This document discusses formulating clinical questions using the PICO framework and conducting evidence-based medicine research. It provides an example of a clinical question that could be asked about a 5-year-old female patient presenting with acute otitis media. The question focuses on whether antibiotics are necessary for this condition, as the patient's mother is concerned about antibiotic overuse and resistance. Well-formulated clinical questions are the starting point for evidence-based practice and help focus the literature search on the specific needs of the patient case.

1. ..non ti resta che cercare, se vuoi trovare qualcosa…..

2. EBM L’ Evidence based medicine (EBM) consiste in 4 processi separati: Formulare il quesito clinico Trovare le evidenze Valutare e Sintetizzare le Evidenze Applicare le Evidenze

3. Scenario possibile Sei di fronte ad un lattante di 2 mesi (ex prematuro con DIV), ricoverato in PICU ( Unità di Terapia Intensiva Pediatrica) per Bronchiolite da VRS Lo specializzando che lo ha visitato ricorda di aver sentiuto che in tale situazione dovrebbe essere somministrato il Surfactant, ma non ricorda i dettagli Il medico di reparto prende il Nelson ( vecchia edizione) che non fa cenno a cosa fare Va al computer e digita “bronchiolite” e “ surfactant” con Google La ricerca dà esito a 29.000 voci, ha poco tempo ma fortunatamente la prima citazione sembra essere rilevante: è una Cochrane Review

4. Come formulare il quesito Il miglior modo per struttura la domanda è usare l’acronimo PICO : P per paziente I per Intervento C per Comparison (confronto) non sempre necessario O per Outcome

5. Scenario precedente Bambino con Bronchiolite La nostra domanda dovrebbe essere: In un lattante con Bronchiolite (paziente) in Surfactant (Intervento) comparato al placebo (Comparison) porta ad una riduzione della degenza in Terapia Intensiva (outcome)?

6. Formulating a Clinical Question Objectives: From this tutorial you will learn: The impact of the clinical question on EBM research The key elements of a clinical question How to form an answerable clinical question The role of the clinical question in the overall EBM process

7. The Clinical Question Formulating a clinical question is the first step in the Evidence-Based Medicine (EBM) process.

8. Your clinical question will impact the entire EBM research process. Make sure you start with a well-developed and answerable question. A good clinical question will: Save time when researching Keep the focus directly on the patient's need Suggest the appropriate form that a useful answer may take Note : Your clinical situation may raise more than one question. Don't try to squeeze multiple topics into one clinical research question. Strauss, Sharon E.; Richarson, W.; Glasziou, Paul, et al. Evidence-based medicine: How to practice and teach EBM. 3rd ed. London: Elsevier; 2005

9. The Clinical Question You examine a five-year old Asian American female, Junko Morioka, in your office and determine that she is suffering from Acute Otitis Media. Her mother mentions that Junko seems to get these ear infections every once and a while and that sometimes they "just go away" and other times Junko seems to need antibiotics. Junko's mother is worried about Junko developing a resistance to all these antibiotics and wonders aloud if antibiotics are really necessary. Formulate a question you might research for the case above

10. A clinical question has four major elements:

11. Who is your patient? A clinical question must identify a patient or patient group. Additionally a clinical question should include any information that is relevant to the treatment or diagnosis or the patient. For example, you might include the patient's: Sex, age or race Disease History Primary Complaint