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Research to Practice:
Advanced Techniques for Finding Information for Clinical Practice

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Asking Clinical Questions You Can Answer

Each encounter with a patient may raise many questions about diagnosis, treatment, prevention, and other aspects of clinical practice. There is no perfect question, but questions that are composed of four key elements are more likely to lead you efficiently to precise, relevant answers.

  1. the patient or problem
  2. the clinical action or intervention being considered
  3. a comparison intervention, if relevant
  4. the outcome

The question you formulate using the four elements above will guide your search for clinical evidence using the tools mentioned below. For more information, read The Well-Built Clinical Question.

Question 1: Clinical Scenario

I am an adult and women's health ARNP providing primary care to approximately 250 of the 760 adolescents and adult women in a women's prison. My primary patients range in age from 18 to 72 with an average age of 30.

Health care is paid for by the state through the Department of Corrections. The mandate for prisoner health care is that inmates receive adequate and basic care. There is a limited formulary within the prison system but this can be expanded with proven need and approval by the pharmacy committee. Use of prescriptions, including antibiotics, are monitored at each site and on a state-wide level.

One of the most common presenting problems is acute maxillary sinusitis. There is no single protocol for care in the treatment of sinusitis in this setting, but one is under development.

Sample Question:

Under what conditions are antibiotics effective in eliminating symptoms of acute maxillary sinusitis in adults?

Question 2

What are effective interventions for preventing falls in the elderly?

Searching the Literature

Researchers perform comprehensive literature reviews as a preliminary step in research studies. Clinicians perform more focused searches of the literature to discover information that is useful for patient care. Clinical information is developed gradually through research studies and individual interactions between clinicians and patients. Different types of publications summarize information from both these sources.

This outline highlights the major resources a clinician might consult to answer a clinical question. Not every question requires consulting the full range of resources.

The sample searches below build on the basic techniques demonstrated in:

Textbooks

Review Articles

Research Articles

Clinical Practice Guidelines

Structured Abstracts andSummaries

MetaSearch Engines

Systematic Reviews and Meta-Analyses

Evaluating Research Studies

Before using information as the basis for patient care, you must assess its scientific and clinical merit. The Users' Guides to Evidence-Based Practice provide useful questions to guide your evaluation. Key questions to quickly analyze all types of research studies are listed in Table 1: Guides for Selecting Articles That Are Most Likely to Provide Valid Results.

Sample questions from the guide for articles about therapy are listed below.

Scientific Merit

Was the study design valid?

  1. Was the assignment of patients to treatments randomized?
  2. Were all patients who entered the trial properly accounted for and attributed at its conclusion?
    • Was followup complete?
    • Were patients analyzed in the groups to which they were randomized?
  3. Were patients, health workers, and study personnel "blind" to treatment?
  4. Were the groups similar at the start of the trial?
  5. Aside from the experimental intervention, were the groups treated equally?

What do the results show?

  1. How large was the treatment effect?
  2. How precise was the estimate of the treatment effect?

Clinical Merit

Will the results help me in caring for my patients?

  1. Can the results be applied to my patient care?
  2. Were all clinically important outcomes considered?
  3. Are the likely treatment benefits worth the potential harms and costs?
You may also want to consider these questions from Talbot's Principles and Practice of Nursing Research:

For More Information

Online Class Evaluation Form (class use only)

Janet G. Schnall, MS, AHIP
Information Management Librarian
Library Liaison to the University of Washington School of Nursing, Department of Pediatrics, Department of Ophthalmology and Multicultural Affairs
schnall@u.washington.edu
healthlinks.washington.edu/hsl/liaisons/schnall/

Created March 31, 1999.
Revised April 7, 2003.

This page may be reprinted or adapted for academic nonprofit purposes, providing the source is accurately quoted and credited.