Introduction to Inquiry Content Authors Stephanie Schulte, MLIS, Associate Professor, Health Sciences Library A production of Health Sciences Library Digital Solutions © 2015 The Ohio State University eModule 1 LSI Curriculum, Year 1

Learning Objectives 1.Summarize the steps of evidence based practice. 2.Distinguish between research and clinical questions, and background and foreground questions. 3.Construct a question using the PICO (Population, Intervention, Comparison intervention, Outcome) framework.

Case Scenario  Suspected meconium ileus  Negative (or borderline) sweat test  Negative neonate screening test Seven years later…  History of respiratory infections  Repeat sweat test, higher  df508 and kb, C-T mutation  Kalydeco of questionable efficacy

Definition of EBP EBP began in earnest in the early 1990s. The most cited definition is that of Sackett et al., “Evidence based medicine: what it is and what it isn’t?” an editorial published in 1996 in the British Medical Journal: “ ” external clinical evidence from systematic research. individual clinical expertise with the best available practice of evidence based medicine means integrating decisions about the care of individual patients. The and judicious use of current best evidence in making Evidence based medicine is the conscientious, explicit,

5 commonly known steps to EBP Construct a good question Efficiently and effectively search for literature to answer the question Critically appraise the literature for quality, strength of evidence and usefulness to your question Make a decision based on what you've found and evaluated Evaluate the impact of the decision and start the process again Ask Acquire Appraise Apply Adjust

Apply EBP to broad questions Traditionally, the EBP process has been used for clinical questions. However, it is just as suitable for other types of questions, including research, community or public health questions. Clinical questions Research questions Community or public health questions

Patient, problem or population These words describe your patient's or population's condition or disease state. I Intervention Most times the intervention is a therapeutic one, meaning a drug, physical therapy, lifestyle intervention, or an educational program. When asking certain types of questions that are prognostic or etiologic in nature, the intervention may be the passage of time. If asking about a diagnostic test, this will be the test or diagnostic modality in question. Comparison intervention It could be a comparison therapy, a gold standard therapy or diagnostic test, or possibly, you could have no comparison. Outcome of interest It might be whether a patient lives or dies, whether a drug cures or prevents recurrence or hospitalization, or whether a population loses weight or has fewer heart attacks or strokes. Outcomes can vary depending on the question. PICO

Research questions Thinking back to our case, we could ask a lot of different questions and those questions might reflect our level of understanding at the time. Once our knowledge base is built up a bit, we can ask more complex and specific research questions, such as: The question can be broken down into parts using the PICO framework as follows… For instance, we might ask general questions like: These questions would be classified as questions, and given their more core research slant, they are background questions. background research

Applying PICO Delta F508 CFTR mutation mutation coupling to folding of the first nucleotide-binding domain mutation coupling to the folding of first nucleotide-binding domain PLUS interaction with the fourth intra- cellular loop or coupling to the fourth intracellular loop alone restoration of function of the mutation to wild-type levels I When we are able to ask questions with direct comparisons or look at the outcomes from some kind of intervention, technique, or test on a patient, population or specific problem, we have a question. These types of questions lend themselves well to a good search of the literature. foreground

Clinical questions Thinking more about the clinical side of this scenario, we could ask some different questions. background Here we see the difference in the nature of the question. We are clearly most interested in some aspect of cystic fibrosis. clinical This is a foreground PICO question. This is a background question.

Community health questions Lastly, we could consider the side of the case. community health

Why is this important? So, why do we care about the type of question we’re asking? Can't we just Google the answer and call it good? Well, maybe that might work as a starting point, but the reason for recognizing the type of question you are asking is to guide you to the best source to answer it the fastest. And why bother with PICO? Because it can help provide the backbone of a good search strategy for searching the literature efficiently and effectively. Clinical questions Research questions Community or public health questions I

Let's review what we've learned so far… EBP is a 5-step process that integrates the best research evidence with clinical expertise and patient preferences. EBP has traditionally used the PICO framework for asking clinical questions, but PICO can be easily applied to research other types of questions as well. The two common kinds of questions are background and foreground. Background questions are general questions without comparisons, whereas foreground questions are specific questions that compare interventions. Recognizing whether your question is a background or foreground question can identify your choice of resource to answer the question the fastest. Using PICO to break down your foreground questions can help you construct effective search strategies.

Questions? Contact Stephanie Schulte, MLIS The librarians at the Health Sciences Library are available to meet with you by appointment to help you search the literature. Visit us in person or ask questions via the Ask a Librarian form on our website.Ask a Librarian form Thank you for watching!

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