How to ask (structure) clinical questions and efficiently search for answers will be a focus of this course. One way to categorize the questions that come up in clinical practice is to ask whether they require background or clinical (patient-centered) information to answer them. In reality, what begins as a background question may spill over into a clinical question and vice versa.
Clinical (or patient-centered or foreground) questions ask for knowledge in relation to individual patients or case scenarios; they generally focus on etiology, diagnosis, therapy, and/or prognosis. Developing an answerable clinical question is crucial to efficiently searching the research literature -- and the PICO framework makes that easy! (See below.)
Research databases, such as PubMed and Embase, and/or clinical consult tools, such as BMJ Best Practice, UpToDate, and Dynamed are most useful in answering clinical questions, which tend to be more complex than background questions, requiring higher level search skills.
Background questions ask for general knowledge (who, what, how, why, when) about a health condition, syndrome, issue or disease. Examples:
How does diet during pregnancy affect birth weight?
When do complications of whooping cough usually occur and in what age groups?
Textbooks, government websites, and other types of secondary sources are usually the best sources for answers to background questions.
Clinical Scenario:
Your patient is low-risk, at term, and has expressed a desire to avoid cesarean birth if at all possible. Friends keep telling stories about having their bag of water broken or receiving IV pitocin to speed up their labors, and your client is asking you today at a routine prenatal visit if these interventions might actually lead to more cesarean births. You say, “That’s a great question! I don’t know the answer off the top of my head, but let me do some looking at the research and I will get back to you."
Patient population or Problem: For which patient, group or health condition do you need information?
Individuals with low-risk, term pregnancies.
Intervention (or Exposure): Which medical event or therapy do you need to study the effect of?
Artificial rupture of membranes.
Comparison (if known): With what will you compare the intervention's results?
IV pitocin.
Outcomes: What are the relevant effects (outcomes) you'll be monitoring?
Higher rate of vaginal delivery.
Clinical Question:
For individuals with low-risk, term pregnancies, does augmentation of labor by artificial rupture of membranes result in a higher rate of vaginal delivery than IV pitocin?
NOTE: You don't necessarily need to use all of the elements from your PICO and/or clinical question in the database search; in many cases, information from PICO's P and I may be sufficient.
Sample database search query: vaginal delivery AND artificial membrane rupture AND pitocin
Don't forget to set applicable filters for sex or gender, ages, publication date, type of study, etc. when you run your search.
Scan results, revise search by adding or deleting terms as necessary, and rerun it.
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