Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

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Chapter 8
IDENTIFYING AND DEFINING RELEVANT QUESTIONS
Everyday clinical practice can present a vast array of dilemmas
regarding the prevention, diagnosis, prognosis or treatment of oral
diseases and disorders. EBP encourages the recognition of uncer-
tainty when making clinical decisions. The first step in the EBP 
process requires the area of clinical uncertainty to be translated into a
focused, clinically relevant question.
For example, an adult patient presents with a cavity in a posterior
tooth. You explain the different restoration options available to them.
They stress that the appearance of the restoration is important to them
and that they have heard that ceramic inlays can produce a good
colour match with the surrounding tooth. However, they have 
concerns over the longevity of such restorations in comparison to
amalgam and want to know exactly how long they might expect a
ceramic inlay to last. You decide to examine the research literature to
try and find an answer to their question.
Before looking for relevant information to answer your question, it
is a good idea to define your question so that you know exactly what
you’re looking for. One way to do this is to break it down into 
sections. Clinical research questions can usually be broken down 
into the following (PICO) components:
5. Evaluation of practice
4. Implementation of findings
1. Identification of a clinically 
relevant question
2. Searching for relevant
research evidence
3. Appraisal of research
evidence
Fig. 8.1
The key stages involved in evidence based practice.
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• Population – who are the participants within the study?
• Intervention/Exposure – what are the interventions, risk factors or
exposures of interest?
• Comparison – what control comparisons do you want to make?
• Outcomes – what outcome measures are of interest to you and your
patient?
Using the previous example, the question you want to answer is
‘how effective are ceramic inlays?’ Applying the PICO format allows
us to define the question further. The patient group (P) of interest can
be defined as adults requiring a restoration to any posterior tooth. The
restoration/intervention (I) of interest to the patient is ceramic inlays.
The patient wants to know how long ceramic inlays are likely to last in
comparison (C) to amalgam. The outcomes (O) of importance to both
you and your patient include the longevity of the restoration and
aesthetics.
Structuring the question in this way can help clarify the type of
question you are asking and how to identify the relevant information
to answer your question.