Services on Demand
Revista da Associação Médica Brasileira
On-line version ISSN 1806-9282
NOBRE, Moacyr Roberto Cuce; BERNARDO, Wanderley Marques and JATENE, Fabio Biscegli. Evidence based clinical practice. Part 1: well structured clinical questions. Rev. Assoc. Med. Bras. [online]. 2003, vol.49, n.4, pp. 445-449. ISSN 1806-9282. http://dx.doi.org/10.1590/S0104-42302003000400039.
Clinical decisions in daily practice, to resolve patient's problem, are usually based at the conscious use of the avaliable information, through explicit determined rules. Evidence based clinical practice recognize the explicit and tacit knowledge, understanding that it is impossible all the aspects of professional competence become explicit. The doubt becomes part of the decision process, identifying initialy the inconcious component envolved and after the explicit knowledge used. When we make a stuctured clinical question with a possible answer, it is necessary to remember that the doubt can be relationned to basics and of definition aspects of the disease or relationned to the patient's mananger, like diagnose, treatment and prognose. Along our medical life, both types of question are present, with proportional change as the experience increase along the clinical practice. The process to find an appropriate answer to the doubt, came out at patient's care, depends on how the parts of this process will be structured. The recommended form is known by PICO abreviature, that means: P: patient or population, I: intervention or indicator, C: comparison or controle and O: outcome, or the answer expected found at the cientific information bases. This is the first basic need to a successfull search, and the second need is to find the key words that better describe each of the four components of the questions. Without this caution, the search at compute databases results in absence of information or in a lot of information that it is not related to our interest.
Keywords : Evidence based medicine; Clinical pathway; Patient centered care; Physician patient relation; Information science; Outcome.