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
 Understand the necessary steps you take to solve the
problem?
 Know electronic medical resources you use to gain
knowledge?

Clinical scenario



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
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?
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?
Back ground questions

When you need to know more information
about the disease
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 questions

When you need to know information that you
will:
Tell your patient about
 Decide on his management


Usually related to
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Diagnosis
Therapy
Prognosis
harm
Your Therapy Question
The PICO
Patient/
Population
Intervention/
Exposure
Child with
acute ITP
Steroids
Comparison
IVIG
Outcome
Rapid cure
Your Diagnosis PICO Question
Patient/
Population
Intervention/
Exposure
Child with
Acute ITP
Blood
picture
Comparison
Bone
marrow
Outcome
Accurate
diagnosis
Your Prognosis PICO Question
Patient/
Population
Child with
Acute ITP
Intervention/
Exposure
Comparison
Outcome
Risk of
being chronic
ITP
Your Harm PICO Question
Patient/
Population
Intervention/
Exposure
Febrile
child
Aspirin
Comparison
Outcome
Gastric ulcer
Basic Search Terms

Pick up important elements in your question
 ITP
 IVIG
 Steroids
 child
Start your search
Online Resources
 Cochrane
abstracts
 Guidelines
websites
 Medline
 Search
engines
www.cochrane.org
TRIPdatabase
www.tripdatabase.com
Guidelines
www.guideline.gov
Medline search
www.pubmed.com
Search limits
Search
by phrase
Use AND, OR, NOT
Use Pubmed limits
Questions