SCENARIO (PICO exercise)

Dewi Sutriani Mahalini

Scenario 1 (Diagnosis)

A female patient, 30 years old, come to hospital with the chief complain fever for 3 days.
The patient worries about Dengue Hemorrhage Fever infection, because she stay in
endemic area and many people in the her city had dengue infection. She ask to the doctor,
what is the the best test to confirmed the diagnosis of Dengue?. The doctor know there
are many kind diagnostic test for Dengue such as molecular testing (polymerase chain
reaction, PCR), rapid diagnostic test (RDT) such as NS1 antigen RDT and IgM and IgG
capture ELISA.

1. Identify what type of question of the above scenario?

2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values

Scenario 2 (Diagnosis)

A medical student, 21 years old, female came to a doctor with chief complaint of mass in
her left breast with 2 cm in diameter. Based on physical examination, the doctor didn’t
sure if the mass was a malignancy or not. The doctor told her to do mammography but
she was worried that mammography will expose her to x ray. She asked for
ultrasonography. She thought that ultrasonography was safer compared to
mammography. The problem was the doctor didn’t know if ultrasonography can
accurately diagnosed breast cancer compared to mammography.
1. Identify what type of question of the above scenario?
2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
 4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values

Scenario 3 (Aspek terapi)

The incidence of epilepsy is greatest in the first 2 years of life. Early control of seizures
can be associated with better developmental outcome but many of the epilepsies
presenting in infancy are poorly responsive to antiepileptic medication. The ketogenic
diet (KD) is a high-fat, low-carbohydrate diet designed to mimic the effects of starvation
on the body. Dietary fat is converted into ketones in the body and used as an energy
source by the brain. The KD has been shown to be successful in controlling seizures in
many observational studies. However the pediatric neurologist want to find the best
evident of KD in children.

1. Identify what type of question of the above scenario?

2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values

Scenario 4 (Aspek terapi)

Asthma is a prevalent chronic disease of the respiratory system and acute asthma
exacerbations are among the most common causes of presentation to the emergency
department (ED) and admission to hospital particularly in children. Bronchial airways
inflammation is the most prominent pathological feature of asthma. Inhaled
corticosteroids (ICS), through their anti-inflammatory effects have been the mainstay of
treatment of asthma for many years. Systemic and Inhaled corticosteroids (ICS) are also
 used in the treatment of acute asthma exacerbations. Several international asthma
management guidelines recommend the use of systemic corticosteroids in the
management of moderate to severe acute asthma early upon presentation to the ED. The
doctor want to find the best evident about the medicine.

1. Identify what type of question of the above scenario?

2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values

Scenario 5 (Risk factor)

Some patients with Coronary Artery Disease (CAD) have no well-known risk factors of
this disease, but are diagnosed with cardiovascular events. Atherosclerosis is one of the
major causes of death worldwide. Knowledge of the risk factors of atherosclerosis plays a
significant role in prevention and treatment of this disease. Recently, in addition to the
known risk factors, other new risk factors, including APO lipoprotein A1 and APO
lipoprotein B, have been proposed for this disease. In clinical conditions, High Density
Lipoprotein Cholesterol (HDL–C) and APO A1 have anti-atherogenic effect. We want to
find the best evidence about risk factor association to the severity of CAD and determine
whether these parameters are better predictors of Ischemic Heart Disease (IHD).

1. Identify what type of question of the above scenario?

2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values
Scenario 6 (Aspek Prognosis)

Intracerebral hemorrhage (ICH), a form of stroke syndrome results from the rupture of an
intracerebral vessel. The parents of children 2 years old with hemorrhage stroke ask to the
doctor about their quality of live after the disease. The doctor want to find the best evidence to
determine long-term prognosis of intracranial hemorrhage in children.

1. Identify what type of question of the above scenario?

2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values

Scenario 7 (Aspek Prognosis)

Patients with epilepsy are frequently required to take antiepileptic drugs (AEDs) for a
long period of time. Many studies have shown that AEDs have a negative influence on
endocrine function including the thyroid gland, however the risk factors for the
development of low thyroid function in these patients are unclear. As a Pediatrician, we
want to determine the potential risk factors of low thyroid function in patients with
epilepsy by search the best evidence.

1. Identify what type of question of the above scenario?

2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values

Scenario 8 (cohort/ aspek terapi)

 A 40 years old man who work as a teacher in department of Agriculture, had diabetes
mellitus for 6 years, came to a doctor. The doctor said that he had mild decreased of renal
function (secondary to diabetic nephropathy). The doctor advised him to have low protein
diet and go to a dietitian to ask for a menu that he needed. He asked if the low protein
diet really necessary because other doctor advised him to have a low calories and normal
protein intake to maintain his nutritional status. This doctor told him that low protein diet
was needed to prevent the progression of renal failure. He was confused which doctor
was right and asked for an evidence. The doctor didn’t have an evidence to show his
patient. Could you help this doctor to find evidence from the internet?
1. Identify what type of question of the above scenario?
2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values

Scenario 9 (aspek Prognosis)

A marketing staff from a well-known laboratory came to a doctor to offer a homocysteine

serum test for diabetes mellitus patients. This staff said that this new marker,
homocysteine, can predict the mortality rate in patients if the level in serum was high.
The doctor asked for an evidence for that statement. The staff didn’t have the answer for
the doctor question. Could you help the marketing staff to search for the evidence from
the internet?
1. Identify what type of question of the above scenario?
2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values
Scenario 10 (Aspek terapi and harm))

Japanese encephalitis (JE) caused by mosquito-borne Flavivirus is one of the leading causes of
viral encephalitis in Asia. A number of Japanese encephalitis (JE) vaccines have been used for
preventing Japanese encephalitis around the world. We want to know the immunogenicity and
safety of the currently available Japanese encephalitis vaccines in adult or in children.

1. Identify what type of question of the above scenario?

2. Please, build up a clinical research question using PICO !
3. Formulate a clinical research question from scenario above !
4. Please search the best evidence (journal) to answer the clinical research question?
5. Critically appraise the evidence/ journal that you find from your search! (Find out
how good it is and what it means)
6. Apply the evidence: integrate the results with clinical expertise and patient values