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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Why PICO?
- Jessica M. Langenhoff (22 April 2009)
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Re: Why PICO?
- Trish Groves (22 April 2009)
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Effect of food intake during labour on obstetric outcome. A response
- David R. Windsor, Mike McSwiney (1 May 2009)
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Jessica M. Langenhoff, information specialist NL 2300 RC Leiden
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With great interest I read the PICO summary of this article in in the paper version of BMJ. The summary of this article seems to reflect the contents of the full article adequately. Publishing abbreviated research articles to enhance reading of research studies, which is often considered to be too time- consuming, is a good idea. It can help busy clinicians keeping up with literature. Studies like this one should find their way to clinical practice as fast as possible. It will prevent patients from being exposed to habit- of even ritual-based care instead of evidence based care. The publication of high quality summaries possibly contributes to evidence based medicine. My question is: why do you call this a PICO? Generally, a PICO is an aid to formulate clinical questions in a way which supports literature searching. Therefore it is sometimes used as a synonym for critical appraised topics. The original article is a primary study, not a review article or a CAT. In the summary of the above mentioned article, all the elements of PICO ( patients: primiparous women in labour, intervention: allowing them to eat and drink light as they prefer, compare: water only, outcome: normal vaginal delivery rate) are present but not highlighted. It might be a good idea to structure the PICO article in this way as it possibly supports the readers. Competing interests: None declared |
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Trish Groves, deputy editor BMJ
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It was good to hear from Jessica M. Langenhoff that the abridged version of this paper (the BMJ pico) in the print BMJ summed up the paper well. Ms Langenhoff asks "Why Pico?". BMJ pico is essentially an extended abstract that gives the research question, study design, and findings, along with details of funding and competing interests. [1] We chose the term "pico" because it means small (10 to the power of minus 12 in SI units) and is also the name of the widely used critical appraisal tool PICO (population, intervention or exposure, comparison, outcomes), which this new format echoes but does not exactly replicate. For nearly 10 years we've been abridging research articles to better engage readers of the print BMJ, using a process called ELPS (electronic long, paper short). We believe BMJ pico to be a clearer, more readable format, and much less likely to be confused with the full research articles that are published - with full text that has no word limit and with open access - on bmj.com. BMJ pico gives authors more control, because they produce their own BMJ picos using basic templates from us. And it allows us to fit more research papers into each print issue, saving paper and freeing up resources we would rather spend on improving our services to authors and readers. 1. Groves T, Godlee F. Innovations in publishing BMJ research. BMJ 2008;337:a3123 Competing interests: I'm the BMJ's senior research editor |
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David R. Windsor, StR2 Anaesthesia Cheltenham General Hospital, GL53 7AN, Mike McSwiney
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We wish to extend our congratulations to O’Sullivan et al on the content of their paper. However, we would like to add a note of caution to the broader conclusions that might be made following a reading of the PICO version.
The paper demonstrates that feeding obstetric patients did not alter the incidence of vaginal delivery. We believe that it is important to emphasise that feeding parturients is not without risk. The successful reduction in maternal morbidity and mortality is a triumph of modern medicine. One turning point in this reduction was the recognition and subsequent prevention of ‘Mendelson’s syndrome’. Aspiration of gastric contents and resulting chemical pneumonitis occurs in 1 in 3216(1) all general anaesthetics , has a mortality of 30 percent and accounts for up to 20 percent of all deaths attributable to anaesthesia(2). The obstetric population has a tenfold risk of failed intubation when compared with the general population. This translates to a frequency of 1 in 250 and a more recent report suggested an increase to 1 in 130(3), attributed to the reduced exposure to obstetric general anaesthetics amongst trainee anaesthetists. Mendelson’s syndrome is more common in the obstetric population(4)and is associated with failed intubation. This has led to the increasing use of regional anaesthesia in obstetric emergencies. The result is a significant reduction in obstetric deaths. General anaesthesia is however, still inevitable in some cases and emergency caesarean section remains unpredictable. What is predictable is that; non fasted obstetric patients have a much greater risk of gastric aspiration than the fasted normal population. If low risk women are offered a light, easily digestible diet during labour they should be advised this will not improve their obstetric and neonatal outcome(5), but should they be advised that it may do them harm? Dr D. R. Windsor (StR2 in Anaesthesia)
References 1) Warner MA, Warner ME, Weber JG. Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology. 1993;78(1):56-62 2) Knight, P.R, Curtis L. Mendelson, M.D.: Aspiration Investigator. American Society of Anaesthesiologists Newsletter. Sept 1999;63(9) www.asahq.org/Newsletters/1999/09_99/mendelson.html 3) Jenkins, J. G. Failed intubation during obstetric anaesthesia. British Journal of Anaesthesia. 1996;77:698. 4) Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191-205. 5) O’Sullivan G, Liu B, Hart D, Seed P, and Shennan A. Effect of food intake during labour on obstetric outcome: randomised controlled trial. BMJ 2009; 338: b784 Competing interests: None declared |
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