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Formulating Clinical Question AND Searching The Medical Literature. Session Objectives. By the end of this session and your practical training you will be able to: recognize your knowledge gap, when facing clinical problem Formulate clinical questions according to your learning needs

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Formulating clinical question and searching the medical literature

Formulating Clinical Question AND Searching The Medical Literature


Session objectives
Session Objectives

  • By the end of this session and your practical training you will be able to:

    • recognize your knowledge gap, when facing clinical problem

    • Formulate clinical questions according to your learning needs

    • Understand the necessary steps you take to solve the problem?

    • Know electronic medical resources you use to gain knowledge?


Clinical scenario
Clinical scenario

  • Your patient is a three years old male, presented to the ER with Purpura, mild gum bleeding

  • The patient is clinically stable, and his physical examination is otherwise normal

  • Complete blood count is totally normal apart from severe thrombocytopenia ( platelet count<10000/mm).

  • You decided to admit the child and start treatment with intravenous immunoglobulin.

  • One student asked you if treatment with pulsed high dose methyl-prednisolone would result in similar improvement at much lower cost for the hospital?


Types of questions raised
Types of questions raised

  • What is idiopathic thrombocytopenic purpura

  • What is the clinical signs and symptoms?

  • How can we diagnose this disease?

  • What are the treatment options for ITP?

Background Questions


Back ground questions
Back ground questions

  • When you need to know more information about the disease


Types of questions raised1
Types of questions raised

  • In child suffering from ITP does treatment with steroids, compared to IVIG results in rapid cure

  • In children suffering from ITP is complete blood picture as accurate as bone marrow aspirate in diagnosis.

Foreground question


Foreground questions
Foreground questions

  • When you need to know information that you will:

    • Tell your patient about

    • Decide on his management

      • Usually related to

        • Diagnosis

        • Therapy

        • Prognosis

        • harm


Your therapy question the pico

Patient/

Population

Intervention/

Exposure

Comparison

Outcome

Your Therapy QuestionThe PICO

Steroids

IVIG

Child with

acute ITP

Rapid cure


Your diagnosis pico question

Patient/

Population

Intervention/

Exposure

Comparison

Outcome

Your Diagnosis PICO Question

Child with

Acute ITP

Blood

picture

Bone

marrow

Accurate

diagnosis


Your prognosis pico question

Patient/

Population

Intervention/

Exposure

Comparison

Outcome

Your Prognosis PICO Question

Child with

Acute ITP

Risk of

being chronic

ITP


Your harm pico question

Patient/

Population

Intervention/

Exposure

Comparison

Outcome

Your Harm PICO Question

Febrile

child

Aspirin

Gastric ulcer


Basic search terms
Basic Search Terms

  • Pick up important elements in your question

    • ITP

    • IVIG

    • Steroids

    • child

Start your search


Online resources
Online Resources

  • Cochrane abstracts

  • Guidelines websites

  • Medline

  • Search engines



Tripdatabase
TRIPdatabase

www.tripdatabase.com


Guidelines www guideline gov
Guidelineswww.guideline.gov


Medline search www pubmed com
Medline searchwww.pubmed.com


Search limits
Search limits

  • Search by phrase

  • Use AND, OR, NOT

  • Use Pubmed limits