Planning for Action Defining a clinical question

2 Defining a clinical question Search Types Keyword or simple search Searching at its most basic level One or two words as the search strategy. Advantage – fast return of information Disadvantage – too many results due to lack of focus. Advanced Search More sophisticated searching Planning and strategy Advantage – fewer, more relevant results Disadvantage – time needed to plan search strategy

3 Defining a clinical question Developing an effective search strategy is essential to the recovery of required information. A simple, generic search strategy : Formulate research question Identify important concepts within the question Identify search terms describing those concepts Generate synonyms and variations of those terms Prepare the search statement

4 Search stages broad, to minimise the risk of missing relevant information 1. Sensitive 2. Focussed narrower, to ensure relevance of recovered information narrowest, through use of filtering 3. Best Evidence

5 Focussing a question The four elements P Person, problem, population I (or E) Intervention (or Exposure) C Comparison intervention O Outcome(s)

6 Focussing a question The four elements - an example Person/Problem/ Do people with insulin- Population dependent diabetes Interventionwho are treated with an intensive insulin regimen Comparison compared with those Intervention treated with a traditional insulin regimen Outcome(s)have fewer long-term complications or a lower mortality rate?

7 Focussing a question Key characteristics and synonyms

8 Focussing a question Scenario 1 A 17 year old female was travelling home one night when the car her friend was driving careered off the road. Fortunately, no-one was seriously injured but she presented to A&E with localised low back pain and was diagnosed with lumbar strain. For some time, the Senior Physio has been considering the treatment for low back pain and wonders if acupuncture might be an effective alternative.

9 Focussing a question Scenario 1 - PICO Person/Problem/ 17 year old female Population Low back pain/lumbar strain InterventionAcupuncture Comparison Current treatment Intervention Outcome(s)Pain relief

10 Focussing a question Key characteristics and synonyms

11 Focussing a question Scenario 2 Donald Brown is an 18 year old school student currently preparing for examinations. He has suffered various allergies throughout his life. His main concern at the moment is eczema as it often breaks out when he is anxious. Although it is under control for now, using Hydrocortisone Cream 1%m/m, Donald and his parents would like some advice on whether there are other steps they can take to help ensure that he doesn’t experience a ‘flare-up’ during the examination period as the itching disrupts his concentration

12 Focussing a question Scenario 2

13 Focussing a question Scenario 3 Joseph Smith is 65 years old and lives in rural Lanarkshire. His general health is good and he is reasonably fit for his age. Over the past few years, Joseph has had difficulty sleeping. He claims that this is the result of having to get up to urinate three or four times a night. He was recently diagnosed as having an enlarged prostate (benign prostatic hyperplasia) and was prescribed 10mg Alfuzosin XL each day. He has been taking the tablets for around six weeks but feels that they are not easing his symptoms. He has heard of a herbal preparation which is popular in treating the condition - saw palmetto - and would like to know more about it and, in particular, whether it is likely to be helpful in his case.

14 Focussing a question Scenario 3