Bài giảng Y học: Xây dựng câu hỏi lâm sàng PICO

Bài giảng cung cấp cho người học các kiến thức: Xây dựng câu hỏi lâm sàng PICO, evidence based medicine, evidence based practice, evidence based clinical practice, evidence based health care,... Hi vọng đây sẽ là một tài liệu hữu ích dành cho các bạn sinh viên đang theo học môn dùng làm tài liệu học tập và nghiên cứu. Mời các bạn cùng tham khảo chi tiết nội dung tài liệu.

Sheila Snow-Croft NN/LM SE/A

Taken in part from the tutorial developed by Connie Schardt, Duke

University Medical Center Library and Jill Mayer, University of North

Carolina at Chapel Hill Health Sciences Library, at

http://www.hsl.unc.edu/services/tutorials/ebm  

Xây dựng câu hỏi lâm sàng

PICO

"Evidence­based medicine is the integration of best  research evidence with clinical expertise and 

patient values." 

Sackett, D L (2000). Evidence­based medicine: How 

to practice and teach EBM(2nd ed.) Edinburgh; New

York: Churchill Livingstone.

Evidence-Based Medicine (EBM)

Evidence-Based Practice (EBP)

Evidence-Based Clinical Practice (EBCP)

Evidence-Based Health Care (EBHC)

Evidence-Based Nursing (EBN)

Sackett’s definition refers to all of these; EBP and EBHC are more universally used.

patient

(from Introduction to Evidence Based

Practice tutorial)

EBM:

(from Centre for Evidence Based Medicine www.cebm.net)

Clinical expertise: the clinician’s cumulated experience, education, and clinical skills

Patient values: The patient brings to the

encounter his or her own personal and unique

concerns, expectiations, and values

Best Research Evidence: usually found in

clinically relevant research that has been conducted using sound methodology

Forming a question

 Identify key patient problem

 Phrased to facilitate finding an answer

 What treatment might be considered

 Alternative treatments to consider

 Outcome to avoid or promote

P= Patient or problem

I = Intervention, prognostic

C=Comparison

O=Outcomes

(T)=Type of Study

Exercises: PICO scenarios

Types of Studies

 Case series and Case Reports

 Case control studies

 Cohort studies

 Randomized, controlled clinical trials

 Systematic Reviews

 Meta-analysis

Case series and Case reports

 Collections of reports on the treatment

of individual patients or a report on a single patient

 No control groups with which to

compare outcomes, so limited

statistical validity.

Case control studies

compared with people without the condition

Researcher looks back to identify factors or exposures possibly associated with the condition, often relying on medical records and patient recall

Less reliable because showing a statistical relationship does not mean than one factor necessarily caused the other. 

and looks backwards to possible exposures

Cohort studies

particular treatment or have an exposure, follow them forward over time, and then compare for outcomes with a similar group that has not been affected by the treatment or exposure

controlled studies, since the two groups may differ in ways other than in the variable under study.  

forward to an outcome

Randomized, controlled clinical

trials

or exposure to study its effect on patients

bias (randomization and blinding) and allow for

comparison between intervention and control groups. 

cause and effect.  

patients forward to an outcome

Systematic Reviews

specific question An extensive literature search is conducted to identify studies with sound

methodology The studies are reviewed, assessed, and the results summarized according to the

predetermined criteria of the review question. 

topic and combines the results using accepted

statistical methodology to report the results as if it

were one large study. 

the areas of systematic reviews and meta-analysis