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lets go through this example a 52 year old male is admitted through the emergency department for presumed acute bacterial meningitis fluids and antibiotic treatment are started but the emergency department physicians did not start a corticosteroid instead they wanted to wait for the lumbar puncture results lets go through this situation and identify the question regarding whether we need a corticosteroid or not this would be a typical question that would come up with managing acute bacterial meningitis and the answer to this question is not written in stone so lets go through the Pico format what kind of patients are we talking about the patient part of Pico will be adults admitted with presumed acute bacterial meningitis how about the intervention well it is the use of some sort of corticosteroid and we dont have to be any more specific than that what is the comparator the comparison would be no additional treatment or in a study a placebo treatment last is the outcome in other wo