Sample clinical scenario - 此例取自實證網站之 第7項

Consider the following clinical situation:
Amelia is a 72-year-old women who you are seeing in your office today for continuing problems with sharp , burning pain and extreme sensitivity to touch in her middle back. Six months ago you prescribed acyclovir for Amelia’s bout with shingles (herpes zoster).Her rash and blisters resolved within a month.
However, Amelia admits being under a lot of stress lately caring for her husband, who is in frail health. She has had trouble sleeping and her appetite is down. On exam today, Amelia exhibits allodynia and shows clear signs ofpostherpetic neuralgia.
You know that tricyclic antidepressants have proven effective for many patients with this problem, but Amelia has some concerns about taking medications. You remember seeing some discussion of the use of two topical therapies, capsaicin and lidocaine patches, but are unsure of their efficacy and side effects.
Considering Amelia’s concerns, what do you recommend for relief of her pain?
Developing a searchable clinical question - 形成一道可搜尋的臨床問題
The first step in gathering the best evidence is designing a searchable, focused clinical question using the PICO model. A question that uses the PICO format has four components: patient, intervention, comparison and outcome.
The next step is determining the category or type of clinical question you are trying to answer. Are you interested in therapy, diagnosis, prognosis, or etiology? Do you need to know more about prevention or screening? Each type of question requires looking for studies using different designs or methodologies.
When looking for the best information on therapies, for example, you should consider the hierarchy of research studies, also referred to as the evidence pyramid.
Source: SUNY Downstate Medical Center Evidence Based Medicine Course
http://servers.medlib.hscbklyn.edu/ebmdos/3ebm100.htm
Ideally, you would hope to find a systematic review of randomized, controlled trials. This type of review would offer an analysis of the highest quality therapeutic studies on your topic and provide recommendations for treatment. One very real limitation to keep in mind, however, is that this kind of rigorous review is often not available. This is due to both the complex nature of many health issues as well as the lack of scientific data on some therapeutic options.
Sample clinical question - 臨床問題實例
Based on the PICO model just described, here is the focused question for our clinical scenario:
In an elderly woman with postherpetic neuralgia, are topical treatments as safe and effective as antidepressants in relieving pain?
Let’s assume you are starting off with limited knowledge of postherpetic neuralgia. Your first step is finding a summary to give you background information on this topic. We will now consider how to search UpToDate for this kind of overview. We will then look at resource options for foreground information to supplement your background knowledge by searching for systematic reviews and high quality research studies. For this, we will use the Cochrane Database of Systematic Reviews and the ACP Journal Club. Finally, we will see what additional foreground information is available by looking at the primary research literature, using the Clinical Queries feature in PubMed. The next sections of this tutorial will lead you step-by step through this process.
 
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