EBD Course: Lecture 2 - Asking Answerable Questions

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

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EBD Course: Lecture 2 - Asking Answerable Questions

  1. 1. Asking Answerable Questions<br />Dr. SohailBajammal<br />September 26, 2011<br />
  2. 2. Outline<br />Review of the previous assignment<br />Types of questions<br />Good questions<br />Why do we need to ask good questions?<br />
  3. 3. Review of the previous assignment<br />The quality varied from excellent to unacceptable<br />For the first assignment, all of you who submitted were given the mark (1 mark)<br />It is an essay (not question and answer)<br />Most got the meaning of EBD right (some are still confused), some used diagrams<br />Some of you had the assignment written for them<br />
  4. 4. Review of the previous assignment<br />Some of you saved the file as “first assignment – name” (excellent)<br />We are interested in the content more than the style<br />Some of you cited different sources and websites (excellent)<br />Some of you think that this course should not be mandatory (excellent, freedom of speech)<br />
  5. 5. Concerns/Difficulties<br />Time-consuming<br />More important subjects<br />Confusion<br />The exam<br />
  6. 6. Ideal Assignment<br />
  7. 7. This how not to do copy & paste<br />
  8. 8.
  9. 9. One more time, why we are teaching EBD Course<br />It will teach you the skills of asking, finding, and evaluating the information<br />It will teach you critical thinking & life-long learning<br />What you learn in this course will help you in your career (the coming 4 years & after graduation)<br />Focus on how to get the full benefits of the course (rather than thinking about the exams)<br />
  10. 10. RELAX!<br />
  11. 11. Doing<br />Research Methodology<br />Research<br />Evidence-Based Clinical Practice<br />Using<br />
  12. 12. Evidence-Based Clinical Practice<br />Research Evidence<br />Patients’ Preferences<br />Clinical Expertise<br />Clinical Circumstances<br />12<br />Haynes et al. BMJ 2002;324:1350<br />
  13. 13. Steps of Evidence-Based Dentistry<br />5A<br />
  14. 14. Types of Questions<br />Background questions:<br />About the condition<br />5W questions (who, what, when, why, where, how)<br />General knowledge<br />Look up the answers in textbooks<br />Foreground questions:<br />About the options<br />Specific information<br />Look up the answers in the literature (articles)<br />
  15. 15. Back Pain<br />Which of the following are background questions & foreground questions?<br />What is the pathophysiology of back pain?<br />What are the causes of back pain?<br />How can we diagnose back pain?<br />What is the best diagnostic test for back pain?<br />What are the treatments available for back pain?<br />What is the best treatment for back pain?<br />B<br />F<br />B<br />B<br />B<br />F<br />B<br />F<br />
  16. 16. Is this a good foreground question?<br />What is the best treatment for back pain?<br />
  17. 17. Is this a good foreground question?<br />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?<br />P: Adult patients <50yr with acute LBP<br />I: Physiotherapy<br />C: Bedrest<br />O: Recurrence of pain within one year<br />
  18. 18. Which is a better question?<br />What is the best treatment for back pain?<br />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?<br />
  19. 19. PICO<br />P: Population (or problem)<br />I: Intervention<br />C: Comparison (control)<br />O: Outcome<br />
  20. 20. Questions Categories<br />Diagnosis<br />Prognosis<br />Therapy (Treatment)<br />Harm/Causation<br />Prevention<br />Cost (Economic)<br />Qualitative<br />
  21. 21. Class Activity<br />10 minuets<br />Split into groups of 3<br />Think of a foreground question<br />From the topics you studied the last 2 weeks<br />PICO format<br />What category?<br />Be prepared to discuss with the group<br />
  22. 22. Your PICO questions – 30 minutes<br />
  23. 23. Why do we need to PICO?<br />Keep the question patient-oriented<br />Make searching effective & focused<br />Will help you in designing your search strategy<br />Will make you think of what type of study you will be looking for<br />What category <br />
  24. 24. How would you search for answers for these questions?<br />What is the best treatment for back pain?<br />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?<br />
  25. 25. Search strategy for a broad question<br />Low Back Pain<br />Treatment<br />OR<br />OR<br />Low Back Ache<br />Management<br />Acute<br />OR<br />OR<br />Low Backache<br />Therapy<br />AND<br />AND<br />OR<br />OR<br />"Low Back Pain"[Mesh]<br />Surgery<br />25<br />
  26. 26. Search Strategy for PICO Question<br />
  27. 27.
  28. 28.
  29. 29.
  30. 30.
  31. 31. OR<br />
  32. 32. OR<br />
  33. 33. OR<br />OR<br />
  34. 34. OR<br />OR<br />
  35. 35. OR<br />OR<br />OR<br />
  36. 36. OR<br />OR<br />OR<br />
  37. 37. OR<br />OR<br />OR<br />OR<br />
  38. 38. OR<br />OR<br />OR<br />OR<br />
  39. 39. OR<br />OR<br />OR<br />OR<br />
  40. 40. OR<br />OR<br />OR<br />OR<br />
  41. 41. OR<br />OR<br />OR<br />OR<br />
  42. 42. OR<br />AND<br />OR<br />OR<br />OR<br />
  43. 43. OR<br />AND<br />OR<br />AND<br />OR<br />OR<br />
  44. 44. OR<br />AND<br />OR<br />AND<br />OR<br />AND<br />OR<br />
  45. 45. That’s why you need to learn<br />PubMed<br />History Feature in PubMed<br />MeSH<br />
  46. 46. DO NOT PANIC<br />We will repeat<br />the search strategy again next week<br />
  47. 47. Additional Readings (with the leaders)<br />1st Chapter of the Book<br />Gillette J. Answering Clinical Questions using the Principles of Evidence-Based Dentistry. J Evid Base Dent Pract2009;9:1-8<br />Weinfeld JM, Finkelstein K. How to Answer Your Clinical Questions More Efficiently. Family Practice Management 2005<br />
  48. 48. Assignment # 2<br />Due October 1<br />Submit electronically to my email<br />Keep a copy in your portfolio<br />Type your name & EBD2 in the file name & email subject<br />1 Mark<br />From the subjects that you will learn this week, write two background questions and two foreground questions<br />

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