A Prática Clínica Baseada em Evidências. Parte I - Questões Clínicas Bem Construídas

Abstract

Clinicai decisions in daiiy practice, to resoive patient 's probiem, are usua11y based at the conscious use ofthe avaliabie information, through explicit determined mies. Evidence based clinicai practice recognize the explicit and tacit knowledge, understanding that it is impossibie a11 the aspects of professionai competence become explicito The doubt becomes part of the decision process, identifying initiaiy the inconcious component envoived and after the explicit knowiedge used. When we m ake a stuctured clinicai quescion with a possibie answer, it is n ecessary to remember chac the doubc can be relacionn ed to basics and of definicion aspects of the disease or relationned to the patient's mananger, like diagnose, treatment and prognose. Aiong our medicai Jjfe, both types of question are present, with proportionai change as the experience increase along the clinicaI practice. The process to find an appropriate answer to the doubt, carne out at patient's care, depends on how the pares of this process wi11 be structured. The recommended form is known by PICO abreviature, th at means: P: patient or population, I: intervention or indicator, C: comparison or controle and O: outcome, or the answer expected found at the ciencific information bases. This is the first basic need to a successfu11 search, and the second need is to find the key words that better describe each of the fo ur components of the questions. Without this caution, the search at compute data bases results in absence of information or in a lot of informacion chac it is noC related to our interest.[Rev Assoc Med Bras 2003; 49(4): 445-9].