Going through the first step of evidence-based clinical practice. Asking answerable PICO questions.

1. Asking Answerable Questions Dr. SohailBajammal September 26, 2011

2. Outline Review of the previous assignment Types of questions Good questions Why do we need to ask good questions?

3. Review of the previous assignment The quality varied from excellent to unacceptable For the first assignment, all of you who submitted were given the mark (1 mark) It is an essay (not question and answer) Most got the meaning of EBD right (some are still confused), some used diagrams Some of you had the assignment written for them

4. Review of the previous assignment Some of you saved the file as “first assignment – name” (excellent) We are interested in the content more than the style Some of you cited different sources and websites (excellent) Some of you think that this course should not be mandatory (excellent, freedom of speech)

5. Concerns/Difficulties Time-consuming More important subjects Confusion The exam

6. Ideal Assignment

7. This how not to do copy & paste

9. One more time, why we are teaching EBD Course It will teach you the skills of asking, finding, and evaluating the information It will teach you critical thinking & life-long learning What you learn in this course will help you in your career (the coming 4 years & after graduation) Focus on how to get the full benefits of the course (rather than thinking about the exams)

10. RELAX!

11. Doing Research Methodology Research Evidence-Based Clinical Practice Using

12. Evidence-Based Clinical Practice Research Evidence Patients’ Preferences Clinical Expertise Clinical Circumstances 12 Haynes et al. BMJ 2002;324:1350

13. Steps of Evidence-Based Dentistry 5A

14. Types of Questions Background questions: About the condition 5W questions (who, what, when, why, where, how) General knowledge Look up the answers in textbooks Foreground questions: About the options Specific information Look up the answers in the literature (articles)

15. Back Pain Which of the following are background questions & foreground questions? What is the pathophysiology of back pain? What are the causes of back pain? How can we diagnose back pain? What is the best diagnostic test for back pain? What are the treatments available for back pain? What is the best treatment for back pain? B F B B B F B F

16. Is this a good foreground question? What is the best treatment for back pain?

17. Is this a good foreground question? In adult patients younger than 50 years old with acute low back pain (< 6 weeks), does bedrest reduce the risk of recurrence of pain within one year compared with physiotherapy? P: Adult patients <50yr with acute LBP I: Physiotherapy C: Bedrest O: Recurrence of pain within one year

18. Which is a better question? What is the best treatment for back pain? In adult patients younger than 50 years old with acute low back pain (< 6 weeks), does bedrest reduce the risk of recurrence of pain within one year compared with physiotherapy?

19. PICO P: Population (or problem) I: Intervention C: Comparison (control) O: Outcome

20. Questions Categories Diagnosis Prognosis Therapy (Treatment) Harm/Causation Prevention Cost (Economic) Qualitative

21. Class Activity 10 minuets Split into groups of 3 Think of a foreground question From the topics you studied the last 2 weeks PICO format What category? Be prepared to discuss with the group

22. Your PICO questions – 30 minutes

23. Why do we need to PICO? Keep the question patient-oriented Make searching effective & focused Will help you in designing your search strategy Will make you think of what type of study you will be looking for What category

24. How would you search for answers for these questions? What is the best treatment for back pain? In adult patients younger than 50 years old with acute low back pain (< 6 weeks), does bedrest reduce the risk of recurrence of pain within one year compared with physiotherapy?

25. Search strategy for a broad question Low Back Pain Treatment OR OR Low Back Ache Management Acute OR OR Low Backache Therapy AND AND OR OR "Low Back Pain"[Mesh] Surgery 25

26. Search Strategy for PICO Question

31. OR

32. OR

33. OR OR

34. OR OR

35. OR OR OR

36. OR OR OR

37. OR OR OR OR

38. OR OR OR OR

39. OR OR OR OR

40. OR OR OR OR

41. OR OR OR OR

42. OR AND OR OR OR

43. OR AND OR AND OR OR

44. OR AND OR AND OR AND OR

45. That’s why you need to learn PubMed History Feature in PubMed MeSH

46. DO NOT PANIC We will repeat the search strategy again next week

47. Additional Readings (with the leaders) 1st Chapter of the Book Gillette J. Answering Clinical Questions using the Principles of Evidence-Based Dentistry. J Evid Base Dent Pract2009;9:1-8 Weinfeld JM, Finkelstein K. How to Answer Your Clinical Questions More Efficiently. Family Practice Management 2005

48. Assignment # 2 Due October 1 Submit electronically to my email Keep a copy in your portfolio Type your name & EBD2 in the file name & email subject 1 Mark From the subjects that you will learn this week, write two background questions and two foreground questions