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Formulating Clinical Question AND Searching The Medical Literature

Formulating Clinical Question AND Searching The Medical Literature. Session Objectives. By the end of this session and your practical training you will be able to: recognize your knowledge gap, when facing clinical problem Formulate clinical questions according to your learning needs

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Formulating Clinical Question AND Searching The Medical Literature

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  1. Formulating Clinical Question AND Searching The Medical Literature

  2. Session Objectives • By the end of this session and your practical training you will be able to: • recognize your knowledge gap, when facing clinical problem • Formulate clinical questions according to your learning needs • Understand the necessary steps you take to solve the problem? • Know electronic medical resources you use to gain knowledge?

  3. Clinical scenario • Your patient is a three years old male, presented to the ER with Purpura, mild gum bleeding • The patient is clinically stable, and his physical examination is otherwise normal • Complete blood count is totally normal apart from severe thrombocytopenia ( platelet count<10000/mm). • You decided to admit the child and start treatment with intravenous immunoglobulin. • One student asked you if treatment with pulsed high dose methyl-prednisolone would result in similar improvement at much lower cost for the hospital?

  4. 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? Background Questions

  5. Back ground questions • When you need to know more information about the disease

  6. Types of questions raised • In child suffering from ITP does treatment with steroids, compared to IVIG results in rapid cure • In children suffering from ITP is complete blood picture as accurate as bone marrow aspirate in diagnosis. Foreground question

  7. Foreground questions • When you need to know information that you will: • Tell your patient about • Decide on his management • Usually related to • Diagnosis • Therapy • Prognosis • harm

  8. Patient/ Population Intervention/ Exposure Comparison Outcome Your Therapy QuestionThe PICO Steroids IVIG Child with acute ITP Rapid cure

  9. Patient/ Population Intervention/ Exposure Comparison Outcome Your Diagnosis PICO Question Child with Acute ITP Blood picture Bone marrow Accurate diagnosis

  10. Patient/ Population Intervention/ Exposure Comparison Outcome Your Prognosis PICO Question Child with Acute ITP Risk of being chronic ITP

  11. Patient/ Population Intervention/ Exposure Comparison Outcome Your Harm PICO Question Febrile child Aspirin Gastric ulcer

  12. Basic Search Terms • Pick up important elements in your question • ITP • IVIG • Steroids • child Start your search

  13. Online Resources • Cochrane abstracts • Guidelines websites • Medline • Search engines

  14. www.cochrane.org

  15. TRIPdatabase www.tripdatabase.com

  16. Guidelineswww.guideline.gov

  17. Medline searchwww.pubmed.com

  18. Search limits • Search by phrase • Use AND, OR, NOT • Use Pubmed limits

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