Escolar Documentos
Profissional Documentos
Cultura Documentos
1. Explosion of
Literature
2. Unmet
Information Needs
3. Implementation
Delays
Formulating Questions
The fundamental skill necessary to conduct evidence-based practice is learning
to design aWell-Built Clinical Question.
Once you decide what you are interested in learning about, you need to change
that thought into a question.
You can develop this important question by using PICO. PICO is an acronym for
population, intervention, comparison, and outcome.
By answering four questions
what about the population?
what about the intervention?
what about the comparison?
what about the outcome?
you will have the key terms you need to search the literature
Questions to ask
On what patient group do you want information?
Starting with your patient, ask "how would I describe a group of
patients similar to mine?"
Questions to ask
What medical event do you want to study the effect on?
Ask, "What key intervention am I considering?"
Questions to ask
Compared to what? Better or worse than no intervention at all or than
another intervention?
Ask, "What is the main alternative to compare with the intervention?"
Questions to ask
What is the effect of the intervention?
Ask, "What do I hope to accomplish?" or
"What could this exposure affect?"
P = Population
In hospitalized patients
as effective as traditional
C = Comparison
handwashing
O = Outcome
in controlling
infection?
Research studies and clinical trials published in the journal literature form the foundation
of scientific evidence, but not all research meets the highest standards of quality.
Systematic Reviews/Meta-analyses
If one research study or clinical trial provides good evidence, several studies with similar
results may provide even stronger evidence or negate previous findings. This logic is
applied by researchers to systematically identify, appraise and synthesize evidence from
individual studies on a particular topic.
Resources
Cochrane Database of Systematic Reviews
DARE (Database of Abstracts of Reviews of Effects)
Joanna Briggs Institute
Clinical Evidence
Agency for Healthcare Research and Quality (AHRQ)
National Guidelines Clearinghouse
While there are more detailed questions that you would need to ask depending
onthe type of study(therapy, diagnosis, etiology, or prognosis), you can begin
by asking these general questions to determine if the evidence is applicable to
your clinical question.
Are the results of the study good enough?
Is it clear what the research question is?
Were appropriate study methods used?
Do the authors give you enough information about how the data was collected?
Is there enough analysis of the data to determine if the study is valid?
Was the data interpreted and the conclusions clearly stated?
Are there other studies with similar conclusions?
Do the findings apply to this clinical setting and patient population?
Were the patients in the study similar to patients here?
Are the findings applicable to more than one clinical setting?
Is the evidence strong enough to warrant a change in practice?
Where does this study type fall on theHierarchy of Evidence?
Appraising the evidence is a complex issue. TheTools for Critically Appraising
the Literaturemay help you identify the study design, type of question, level of
evidence for an individual research article.
Question about
THERAPY
DIAGNOSIS
PROGNOSIS
ETIOLOGY
Cohort Studies
Level I
Level II
Level III
Level IV
Level V
Level VI
Level VII
Clinical Scenario 1
Currently every child who presents in the
emergency room has a rectal temperature
taken. Are other methods of temperature
assessment as accurate as rectal
temperatures?
Clinical Scenario 2
It is common that women are put into the
lithotomy position during delivery. Are there
better outcomes if women are allowed to
remain in an upright position during delivery?
Diagnosis:
Did the patient sample include an appropriate spectrum
of patients similar to those found in the general practice?
Was the gold standard applied to all cases?
Therapy:
Was the assignment of patients to treatment groups
randomized?
Were all enrolled patients accounted for at the conclusion
of the study?
Were the treatment groups similar at the start of the
study?
Harm:
Were exposures and outcomes measured similarly in the
groups compared?
Were the comparison groups similar in outcome in all
respects except for the variable studied?
Was the follow-up adequate?
Prognosis:
Was the patient sample representative at a well-defined
point in the course of the disease or disorder?
Was the length of follow-up adequate?
Was the follow-up complete?
Diagnosis:
Is the test affordable, accurate, and available in
my hospital?
Can I estimate the pretest probability of the
disease in question?
Will the posttest probability affect my
management?
Therapy:
Is my patient so different from those in the
study group that the results cannot be applied?
According to the study results, how much would
my patient benefit from the treatment?
Harm:
Can the study results be applied to my
patient?
What is my patients risk for adverse effect?
Are there alternative therapies?
Prognosis:
Is my patient similar to the patients in the
study group?
How will the evidence influence my choice
of treatment?