Asking the questions

Easy ?

Triggers Individual patients Group initiatives Topical issues National initiatives

Is the Question Right? Will the answer help me? Will the answer help the patient? Will the answer help the community at

large Is the question amenable to an

answer? Is it defined tightly enough

Remember the adage about tests – Will the result affect patient

management?

The same is true of EBM questions – Will the answer affect my patients

management

Questions Have Parts By critically analysing a question one

can ensure we are asking the right question

By breaking the question into its parts one creates a ready made search strategy

Question Components The patient or problem

The intervention

Comparison – with what etc

Outcome – one is concerned about

Analysis Grid

Patient

Or Problem

Intervention Comparison Outcomes

Example 1A TV programme has highlighted a

hospital in Suffolk in which a stroke unit has been set up that specialises in the treatment of patients who have suffered strokes. The hospital trust wants to know about the effectiveness of stroke units in terms of lives saved before deciding whether to invest in one.

Patient

Or Problem

Intervention Comparison Outcomes

Patient

Or Problem

Intervention Comparison Outcomes

Patients who have suffered strokes

Patient

Or Problem

Intervention Comparison Outcomes

Patients who have suffered strokes

Stroke units

Patient

Or Problem

Intervention Comparison Outcomes

Patients who have suffered strokes

Stroke units

Normal hospital care

Patient

Or Problem

Intervention Comparison Outcomes

Patients who have suffered strokes

Stroke units

Normal hospital care

Lives saved

Or

Do stroke units save lives ?

Example 2

A acute cough is a common reason for patients to consult their GP. The causes of acute cough varies a lot. In GP the treatment often includes antibiotics. The effectiveness of Abx is questionable and there has been a great deal of concern about bacterial resistance from over-prescribing.

Patient

Or Problem

Intervention Comparison Outcomes

Patient

Or Problem

Intervention Comparison Outcomes

Acute Cough in primary care setting

Patient

Or Problem

Intervention Comparison Outcomes

Acute Cough in primary care setting

Antibiotics

Patient

Or Problem

Intervention Comparison Outcomes

Acute Cough in primary care setting

Antibiotics No antibiotics

Patient

Or Problem

Intervention Comparison Outcomes

Acute Cough in primary care setting

Antibiotics No antibiotics

Duration and severity of illness

Or

Do antibiotics shorten a acute cough in primary care?