Formulate an answerable question: Difference between revisions
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Every time we see a patient, we need new information about some element of the diagnosis, prognosis or management. Because our time to try to find this information is often limited, we need to be very efficient in our searching. To achieve this efficiency, we need to become skilled at formulating clinical questions<ref name="KTCH">Formulating and answerable question. KT Clearinghouse, Centre for Evidence Based Medicine, Toronto. Accessed at http://ktclearinghouse.ca/cebm/practise/formulate on24 March 2015</ref>. | Every time we see a patient, we need new information about some element of the diagnosis, prognosis or management. Because our time to try to find this information is often limited, we need to be very efficient in our searching. To achieve this efficiency, we need to become skilled at formulating clinical questions<ref name="KTCH">Formulating and answerable question. KT Clearinghouse, Centre for Evidence Based Medicine, Toronto. Accessed at http://ktclearinghouse.ca/cebm/practise/formulate on24 March 2015</ref>. | ||
This first step in evidence-based practice is to formulate a specific question. The question you have concerning your practice should be formulated so it is possible to find a scientific answer to the question. Posing specific questions relevant to a patient’s problem provides a focus to thinking, and it helps in the formulation of search strategies and in the process of critical appraisal of evidence.<ref name="Herbert" /> | This first step in evidence-based practice is to formulate a specific question. The question you have concerning your practice should be formulated so it is possible to find a scientific answer to the question. Posing specific questions relevant to a patient’s problem provides a focus to thinking, and it helps in the formulation of search strategies and in the process of critical appraisal of evidence.<ref name="Herbert" /> | ||
== Types Of question: == | == Types Of question: == | ||
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=== Background Questions === | === Background Questions === | ||
Background questions ask for general knowledge about a disorder and contain two essentials components<ref>http://www.ebnp.co.uk/Background%20Questions.htm | Background questions ask for general knowledge about a disorder and contain two essentials components<ref name="Morton">Morton and Morton. Background questions. In Evidence Based Practive Nursing. Accessed at http://www.ebnp.co.uk/Background%20Questions.htm on 21 March 2015</ref><span style="line-height: 1.5em; font-size: 13.2799997329712px;">:</span> | ||
*A question root (who, what, where, how, why) | *A question root (who, what, where, how, why) | ||
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=== Outcome: === | === Outcome: === | ||
The clinical outcome or effects you are interested in, for example: improvement of symptoms, reducation of pain, improved quality of life, cost effectiveness and benefits for the service provider. | The clinical outcome or effects you are interested in, for example: improvement of symptoms, reducation of pain, improved quality of life, cost effectiveness and benefits for the service provider. | ||
== Examples == | == Examples == | ||
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1DgoOSh9lgM8Qe2DVNCTiK7YOvFvV9c4dQXISofSops6sR1QYx!!|charset=UTF8|short|max=10</rss>
</div> | <div class="researchbox">
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1DgoOSh9lgM8Qe2DVNCTiK7YOvFvV9c4dQXISofSops6sR1QYx!!|charset=UTF8|short|max=10</rss>
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== References == | == References == | ||
<references /> | <references /> | ||
[[Category:EBP]] | [[Category:EBP]] | ||
Revision as of 07:54, 24 March 2015
Description:[edit | edit source]
Every time we see a patient, we need new information about some element of the diagnosis, prognosis or management. Because our time to try to find this information is often limited, we need to be very efficient in our searching. To achieve this efficiency, we need to become skilled at formulating clinical questions[1].
This first step in evidence-based practice is to formulate a specific question. The question you have concerning your practice should be formulated so it is possible to find a scientific answer to the question. Posing specific questions relevant to a patient’s problem provides a focus to thinking, and it helps in the formulation of search strategies and in the process of critical appraisal of evidence.[2]
Types Of question:[edit | edit source]
Background Questions[edit | edit source]
Background questions ask for general knowledge about a disorder and contain two essentials components[3]:
- A question root (who, what, where, how, why)
- A disorder or aspect of a disorder
Textbooks answer background questions. Not all topics are covered, easy to use, relatively inexpensive and can be opinion-based rather than evidence-based, written by experts in their fields.
Foreground Question[edit | edit source]
Foreground questions are descriptive and ask for specific knowledge about managing patients with a disorder. These types of questions have a number of essential components (PICO analysis)[4]:
- P - Patient/problem
- I – Intervention
- C - Comparison or control
- O - Outcome
PICO Questions[2][edit | edit source]
Before we begin the hunt for evidence that relates to our clinical questions,we need to spend some time making the questions specific. Structuring and refining the question makes it easier to find an answer. One way to do this is to break the problem into parts.
We break questions in 4 parts:
- Patient group
- Intervention (cause, diagnostic test, treatment etc0
- Comparison intervention
- Outcome
Patient or Problem:[edit | edit source]
This involves identifying those characteristics of the patient or problem that are most likely to influence the effects of the intervention. If you specify the patient or problem in a very detailed way you will probably not get an answer, because the evidence is usually not capable of providing very specific answers. So a compromise has to be reached between specifying enough detail to get a relevant answer, but not too
much detail to preclude getting any answer at all.
Intervention :
[edit | edit source]
This includes the intervention that we are interested in and what we want to compare the effect of that intervention to.
- Type of treatment (drug, procedure, therapy)
- Intervention level (dosage, frequency)
- Stage of intervention (preventative, early, advanced)
- Delivery (who delivers the intervention? where?)
Comparison intervention:[edit | edit source]
This is relevant when looking at most 'Therapy' questions. It compares the effect of an intervention to no intervention, or to another alternative intervention. There may not always be a comparison
Outcome:[edit | edit source]
The clinical outcome or effects you are interested in, for example: improvement of symptoms, reducation of pain, improved quality of life, cost effectiveness and benefits for the service provider.
Examples[edit | edit source]
1. In patients with suspected pulmonary fibrosis, how does high-resolution CT compare with lung biopsy for establishing the diagnosis?”
- P = Pulmonary fibrosis
- I = High-resolution CT
- C = Lung biopsy
- O = Sensitivity/specificity
2. Do obstetrical complications during pregnancy increase the likelihood of schizophrenia in the child
- P = Pregnant Female
- I = Obstetrical complications
- C = No obstetrical complications
- O = Child hood
3. In patients with recurrent furunculosis, do prophylactic antibiotics, compared to no treatment, reduce the recurrence rate?’
- P = patients with recurrent furunculosis
- I = prophylactic antibiotics
- C = no treatment
- O = reduction in recurrence rate of furunculosis[5]
Recent Related Research (from Pubmed) [edit | edit source]
References[edit | edit source]
- ↑ Formulating and answerable question. KT Clearinghouse, Centre for Evidence Based Medicine, Toronto. Accessed at http://ktclearinghouse.ca/cebm/practise/formulate on24 March 2015
- ↑ 2.0 2.1 Herbert, Jamtvedt, Hagen, Mead. Practical Evidence-Based Physiotherapy, Elsevier, 2011.
- ↑ Morton and Morton. Background questions. In Evidence Based Practive Nursing. Accessed at http://www.ebnp.co.uk/Background%20Questions.htm on 21 March 2015
- ↑ Sacket DL, Straus SL, Richardson WS, Rosenberg W and Haynes RB (2000) Evidence-based medicine. How to practice and teach EBM. Edinburgh: Churchill Livingstone.
- ↑ http://learntech.physiol.ox.ac.uk/cochrane_tutorial/cochlibd0e187.phpfckLRMedical Literature Searching Skills
