{"id":43,"date":"2008-11-07T21:58:29","date_gmt":"2008-11-07T20:58:29","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/adc-archimedes\/?p=43"},"modified":"2008-11-07T21:58:29","modified_gmt":"2008-11-07T20:58:29","slug":"ask-and-it-might-be-given-unto-you","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/adc\/2008\/11\/07\/ask-and-it-might-be-given-unto-you\/","title":{"rendered":"Ask, and it might be given unto you."},"content":{"rendered":"

\"DescartesThe five steps of evidence based practice are commonly summarised as ‘Ask, Acquire, Appraise, Apply and Assess’. The first one of these – just asking a question – can prove terribly time consuming and difficult, but with a bit of dissection can be made much easier. The first step when deconstructing the anatomy of inquiry is to ask ‘What sort of question is being asked?’. If it’s about a clinical topic (not directions to the Pharmacy), then the questions can be grossly categorised as ‘foreground’ and ‘background’. Foreground questions are specific and pointed, and can be fitted into a ‘PICO’ frame [1]:Patient-problem, Intervention, Comparision, Outcome. An example might be ‘in bronchilitis [problem], is ipratropium [intervention] or salbutamol [comparison] better for improving respiratory distress? [outcome]’ (The answer, for those who are interested, is ‘Neither’.) Background questions are much much broader, and often of the ‘what is’ or ‘what causes’ type: ‘what is a pilomyxoid astrocytoma?’, ‘what causes asthma in childhood?’.<\/p>\n

There are another group of questions that aren’t quite either, though. Take ‘when should an LP not be performed as part of a septic screen in an infant?’. It seems quite specific, at first glance, but can’t be fitted into the PICO frame … and if you dissect it further, it’s probably an amalgam of a few different questions: In a febrile infant[P] does age [I], max temperature [C], clinical assessment of ‘unwellness’ [C], white cell count [C] or CRP [C] predict meningitis[O]? It may also have elements of clinical\/societal judgement too: ‘How much risk am I\/these parents\/this society prepared to take of undiagnosed meningitis?’ (If it’s “zero”, then you’ll be needing to LP every child, for every febrile illness, and probably twice.)<\/p>\n

It’s this last group of questions – the ‘not quite in focus’ that are the stumbling blocks for many in their search for evidence-based answers. If you hit one of these – your own or one of your learner’s – take a step back and rephrase, dissect and reconstruct. It may be one, two, or more individual questions. Then with a truly foreground focussed question you can move on to acquire the answer.<\/p>\n

[1] Bob Phillips. Practicing evidence based acute paediatrics.<\/p>\n

Current Pediatric Reviews, 2005, 1, 51-54<\/p>\n","protected":false},"excerpt":{"rendered":"

The five steps of evidence based practice are commonly summarised as ‘Ask, Acquire, Appraise, Apply and Assess’. The first one of these – just asking a question – can prove terribly time consuming and difficult, but with a bit of dissection can be made much easier. The first step when deconstructing the anatomy of inquiry […]<\/p>\n

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