EXERCISE - CLINICAL QUESTION

PICO
David L. Sackett
Clinical decision
Clinical
expertise
Scientific
evidence
Patients
preference
Clinical problem
Evidence based medicine
Science and Art of Medicine
Issue of deep vein thrombosis (DVT) on long-
haul flights and whether it is possible to
prevent it by wearing elastic stockings.
PATIENT / PROBLEM : DVT on long-haul flights

INTERVENTION : Elastic stockings

CONTROL / COMPARATOR : No

OUTCOME : Prevention of DVT

CLINICAL QUESTION : Can DVT on long-haul flights be
prevented by wearing stockings?
A 28-year-old male presents with recurrent furunculosis for
past 8 months; these episodes have been treated with drainage
and several courses of antibiotics but keep recurring. He asks if
recurrences can be prevented.
PATIENT / PROBLEM : Patient with recurrent furunculosis

INTERVENTION : Prophylactic antibiotics

CONTROL / COMPARATOR : No treatment

OUTCOME : Prevention of recurrence

CLINICAL QUESTION : In patients with recurrent
furunculosis do prophylactic antibiotics reduce the recurrence
rate (when compared with no treatment)?
Jeff , a smoker of more than 30 years, has come to see you about something
unrelated. You ask him if he is interested in stopping smoking. He tells you he has
tried to quit smoking unsuccessfully in the past. A friend of his, however,
successfully quit with acupuncture. Should he try it? Other interventions you
know about are nicotine replacement therapy and antidepressants.
PATIENT / PROBLEM : Long time smokers

INTERVENTION : Acupuncture

CONTROL / COMPARATOR : NRT / Antidepressants

OUTCOME : Quitting smoking

CLINICAL QUESTION : In long time smokers does
acupuncture compared with NRT/Antidepressants improve
the chance of quitting?
At a routine immunisation visit, Lisa, the mother of a -month-old, tells you that
her baby suffered a nasty local reaction after her previous immunisation. Lisa is
very concerned that the same thing may happen again this time. Recently, a
colleague told you that needle length can affect local reactions to immunisation
in young children but cant remember the precise details.
PATIENT / PROBLEM : Infants receiving immunization

INTERVENTION : Longer needles

CONTROL / COMPARATOR : Shorter needles

OUTCOME : Prevention of local reaction

CLINICAL QUESTION : In infants receiving immunization
injections, does needle length affect the rate of local
reaction?