What do I need to know?

Chapter 2
RELEVANT CLINICAL QUESTIONS
• The most important clinical questions are those
concerning:
• Effects of Intervention
• Patients’ Experiences
• The course of a Condition (Prognosis)
• The accuracy of Diagnostic tests.
Categorization of questions
REFINING YOUR QUESTION
• Making the questions specific.
• Structuring and refining the question makes it
easier to find an answer.
• Breaking the problem into parts.
• Breaking questions about effects of intervention,
experiences, prognosis and diagnosis into parts
EFFECTS OF INTERVENTION
• We usually break questions about the effects of
intervention into four parts (Sackett et al 2000):
• Patient or problem
• Intervention or management strategy
• Comparative intervention
• Outcome.
A useful mnemonic is PICO
 PICO
• The first part identifies the patient or the problem. This involves
identifying those characteristics of the patient or problem that are
most likely to influence the effects of the intervention
• The second and third parts concern the interventions. (specify
the intervention that we are interested in and what we want to
compare the effect of that intervention to. We may want to
compare the effect of an intervention to no intervention, or to a
sham intervention)
• The fourth part of the question specifies what outcomes we are
interested in(important to determine whether the patient is
primarily interested in reductions in pain, or reductions in
disability, or returning to work, or some other outcome)
Example
EXPERIENCES
• Questions about experiences can relate to any aspect of clinical
practice
• potentially very diverse they must be relatively open.
• formulating questions about experiences, you specify the patient or
problem and the phenomena of interest.
 Prognosis
• When asking questions about prognosis you should specify (again) the
patient or problem, and the outcome you are interested in. The question
may be about the expected amount of the outcome or about the
probability of the outcome.
DIAGNOSIS
• Even the best diagnostic tests occasionally misclassify patients.
Misclassification and misdiagnosis are an unavoidable part of
professional practice. It is useful to know the probability of
misclassification so we can know how much certainty to attach to
diagnoses based on a test’s findings.
THANK YOU