PICO is a systematic process for converting information needs and problems into a question that can be used to search the literature for evidence. PICO is an acronym for a four part clinical question that defines the patient problem, intervention, comparison and outcome-referred to as PICO.
A CAT is an organized one-page summary of the evidence related to a focused clinical question.
Evidence-based methods involve converting information needs or problems into a well-defined, specific clinical question that includes the problem, intervention, comparison, and outcome. The question is then used to comprehensively search for the evidence that answers the question. The compiled evidence is then critically appraised for its validity and usefulness (clinical applicability). (Sackett D, Richardson W, Rosenberg W, Haynes R. Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingston, 1997.)
Point-of Care Decision Support Tools are resources designed to be used by practitioners at the point of care to facilitate decision-making and the incorporation of current research into practice.
The American Dental Association (ADA) defines Evidence-Based Dentistry as, “An approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.”
The formalized process and structure for using the skills for identifying, searching for and interpreting the results of clinical research so that the best scientific evidence is considered in conjunction with experience and judgment, patient values, and clinical circumstances when making patient care decisions. (Forrest, Miller et al.)
The American Dental Association Accreditation Standards for Dental Education Programs now expect dental schools to develop specific competencies that are reflective of the evidence-based dentistry definition. The ADA Commission on Dental Accreditation states that, the dentist integrates individual clinical expertise with the best available external clinical evidence from systematic clinical research. Competencies for dental hygienists are stated in the American Dental Education Association Dental Hygiene Curriculum Guidelines: “Evaluate published clinical and basic science research and integrate this information to improve the oral health of the patient.”
By incorporating evidence in conjunction with experience and judgment, patient values, and clinical circumstances practitioners can be confident about patient care decisions. Patients also value answers to their questions that are supported by scientific evidence. However, scientific evidence is just one component of the decision making process. In many instances, the answer to clinical questions is that there is not enough evidence to support a specific therapy or product. Even in these instances, it is helpful to know the status of the available evidence so that the clinician can feel comfortable relying on experience and judgment, the patient values, and clinical circumstances.
The one page summaries can be used during training to educate staff regarding important clinical topics. They are also helpful to show to patients chairside when discussing relevant issues. For educators, they are concise summaries that can easily be shared with dental students in the clinic or in the classroom.