Asking clinical question
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Asking clinical question

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    Asking clinical question Asking clinical question Presentation Transcript

    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Asking AnswerAble CliniCAl Question Dr. Faisal Al HaddadDr. Faisal Al Haddad Consultant of Family Medicine & Occupational HealthConsultant of Family Medicine & Occupational Health Incharge of Occupational Health in PSMMCIncharge of Occupational Health in PSMMC
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee The Five steps (5A) of EBM • Asking an answerable question • Acquiring the “best” evidence • Appraising the evidence • Applying the acquired and critically appraised evidence to your pt. • Assessing your performance and hoping to do better next time!
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Where and how clinical questions arise? • Most common setting is patients’ care setting • They are mostly about issues related to: Etiology Diagnosis Prognosis Therapy Prevention
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Types of questions Background (general knowledge):  Question root: who, what, where, when…etc  An aspect of the disorder  Example: what causes lower limb swelling? Foreground questions  Ask for a specific aspect of the patient’s illness  Example: what is the accuracy of V/Q scan in this patient with lung infiltrate on chest-x rays compared to pulmonary arteriogram
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Background vs. Foreground Questions
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Foreground questions Four components: PICO • Patient/Population • Intervention • Comparison • Outcome Example: In patients with incidentally discovered atrial fibrillation, does anticoagulation compared to no intervention Improve the long-term mortality and morbidity?
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Reactions to knowledge deficit A clinical question arises You know the answer Cognitive Resonance You do not know the answer Cognitive Dissonance Adaptive Response Maladaptive Response
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Why bother to formulate answerable questions? • They help focusing our scarce time on evidence: - That is directly relevant to our patients’ needs - That addresses particular knowledge needs • Help following a highly productive search strategy • May suggest the forms that useful answers may take
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Why bother to formulate answerable questions? • Can help us communicating clearly with other colleagues • Help make teaching understandable • Help improving our learning process
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Problems in formulating an answerable questions • Inability to clearly define the problem • Inability to articulate the question • Many questions, scarce time
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Factors deciding priority questions • Which question is most important to the patient’s well-being? • Which question is most relevant to the learner’s need? • Which question is most feasible to answer? • Which question is most interesting? • Which question is most frequent in our practice?
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee What is an Educational Prescription? • It specifies the clinical problem that generated the question. • It states the question, in all of its key elements. • It specifies who is responsible for answering it. • It reminds everyone of the deadline for answering it (taking into account the urgency of the clinical problem that generated it). • Finally, it reminds everyone of the steps of searching, critically appraising and relating the answer back to the patient
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Case # 1 • 75-year-old man known case of DM since 30 yrs admitted with shortness of breath, fever, and cough, and right lower limb swelling for 1 wk. • On Physical Examination: T=38.5, pulse=110 min regular, O2 Sat 88% Chest: bilateral crackles on the bases Chest x-rays: bilateral lower lobe infiltrates Right lower limb swelling
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Answer #1 In patients suspected to have PE and have CXR changes, what is the diagnostic accuracy of V/Q scan compared to pulmonary angiography in diagnosing PE?
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Case #2 • You saw a 70-year-old man for palpitations with no other complaint • Physical Examination Findings: o pulse is 88/min irregular o Rest of exam: unremarkable o ECG: atrial fibrillation with a rate of 90/min o Echo: normal valves and Ejection fraction
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Answer # 2 In elderly patients with lone AF what is the benefits of long-term anticoagulation compared to no anticoagulation in decreasing the risk of embolic stroke?
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Case # 3 • You have seen a 40-year-old man for general check-up • Has no complaint • Physical examination: unremarkable • Labs: all normal except FBS of 118 mg/dl
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Answer # 3 In middle aged men with impaired FBS, does life style modification compared to no intervention decrease the risk of development of DM?
    • 10th Evidence based medicine workshop Prince Sultan Military Medical City Department of post Graduate Medical education EBM committee Any Question?