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Answering clinical questions

Page history last edited by jon.brassey@... 16 years, 1 month ago

A major part of this site is to help people answer clinical questions.  This includes a number of sections:

 

Asking a question - seems obvious/easy!  We often get questions which get radically restructured once we enter a conversation with the clinician.  With a vague question you get a vague answer.  People often suggest the PICO format (for more information see this Centre for EBM page - click here).  I find it counter-intuitive and don't use it.  However, understanding PICO is important as it helps appreciate the elements of a clear question.

 

Finding the evidence - this revolves around electronic databases and I will restrict to freely available resources.  The ones I favour are:

 

  • TRIP Database, specialises in secondary review articles as well numerous eTextbooks, primary research and a large collection of previously answered questions.  Also, includes special filters to automatically search PubMed via the clinical queries interface.
  • PubMed, contains over 17 million primary research articles, not all are relevant to clinical medicine.  Can be difficult to search, but experience helps (see our section 'How to search PubMed'
  • Google Scholar
  • Google

 

The above assumes that finding the evidence is linked with understanding which evidence is appropriate to the question e.g. a question on therapy is typically best answered using a systematic review or RCT.

 

Extracting the evidence. You've found the evidence, now what?  Experience again is key.  In training users the most frequent errors are:

 

  • Giving too much background material.  A doctor might ask about interventions in diabetes, that does not mean the doctor wants to hear that 'diabetes is a common condition that affects X% of the population'.  The doctor didn't ask about background!
  • Giving too much data.  A doctor might ask about the effects on HbA1c of a particular diabetes drug.  The clue here is that they are interested in HbA1c, not specifically mortality, morbidity.

 

Some example questions we've answered and a talk-through the methodology employed.

 

Q example: Statins in the elderly

Q example: Vitamin supplements post-gastroplasty

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