planning for action defining a clinical question

Planning for Action

Defining a clinical question

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Defining a clinical question Search Types

• Keyword or simple search • Searching at its most basic level • One or two words as the search strategy. • Advantage – fast return of information • Disadvantage – too many results due to lack of

focus.

• Advanced Search• More sophisticated searching• Planning and strategy• Advantage – fewer, more relevant results• Disadvantage – time needed to plan search strategy

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Defining a clinical question

Developing an effective search strategy isessential to the recovery of required information.

A simple, generic search strategy : • Formulate research question • Identify important concepts within the question • Identify search terms describing those concepts • Generate synonyms and variations of those terms • Prepare the search statement

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Search stages

broad, to minimise therisk of missing relevantinformation

1. Sensitive

2. Focussed narrower, to ensure relevance of recovered information

narrowest, through use of filtering

3. Best Evidence

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Focussing a questionThe four elements

P Person, problem, population

I(or E) Intervention (or Exposure)

C Comparison intervention

O Outcome(s)

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Focussing a questionThe four elements - an example

• Person/Problem/ Do people with insulin- Population dependent diabetes

• Intervention who are treated with an intensive insulin regimen

• Comparison compared with those Intervention treated with a

traditional insulin regimen

• Outcome(s) have fewer long-term complications or a lower

mortality rate?

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Focussing a questionKey characteristics and synonyms

Element Characteristic(s) Synonym(s)

P Insulin-dependent diabetes Type 1 diabetes

I Intensive insulin regimen

C Traditional insulin regimen

O Long-term complicationsLower mortality rate

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Focussing a questionScenario 1

A 17 year old female was travelling home onenight when the car her friend was driving careered off the road. Fortunately, no-one was seriously injured but she presented to A&E with localised low back pain and was diagnosed with lumbar strain.

For some time, the Senior Physio has beenconsidering the treatment for low back pain and wonders if acupuncture might be an effective alternative.

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Focussing a questionScenario 1 - PICO

• Person/Problem/ 17 year old femalePopulation Low back pain/lumbar

strain

• Intervention Acupuncture

• Comparison Current treatmentIntervention

• Outcome(s) Pain relief

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Focussing a questionKey characteristics and synonyms


P17 year oldFemaleLow back pain Lumbar strain

I Acupuncture

C Current treatment

O Pain relief

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Donald Brown is an 18 year old school studentcurrently preparing for examinations. He has suffered various allergies throughout his life. His main concern at the moment is eczema as it often breaks out when he is anxious.

Although it is under control for now, using Hydrocortisone Cream 1%m/m, Donald and his parents would like some advice on whether there are other steps they can take to help ensure that he doesn’t experience a ‘flare-up’ during the examination period as the itching disrupts his concentration

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P Eczema Young adult male

Atopic eczema

I Unknown

C Hydrocortisone Cream 1%m/m

O Control of eczema Increased patient satisfaction and confidence

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Joseph Smith is 65 years old and lives in ruralLanarkshire. His general health is good and he is reasonably fit for his age. Over the past few years, Joseph has had difficulty sleeping. He claims that this is the result of having to get up to urinate three or four times a night. He was recently diagnosed as having an enlarged prostate (benign prostatic hyperplasia) and was prescribed 10mg Alfuzosin XL each day. He has been taking the tablets for around six weeks but feels that they are not easing his symptoms. He has heard of a herbal preparation which is popular in treating the condition - saw palmetto - and would like to know more about it and, in particular, whether it is likely to be helpful in his case.

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Focussing a questionScenario 3Element Characteristic(s) Synonym(s)

P Benign prostatic hyperplasia Urinary disorder Elderly Male Rural

BPH, enlarged prostate

I Saw palmetto Serenoa repens

C Alfuzosin XL

O Easing of symptoms Increased patient satisfaction and understanding

planning for action defining a clinical question

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