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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