Formulating Formulating Clinical Question Clinical Question

AND AND Searching The Searching The

Medical LiteratureMedical Literature

Session ObjectivesSession Objectives By the end of this session and your practical training By the end of this session and your practical training

you will be able to:you will be able to: recognize your knowledge gap, when facing recognize your knowledge gap, when facing

clinical problemclinical problem Formulate clinical questions according to Formulate clinical questions according to

your learning needsyour learning needs Understand the necessary steps you take to Understand the necessary steps you take to

solve the problem?solve the problem? Know electronic medical resources you use Know electronic medical resources you use

to gain knowledge?to gain knowledge?

Clinical scenarioClinical scenario Your patient is a three years old male, Your patient is a three years old male,

presented to the ER with Purpura, mild gum presented to the ER with Purpura, mild gum bleedingbleeding

The patient is clinically stable, and his physical The patient is clinically stable, and his physical examination is otherwise normalexamination is otherwise normal

Complete blood count is totally normal apart Complete blood count is totally normal apart from severe thrombocytopenia ( platelet from severe thrombocytopenia ( platelet count<10000/mm).count<10000/mm).

You decided to admit the child and start You decided to admit the child and start treatment with intravenous immunoglobulin.treatment with intravenous immunoglobulin.

One student asked you if treatment with pulsed One student asked you if treatment with pulsed high dose methyl-prednisolonehigh dose methyl-prednisolone would result in would result in similar improvement at much lower cost for similar improvement at much lower cost for the hospital?the hospital?

Types of questions raised Types of questions raised

What is idiopathic thrombocytopenic purpura

What is the clinical signs and symptoms?

How can we diagnose this disease? What are the treatment options for

ITP?

Back ground questions Back ground questions

When you need to know more When you need to know more information about the diseaseinformation about the disease

Types of questions raised Types of questions raised

In In child suffering from ITPchild suffering from ITP does does treatment with treatment with steroidssteroids, compared , compared to to IVIGIVIG results in results in rapid curerapid cure

In In children suffering from ITPchildren suffering from ITP is is complete blood picture ascomplete blood picture as accurate accurate as as bone marrow aspiratebone marrow aspirate in in diagnosisdiagnosis. .

Foreground questionsForeground questions

When you need to know information When you need to know information that you will:that you will: Tell your patient aboutTell your patient about Decide on his management Decide on his management

Usually related toUsually related to DiagnosisDiagnosis TherapyTherapy PrognosisPrognosis harmharm

Patient/Population

OutcomeIntervention/

ExposureComparison

SteroidsIVIG

Rapid cureChild withacute ITP

Your Therapy QuestionYour Therapy QuestionThe PICOThe PICO

Patient/Population

OutcomeIntervention/

ExposureComparison

Bloodpicture

Bonemarrow

Accurate diagnosis

Child withAcute ITP

Your Diagnosis PICO Your Diagnosis PICO QuestionQuestion

Patient/Population

OutcomeIntervention/

ExposureComparison

Risk of being chronic

ITP

Child withAcute ITP

Your Prognosis PICO Your Prognosis PICO QuestionQuestion

Patient/Population

OutcomeIntervention/

ExposureComparison

Aspirin Gastric ulcerFebrilechild

Your Harm PICO Your Harm PICO QuestionQuestion

Basic Search TermsBasic Search Terms

Pick up important elements in Pick up important elements in your questionyour question

ITPITPIVIGIVIGSteroidsSteroidschildchild

Start your search

Online ResourcesOnline Resources

Cochrane abstractsCochrane abstractsGuidelines websitesGuidelines websitesMedlineMedlineSearch enginesSearch engines

www.cochrane.org

TRIPdatabaseTRIPdatabase

www.tripdatabase.www.tripdatabase.comcom

Guidelines

www.guideline.gov

Medline searchMedline searchwww.pubmed.com

Search limitsSearch limitsSearch by phraseSearch by phraseUse AND, OR, NOTUse AND, OR, NOTUse Pubmed limitsUse Pubmed limits

QuestionsQuestions