Ask an Answerable Question
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The document discusses building clinical questions using the PICO framework. It explains that clinical questions can be either background questions seeking general information, or foreground questions seeking specific answers to inform clinical decisions. Foreground questions are best answered using the PICO elements - Patients, Intervention, Comparison, Outcome. Several examples of clinical questions are provided and categorized by question type (diagnosis, prognosis, treatment etc.). Building focused clinical questions in PICO format helps guide appropriate literature searching to find the best evidence quickly.
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Ask an Answerable Question
- 2. 2 5 Steps • 問 • 查 • 讀 • 用 • 審 • Ask • Acquire • Appraise • Apply • Audit
- 3. 3 EBM is like … • We need a President… • Ask: Taiwan (P) / 馬 (I) / 謝 (C) / … (O) • Acquire: Searching • Appraise: Collect/Compare information • Apply: Making decision. • Audit: Enjoy our new P, U vote him again?
- 4. 4 Contents • 介紹臨床問題 • 如何建構臨床問題 – 問題的類型： background or foreground – PICO or PICOT – 臨床問題的類型：治療、診斷、病因、預後、其他… – 練習 • 醫學文獻 • 臨床情境 • 如何處理提出的臨床問題
- 5. 臨床問題… • 臨床上我們每天都會遇到一些問題： – 診斷： accuracy of diagnostic tests – 預後： the power of prognostic markers – 治療： the efficacy & safety of Rx – 平均 • 每 3 個門診病人有 2 個問題 • 每 1 個住院病人有 5 個問題 • 有多少我們去找答案？ < 1/3
- 6. 6 問什麼？ • 精確（ specific ）的問題 – 可以被回答 (answerable) – 可以被搜尋 (searchable)
- 7. 7 Which one is answerable by a single research? • What is the meaning of life? • What is the risk of autism following a measles vaccine? • What is the best treatment for osteoarthritis? • Why don’t patients take their prescribed medications? EBP workbook 2007, 2/e.
- 8. 8 Contents • 介紹臨床問題 • 如何建構臨床問題 1. 問題的類型： background or foreground 2. PICO or PICOT 3. 臨床問題的類型：治療、診斷、病因、預後、其他… – 練習：醫學文獻 & 臨床情境 • 如何處理提出的臨床問題
- 9. 9 Ask – Step 1 – Back/Foreground • Background - 5W & 1H – who, when, where, what, why & how – Question about a disorder, test, treatment … • Foreground - PICO – Specific knowledge to inform clinical decision or action – A & B diagnostic test or treatment for a disorder
- 10. 10
- 11. 11 Ask a foreground question • The specific, answerable, searchable clinical question.
- 12. 12 Ask – Step 2 - PICO • Patients • Intervention / Index test / Indicator (Exposure) • Comparator • Outcomes
- 13. 13 Ask – Step 3 - Type of Questions • Intervention, or Prevention • Etiology (Risks / Causes / Harm) • Diagnosis – DDx or tests • Prognosis - Prediction • Frequency and rate – Clinical manifestations of dx • Disease prevalence, incidence, … – Clinical findings (Hx/PE …) • Experience & meaning, Improvement
- 15. 15 The process of building a question 1. Background or Foreground question 2. PICO 3. Type of clinical question
- 16. 16 Examples 1 • 有哪些中草藥能預防或治療禽流感？ – Background or Foreground ? – What Category ? • 六十歲男性，一年前經診斷有大腸腺性瘜 肉 (adenomatous polyp) ，他需要接受檢 查或治療嗎？有哪些藥物治療適合他？
- 17. 17 Examples 2 • 53 year-old man with chronic tophaceous gout. He is allergic to allopurinol and his creatinine is 2 mg/dL. He suffered from frequent attack of arthritis (once every one to two week). – What is the etiology of gout? – What is the risk factor for gout attack? – Will he require dialysis in the long run? – Is vitamin C supplement decrease serum UA or gout attack?
- 18. 18 Exercise • 醫學文獻 • 臨床情境
- 19. 19 Type Background Foreground Intervention What to do? How to treat? I vs C Etiology What is the cause? I vs C Diagnosis Does the patient have …? I vs C Prognosis Who will have …? Frequency & Rate How common …?
- 20. 20 Contents • 介紹臨床問題 • 如何建構臨床問題 1. 問題的類型： background or foreground 2. PICO or PICOT 3. 臨床問題的類型：治療、診斷、病因、預後、其他… – 練習：醫學文獻 & 臨床情境 • 如何處理提出的臨床問題
- 21. 臨床醫學的問題… • 臨床上我們每天都會遇到一些問題： – 診斷： accuracy of diagnostic tests – 預後： the power of prognostic markers – 治療： the efficacy & safety of Rx – 平均 • 每 3 個門診病人有 2 個問題 • 每 1 個住院病人有 5 個問題 • 有多少我們去找答案？ < 1/3 – Why? time, memory – Sources? Books (31%), articles (21%), consultants (17%)
- 22. 22 Solutions! • 承認不知道 • 隨手記下 • 有空就查
- 23. 23
- 24. 24
- 25. 25 Search Strategy • 精確（ specific ）的問題 – 可以被回答 (answerable) – 可以被搜尋 (searchable)
- 26. 26 Ask … • Selecting, Scheduling, Saving – Immediate – In PICO format (papers, desktop/PDA computers, cards)
- 27. 27 Important, Relevant, Time, Interesting, Recur • Examples 2 – 53 year-old man with chronic tophaceous gout. He is allergic to allopurinol and his creatinine is 2 mg/dL. He suffered from frequent attack of arthritis (once every one to two week). • Recognize potential questions! • Decide which one is the most important Q!
- 28. 28 Ask & then … • 記下 key question • 想一下 – 這類的問題最佳的解決方案（研究方法）為 何？ – 那個資料庫能快速的幫我們找到最佳實證
- 29. 29 Contents • 介紹臨床問題 • 如何建構臨床問題 – 問題的類型： background or foreground – PICO or PICOT – 臨床問題的類型：治療、診斷、病因、預後、其他… – 練習 • 醫學文獻 • 臨床情境 • 如何處理提出的臨床問題
- 30. 30 Which one do you think is/are answerable by a single research? • What is the meaning of life? • What is the risk of autism following a measles vaccine? • What is the best treatment for osteoarthritis? • Why don’t patients take their prescribed medications? EBP workbook 2007, 2/e.
Editor's Notes
- http://www.vghks.gov.tw/erli/Index/clinicaltrainingcenter/ebm/index.htm http://www.vghks.gov.tw/lib http://www2.edah.org.tw/edh/EBM/
- &lt;number&gt; Residents’ medical information needs in clinic: are they being met? Am J Med. 2000 Aug 15;109(3):218-23. PMID:10974185
- EBP workbook 2007, 2/e.
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