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EXERCISE - CLINICAL QUESTION

PICO

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David L. Sackett

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Clinical decision

Clinical

expertise

Scientific

evidence

Patients

preference

Clinical problem

Evidence based medicineScience and Art of Medicine

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Issue of deep vein thrombosis (DVT) on long-

haul flights and whether it is possible to

prevent it by wearing elastic stockings.

PATIENT / PROBLEM : DVT on long-haul flights

INTERVENTION : Elastic stockings

CONTROL / COMPARATOR : No

OUTCOME : Prevention of DVT

CLINICAL QUESTION : Can DVT on long-haul flights be

prevented by wearing stockings?

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A 28-year-old male presents with recurrent furunculosis for

past 8 months; these episodes have been treated with drainage

and several courses of antibiotics but keep recurring. He asks if

recurrences can be prevented.

PATIENT / PROBLEM : Patient with recurrent furunculosis

INTERVENTION : Prophylactic antibiotics

CONTROL / COMPARATOR : No treatment

OUTCOME : Prevention of recurrence

CLINICAL QUESTION : In patients with recurrent

furunculosis do prophylactic antibiotics reduce the recurrence

rate (when compared with no treatment)?

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Jeff , a smoker of more than 30 years, has come to see you about something

unrelated. You ask him if he is interested in stopping smoking. He tells you he has

tried to quit smoking unsuccessfully in the past. A friend of his, however,

successfully quit with acupuncture. Should he try it? Other interventions you

know about are nicotine replacement therapy and antidepressants.

PATIENT / PROBLEM : Long time smokers

INTERVENTION : Acupuncture

CONTROL / COMPARATOR : NRT / Antidepressants

OUTCOME : Quitting smoking

CLINICAL QUESTION : In long time smokers does

acupuncture compared with NRT/Antidepressants improvethe chance of quitting?

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At a routine immunisation visit, Lisa, the mother of a -month-old, tells you that

her baby suffered a nasty local reaction after her previous immunisation. Lisa is

very concerned that the same thing may happen again this time. Recently, a

colleague told you that needle length can affect local reactions to immunisation

in young children but cant remember the precise details.

PATIENT / PROBLEM : Infants receiving immunization

INTERVENTION : Longer needles

CONTROL / COMPARATOR :Shorter needles

OUTCOME : Prevention of local reaction

CLINICAL QUESTION :In infants receiving immunization

injections, does needle length affect the rate of local

reaction?

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