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Developing an Answerable Question

Developing an Answerable Question. PICO Jo Dorsch. Steps in the EBM process. Converting information need into a clinical question Searching the literature for the best evidence Critical appraisal of the literature Applying the literature Evaluation. Types of Clinical Questions. Therapy

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Developing an Answerable Question

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  1. Developing an Answerable Question PICO Jo Dorsch

  2. Steps in the EBM process • Converting information need into a clinical question • Searching the literature for the best evidence • Critical appraisal of the literature • Applying the literature • Evaluation

  3. Types of Clinical Questions • Therapy • Diagnosis • Etiology • Prognosis • Harm • Prevention • Quality Improvement

  4. Levels of Evidence http://www.exempla.org/courses/FindBestEBM/pyramid/

  5. From: http://www.uic.edu/depts/lib/lhs/resources/ebm/levels.shtml More MEDLINE Filters at http://www.exempla.org/courses/FindBestEBM/pyramid/

  6. PICO http://www.uic.edu/depts/lib/lhs/resources/ebm/pico.shtml

  7. PICO • Patient – 54 year old male with a cold Intervention – vitamin c • Comparison – no vitamin c • Outcome – prevent the common cold • Type of Question: Prevention / Treatment • Type of study design: RTC

  8. Clinical Scenario 1 • 55-yr old female; history of hypertension; sudden onset of chest pain and shortness of breath • Swelling in R leg for 2 days since return from recent vacation • Current meds: estrogens and atenelol • V/Q read as high probability for pulmonary embolism • Patient started on Lovenox; treatment with coumadin initiated in hospital • Sent home in stable condition; coumadin for 6 months

  9. PICO Exercises • Clinical Scenario 2: A 72 y/o male with osteoarthritis wants to take glucosamine and chondroitin sulfate instead of other meds. Is there any evidence of effectiveness? • Clinical Scenario 3: A women in her mid 40s with a family history of breast cancer is scheduling her yearly breast exam. Should an MRI or a mammogram be scheduled?

  10. PICO Exercises • Clinical scenario 4: You have an infant with suspected congenital heart disease and order an MRI. The parents request an echocardiogram. Which test should be performed or both? • Clinical scenario 5: In children with asthma, 2mg/kg of prednisone is commonly used. In other countries the usual dose is 1mg/kg. Which is more effective in reducing length of exacerbations?

  11. Searching PubMed PubMed Clinical Queries Sandy De Groote

  12. Steps in the EBM process • Converting information need into a clinical question • Searching the literature for the best evidence • Critical appraisal of the literature • Applying the literature • Evaluation

  13. MEDLINE • MEDLINE is premiere biomedical database. Produced by the National Library of Medicine, MEDLINE is an international bibliographic database of over 4500 biomedical journals. It covers the fields of medicine, nursing, dentistry, veterinary medicine, the health care system and the preclinical sciences. PubMed www.pubmed.gov -search for primary literature (also indexes meta-analyses and systematic reviews) - Clinical Queries • It dates from 1966 to the current

  14. Exercise • Search PubMed • Clinical Scenario 2 • Clinical Scenario 3 • Based on the results – select one or two that you think you might want to look at further. • Why did you choose it?

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