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Evidence-Based Medicine: Clinical Research

Clinical Research

Research Questions

In evidence-based medicine, research questions fall into two broad categories:

Background Questions Foreground Questions

Background questions ask for general information about an illness, condition, disease, process or test.  Encyclopedias, textbooks and monographs can be consulted for answering background questions. 

Example:

What drugs are used to treat hypertension?

Foreground questions ask for specific information about a clinical situation. Often, foreground questions compare interventions.  Medical literature must be consulted for answering foreground questions.   

Example:

In children with allergic rhinitis, are intranasal steroids more effective than antihistamines in the management of symptoms?


Clinical Question Domains 

Six clinical domains designate the investigative purpose of foreground questions and suggest which study design is best suited to provide answers. 

Domain Purpose Suggested Study 

Cost-Analysis

Determines which treatment or test is most cost effective and least harmful for the patient.  

Economic Analysis

Diagnosis

Determines which test is most accurate in diagnosing a condition.

Prospective blind comparison to gold standard

Etiology/Harm

Determines causes or risk factors of a condition.

RCT  Cohort ⇒ Case Control ⇒ Case Series

Prevention

Determines how to reduce chance of condition by identifying and modifying risk factors and how to diagnose early by screening.

RCT ⇒ Cohort ⇒ Case Control

Prognosis

Determines the clinical course over time and possible complications of a condition.

Cohort  Case Control  Case Series

Therapy

Determines which intervention results in the best outcome.

RCT
Qualitative/Meaning Investigates patient experience (perceptions, attitudes, beliefs).   Cross-Sectional

 

 

 

 

 

 

 

 

 

 

Notes:

  • Secondary literature is preferred but not always available 

  •  move to next study type if suggested type is not available

  • RCT - Randomized Controlled Trial 

 

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