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Sample clinical scenario | Developing a searchable clinical question | Sample Clinical Question Now that you know the basics about selecting an evidence-based literature source, let’s look at applying this to a specific clinical situation. We will then review searching for relevant information for this particular clinical scenario using our four key EBM resources, looking for both background and foreground information. Sample clinical scenarioConsider the following clinical situation:
Developing a searchable clinical questionThe first step in gathering the best evidence is designing a searchable, focused clinical question using the PICO model. A question that uses the PICO format has four components: patient, intervention, comparison and outcome. The next step is determining the category or type of clinical question you are trying to answer. Are you interested in therapy, diagnosis, prognosis, or etiology? Do you need to know more about prevention or screening? Each type of question requires looking for studies using different designs or methodologies. When looking for the best information on therapies, for example, you should consider the hierarchy of research studies, also referred to as the evidence pyramid.
Ideally, you would hope to find a systematic review of randomized, controlled trials. This type of review would offer an analysis of the highest quality therapeutic studies on your topic and provide recommendations for treatment. One very real limitation to keep in mind, however, is that this kind of rigorous review is often not available. This is due to both the complex nature of many health issues as well as the lack of scientific data on some therapeutic options. |
In an elderly woman with postherpetic neuralgia, are topical treatments as safe and effective as antidepressants in relieving pain? |
Let’s assume you are starting off with limited knowledge of postherpetic neuralgia. Your first step is finding a summary to give you background information on this topic. We will now consider how to search UpToDate for this kind of overview. We will then look at resource options for foreground information to supplement your background knowledge by searching for systematic reviews and high quality research studies. For this, we will use the Cochrane Database of Systematic Reviews and the ACP Journal Club. Finally, we will see what additional foreground information is available by looking at the primary research literature, using the Clinical Queries feature in PubMed. The next sections of this tutorial will lead you step-by step through this process.
