NR 451 The Clinical Question Discussion

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NR 451 The Clinical Question Discussion

NR 451 The Clinical Question Discussion

 

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Your capstone change project begins this week when you identify a practice issue that you believe needs to change. The practice issue must pertain to a systematic review that you must choose from a List of Approved Systematic Reviews for the capstone project, whose link may be found in the guidelines for the Week 3 Capstone Project: Milestone 1 assignment page.

  • Choose a systematic review from the list of approved reviews based on your interests or your practice situation.
  • Formulate a significant clinical question related to the topic of the systematic review that will be the basis for your capstone change project.
  • Relate how you developed the question.
  • Describe the importance of this question to your clinical practice previously, currently, or in the future.
  • Describe what a research-practice gap is.

    Types of Clinical Questions

    Clinical questions may be categorized as either background or foreground. Why is this important?

    Determining the type of question will help you to select the best resource to consult for your answer.

    Background questions ask for general knowledge about an illness, disease, condition, process or thing. These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment, etc.

    For example

    • How overweight is a woman to be considered slightly obese?
    • What are the clinical manifestations of menopause?
    • What causes migraines?

    Foreground questions ask for specific knowledge to inform clinical decisions. These questions typically concern a specific patient or particular population. Foreground questions tend to be more specific and complex compared to background questions. Quite often, foreground questions investigate comparisons, such as two drugs, two treatments, two diagnostic tests, etc. Foreground questions may be further categorized into one of 4 major types: treatment/therapy, diagnosis, prognosis, or etiology/harm.

    For example

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    • Is Crixivan effective when compared with placebo in slowing the rate of functional impairment in a 45 year old male patient with Lou Gehrig’s Disease?
    • In pediatric patients with Allergic Rhinitis, are Intranasal steroids more effective than antihistamines in the management of Allergic Rhinitis symptoms?

    Formulating a Well Built Clinical Question

    According to the Centre for Evidence Based Medicine (CEBM)“one of the fundamental skills required for practising EBM is the asking of well-built clinical questions. To benefit patients and clinicians, such questions need to be both directly relevant to patients’ problems and phrased in ways that direct your search to relevant and precise answers.”

    A well-built clinical foreground question should have all four components. The PICO model is a helpful tool that assists you in organizing and focusing your foreground question into a searchable query. Dividing into the PICO elements helps identify search terms/concepts to use in your search of the literature.

    P = Patient, Problem, Population (How would you describe a group of patients similar to you? What are the most important characteristics of the patient?)

    I = Intervention, Prognostic Factor, Exposure (What main intervention are you considering? What do you want to do with this patient?)

    C = Comparison (What are you hoping to compare with the intervention: another treatment, drug, placebo, a different diagnostic test, etc.? It’s important to include this element and to be as specific as possible.)

    O = Outcome (What are you trying to accomplish, measure, improve or affect? Outcomes may be disease-oriented or patient-oriented.)

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