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 1 A 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

Patients who have suffered strokes Or Problem Intervention Comparison Outcomes Patients who have suffered strokes

Patients who have suffered strokes Stroke units Or Problem Intervention Comparison Outcomes Patients who have suffered strokes Stroke units

Patients who have suffered strokes Stroke units Normal hospital care Or Problem Intervention Comparison Outcomes Patients who have suffered strokes Stroke units Normal hospital care

Patients who have suffered strokes Stroke units Normal hospital care 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

Acute Cough in primary care setting Patient Or Problem Intervention Comparison Outcomes Acute Cough in primary care setting

Acute Cough in primary care setting Antibiotics Patient Or Problem Intervention Comparison Outcomes Acute Cough in primary care setting Antibiotics

Acute Cough in primary care setting Antibiotics No antibiotics Patient Or Problem Intervention Comparison Outcomes Acute Cough in primary care setting Antibiotics No antibiotics

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?