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Replacing PICO in non-interventional studies
  1. Yishai Mintzker1,2,
  2. Dalit Blum3,4,
  3. Limor Adler2,3
  1. 1 Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Zafed, Israel
  2. 2 Department of family medicine, Maccabi Healthcare Services, Tel Aviv, Israel
  3. 3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  4. 4 Department of family medicine, Clalit Health Services, Tel Aviv, Israel
  1. Correspondence to Dr Yishai Mintzker, Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Zafed 1311502, Israel; mintzker_y{at}

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Dr Luijendijk1 has identified an elephant in the evidence-based medicine (EBM) classroom: patient, intervention, comparison, outcome (PICO acronym) for the formulation of clinical questions, teaching EBM and searching the literature is extremely useful for interventional studies but confusing for other types of studies. Instead of forcing words into the acronym, we suggest adding two acronyms.

The acronym PECO (E for exposure) can replace PICO in observational studies. This acronym is already used for environmental exposures2 but can be used for any exposure, including …

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  • Contributors YM drafted the article. DB and LA edited and approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.