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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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Presentation Transcript
steps in the ebm process
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
Types of Clinical Questions
  • Therapy
  • Diagnosis
  • Etiology
  • Prognosis
  • Harm
  • Prevention
  • Quality Improvement
levels of evidence
Levels of Evidence

http://www.exempla.org/courses/FindBestEBM/pyramid/

slide5

From: http://www.uic.edu/depts/lib/lhs/resources/ebm/levels.shtml

More MEDLINE Filters at http://www.exempla.org/courses/FindBestEBM/pyramid/

slide6
PICO

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

slide7
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
clinical scenario 1
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
pico exercises
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?
pico exercises1
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?
searching pubmed

Searching PubMed

PubMed

Clinical Queries

Sandy De Groote

steps in the ebm process1
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
medline
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
exercise
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?