information in which developing questions using PICO research validity was judged. It also describes what was done to conclude on the question
Purpose aThe purpose of the study is to develop a well formulated PICO question. The question is utilized to detect the appropriate resources for searching purposes.
Summary of other articlesThe section involves a brief summary of other articles that are related to the main topic.
BackgroundPICO questions are informational and are aimed at improving the understandings of the patient by assisting during research.
ResultsThe results include the effects wanted to be identified. It also contains the side effects associated with the form of testing and treatment.
referenceNielson et al 2020. States the facts of formulating a research question.

Garibotto (2017). The articles highlights the search engines for ovid,

Frisoni (2017) the articles talks about filtering a research question.

Vaingankar (2017). The articles introduces the foreground and background of the question.

Subramaniam (2020). The article outlines the limitations of using PICO in formatting research question.

García‐Ruiz (2017). The article dictates the advantanges and conclusions of PICO formulated questions.

Klein, M. B., Cooper, C., Brouillette, M. J., Sheehan, N. L., Benkelfat, C., Annable, L., … & CTN194 Investigators. (2008). CTN-194 (PICCO): design of a trial of citalopram for the prevention of depression and its consequences in HIV-hepatitis C co-infected individuals initiating pegylated interferon/ribavirin therapy. Contemporary clinical trials29(4), 617-630.The last four articles summarize on formulation of research questions using PICO


A question to be researched involves uncertainty concerning the problem to be defied, analyzed, and examined to deliver relevant info. A significant and essential research project mainly be contingent on how good the investigator will formulate the research question (Garibotto et al., 2017). The item must be grounded on the challenges encountered in our daily research events and clinical exercise. The questions fundamental on a research project offers crucial information to resolve whether the topic is pertinent, researchable, and meaningful. A well-formulated research question should include life-threatening specify, which as well as preciseness, which directs the project implementation. Preciseness Should bear the identification of variables and interest population. The paper contains a clinical scenario that evaluates hoe clinical questions may arise. It also includes strategies guiding on how to find shreds of evidence to answers the problem.


The problem was first formulated by identifying specific research objectives. There was the use of relevant questions to understand the context of the problem. The research also entails understanding the phenomena of interests such as behaviors, interventions, and experiences. The study is assessed through the use of crucial clinical questions.

Formulation of the question of research


A three years old boy has presented himself in a case clinic. He has a malaise and unadorned pain coming from the ear on his right. He has been frequently diagnosed with recurrent year infections. His mother has concerns antibiotic amoxicillin has been on him for the previous few months. She is also concerned about using antibiotics for an extended period. She is also worried about the outcome related to ear infections, which occur recurrently. She wants to be explained about the effectiveness of the set amoxicillin. She requests to know if the prescription can be substituted with another available antibiotic since amoxicillin has frequently used diarrhea

Numerous questions ascend from the case, and they can be generally categorized into the foreground and background questions (Frisoni et al., 2017). The general questions related to a disease or clinical problem are regarded as background questions. The questions aim to know when, how, where, and what about the disorder, treatment, and disease. The items may include what otitis media is and how the amoxicillin works.

Patient-oriented questions involve interpreting the disease or therapy and benefits to patients and groups versus considering the risk. These forms of complex clinical problems are answered effectively through pre-assessed and primary literature studies. The questions usually associate either two diagnostic methods or two treatments and drugs. The PICO format is considered a broad known technique for enclosing a foreground in the question of research. Partitioning the problem into four PICO features enhances the facilitation of identifying pertinent info.


OutcomeThe interesting outcome
Interest of populationThe patient and challenge pending to be tackled.
InterventionExposure and treatments to be evaluated
ControlComparison intervention treatment and control standard care
Feasibilityadequate resources as far as staff, time, and funding are concerned. Utilization of appropriate design of study managed in scope sample size.

Population and problem

It is very crucial to address a specific population, demographic information, and its characteristics. In this case, one can identify the pediatric populace and media of otitis, range of phase, history, gender, and complaint presentation.

Intervention and interest treatment

Interventions can either be a diagnostic test, process, or a problem. It can also involve risk and prognostic factors. According to this case, the intervention should be a plan to treat the patient using the diagnostic test, procedure, and prognostic factor. Based on the clinic’s observation, alternative better treatment selection could be cefuroxime compared to amoxicillin in treating otitis media. However, one has no specific assurance about the efficacy of pediatric information with otitis media.

Comparator and control

This occurs when a new therapy tends to be associated with a new current one.


It is the main consequence of the intervention. It may include its overall efficiency in the control of the pain (García‐Ruiz et al., 2016). This implies that the outcome is in a more significant position than the case and can relieve pain and resolution to the infection. It can also decrease the danger of creating resistance. A significant primary outcome must be specific, valid, computable, reproducible, and suitable for research.

Table summary of FINER
F; feasibilityinvolves adequacy of resources concerning time, funding and staff. It also entails appropriate designs and manageable scope
I; interestingShould be interesting as the researcher as well as the collaborator. investigator’s motivation should make the research interesting
N; novelNew and extensions of previous findings accompanied by the thorough literature search. There should guide mentors.
E; ethicalShould follow ethical guidelines and approval from institutional review.
R; relevantThere should be influence from clinical practice and furthering research as well as health policy.

In a clinic’s distinctive setting, the clinician should understand the background and foreground questions question based on a therapy or a particular disease’s experiences. After answering background questions, more complex problems should be addressed. Clinical questions usually are a result of central issues from clinical work. This may include the leading causes of risk factors (etiological questions), comparison of diagnostics tests grounded on specificity and sensitivity, identification of the effective treatment options (therapeutic options), and the treatment outcome (prognostic questions).

The PICO approach is later followed after determining the foreground question. Dissecting the item into several parts make it searchable and easy. About the case, there are several relevant questions. For example, in association with the recurrent ear, what is the possible outcome. What are the potential side effects of using antibiotics for a long time? What harm may be as a result of using the current mode of treatment?

When all the information is gathered for the PICO approach, the following are seral researchable questions that can be formulated:

Relation to children suffering from acute otitis media (P) can use cefuroxime (I) effective by reducing the duration of the symptoms (O) compared to amoxicillin (C)?

From children who suffer from otitis media, can cefuroxime reduce developing resistance and improvement in symptoms?

Does surgery’s procedure have a better treatment outcome for children with otitis media after a recurrent antibiotic therapy?

Does amoxicillin treatment increase develop resistance risk in children from otitis media?

Articles summary

Formulating multiple questions

The article’s author has highlighted that formulated multiple questions are based on the patient’s concerns and illness (Nielsen et al., 2020). The strategy can be used for selecting the best effective options. For instance, one can evaluate the question containing more significance to the well-being of the patient. It is essential to assessing has relevant knowledge needs and the problem, which might lead to exciting answers for clinical queries and patients. It is also crucial to consider the feasibility of attaining evidence in a short period.

Evaluating the question of research in the perspective of design study

A research question should be formulated so that the FINER (novel, interesting, feasible, relevant, and ethical). The answer must have the capability of filling the gaps found in the current knowledge. While assessing the research question, it is crucial to determine the needed resources (Vaingankar et al., 2016). One should also evaluate each element’s cost, including research staff, resources, and study design. A biostatistician should be consulted to advise the less expensive method and outcomes. The investigator should consider the possibility of enrolling the needed figure of subjects all the interested population. The inclusion of the criteria should be expanded if it seems complicated to enrol in the required number.

Importance of making it relevant and interesting

The author of the article has highlighted that any crucial question can fail to be engaging in the way it is accessible. It is always tricky to present a problem of research and hire the learners’ attention and interests (Klein et al., 2008). The author has described the investigation as too much work, which requires a passion for investigating. Working with passion will enable the investigator to have more support for the study being carried out. It is also easier to publish if the topic is in a novel (Kowalski et al.). The collaborators, colleagues, and the community at large will also be interested in the work. It is essential to carry out a question of research to receive the whole truth out of the issue.

Conducting a literature review

As depicted in the article, any research question’s innovation is based on the literature review (Picco et al., 2020). There is no need to replicate an already existing literature. It can only be repeated if the question approaches the problem in an existing way. The literature review aims to ensure that the research aligns with the topic of interest. It also determines how the research has been steered and the existing gaps in the understanding.

Summary flowchart

Search databases

The author has recommended PubMed, CINAHL, Medline Plus, and web science as the primary tool of search databases. However, there is no restriction using other additional databases. PubMed is a user-friendly clinical query used to look for evidence associated with clinical practices. It correspondingly delivers material to search for MEDLINE by conducting segmented research for diagnostic and etiological, extrapolative, and therapeutic searches. Besides, there is an American college for physicians and clinical evidence from publishing groups that are exceptional schemes to look for confirmation of vital inquiries.

Evidence-based medicine

Based on evidence and systematic assessments, medicine has been considered the best approach for proof, as depicted from the post. Systematic reviews are considered the best strategy to find evidence for evidence-based treatments (Duquennoy et al., 2018). They are also rigorous techniques of synthesizing and collecting results of numerous quality studies. Steering a detailed search also aids in identifying the system’s data and calculate the magnitude of the sample. It also helps determine the type of analysis being shown as the research is looking at the difference.

Recommendations and conclusions

The child may be suffering from chronic year infections. It is recommended for the ear infection to be treated promptly. The doctor should prescribe antibiotics that should be taken orally and intravenously if the infection tends to be severe. Year drops should be suggested if there is an eardrum perforation (Delamaro, 2002). If the chronic illness is not responding to medications, the doctor can recommend a surgery. A surgery is mainly required to clean out infections if they spread to mastoids bones.


Using PICCO form formulating research questions may pose several disadvantages. Real-world clinical questions may fail to be structured in accordance with its standards. PICCO knowledge may fail to be suitable for the representation of clinical problems. There may be several concepts and relationships that fail to be captured during PICCO representation.

Summary of other articles

The last four articles highlight the summary of formulating a well-based research question. The authors have all expressed that and conquered that a formulated question of the research is the main initializing point in initializing a research eminence project. It is a good starting point in conducting clinical practice based on evidence. The frameworks presented in the four articles can assist clinicians in formulating a question and the search for the answer. The content from the authors can also help researchers develop new research projects. The best standard methodology is first to detect the question and the literature review based on the FINER and PICO criteria. A good-designed question of research will usually result in the practical design of the study and methodology. The Articles highlight that discussing the problem with biostatisticians, peers, chairs, departments, and mentors at the starting part will result in the completion of a significant project. Other several steps should also be considered, including the clinical trial phase, informed consent, clinical trial, employees, and amenities, and resource constraints should be assessed while framing the question. The articles have also introduced the concepts of foreground and background questions and forms of different problems in the process. The documents include harm, diagnosis, therapy, and is critical to focus on one project at a time ((Ulloa et al, 2020). It should be based on the benefit to main objectives driving the study design and the status of the patient’s health once the research question’s formulation is complete. It is vital to keep updated on the development to find the answer and apply the results to a patient population.

A good question should lead to specific facts apart from opinions, and it should be linked clearly to the general research project objectives. An intensive question of research usually results in the preparation of the study in a systematic manner. The encounter of research question framing does not usually come from a lack of concepts. The main challenge is the transformation of an original question to a good project of the study. This is another step in the filtering process of the research question.

Search engines, including OVID, offers a wide selection of journals and texts. They provide access to additional databases, including the Cochrane library, which contains full books and systematic reviews. A good literature question should be aimed at finding the knowns and unknowns about the project topic.


Garibotto, V., Herholz, K., Boccardi, M., Picco, A., Varrone, A., Nordberg, A., … & for the Roadmap, G. T. F. (2017). Clinical validity of brain fluorodeoxyglucose positron emission tomography as a biomarker for Alzheimer’s disease in a structured 5-phase development framework. Neurobiology of Aging52, 183-195.

Frisoni, G. B., Boccardi, M., Barkhof, F., Blennow, K., Cappa, S., Chiotis, K., … & Hansson, O. (2017). Strategic roadmap for early diagnosis of Alzheimer’s disease based on biomarkers. The Lancet Neurology16(8), 661-676.

Nielsen, S., Picco, L., Campbell, G., Lintzeris, N., Larance, B., Farrell, M., … & Bruno, R. (2020). Development of a brief patient-administered screening tool for prescription opioid dependence for primary care settings. Pain Medicine21(2), e79-e88.

Nielsen, S., Picco, L., Kowalski, M., Sanfilippo, P., Wood, P., Larney, S., … & Ritter, A. (2020). Routine opioid outcome monitoring in community pharmacy: Outcomes from an open-label single-arm implementation-effectiveness pilot study. Research in Social and Administrative Pharmacy.

Picco, L., Yuan, Q., Vaingankar, J. A., Chang, S., Abdin, E., Chua, H. C., … & Subramaniam, M. (2017). Positive mental health among health professionals working at a psychiatric hospital. PloS one12(6), e0178359.

Boano, C. A., Duquennoy, S., Förster, A., Gnawali, O., Jacob, R., Kim, H. S., … & Vilajosana, X. (2018, April). IoTBench: Towards a benchmark for low-power wireless networking. In 2018 IEEE Workshop on Benchmarking Cyber-Physical Networks and Systems (CPSBench) (pp. 36-41). IEEE.


Ulloa, H., Iroumé, A., Picco, L., Vergara, G., Sitzia, T., Mao, L., & Mazzorana, B. (2020). Do the morphological characteristics of Chilean gravel-bed rivers exhibit latitudinal patterns?. Journal of South American Earth Sciences99, 102522.

Picco, N., Hippenmeyer, S., Rodarte, J., Streicher, C., Molnár, Z., Maini, P. K., & Woolley, T. E. (2019). A mathematical insight into cell labelling experiments for clonal analysis. Journal of anatomy235(3), 687-696.

Delamaro, M., & Picco, G. P. (2002, October). Mobile code in. net: A porting experience. In International Conference on Mobile Agents (pp. 16-31). Springer, Berlin, Heidelberg.

García‐Ruiz, J. M., Beguería, S., Lana‐Renault, N., Nadal‐Romero, E., & Cerdà, A. (2017). Ongoing and emerging questions in water erosion studies. Land Degradation & Development28(1), 5-21.

Subramaniam, M., Abdin, E., Vaingankar, J., Picco, L., Shahwan, S., Jeyagurunathan, A., … & Chong, S. A. (2016). Prevalence of psychotic symptoms among older adults in an Asian population. International Psychogeriatrics28(7), 1211.

Klein, M. B., Cooper, C., Brouillette, M. J., Sheehan, N. L., Benkelfat, C., Annable, L., … & CTN194 Investigators. (2008). CTN-194 (PICCO): design of a trial of citalopram for the prevention of depression and its consequences in HIV-hepatitis C co-infected individuals initiating pegylated interferon/ribavirin therapy. Contemporary clinical trials29(4), 617-630.

More resources: Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial

Last Updated on September 13, 2020

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