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Evidence Based Practice

ASK

One way to construct a clinical question is to use the PICO method. PICO is a mnemonic that helps one remember the key components of a well focused question. The clinical question needs to identify the key problem of the patient, what treatment or tests are being considering for the patient, what alternative treatment or tests are being considered (if any), and what is the desired outcome to promote or avoid. 

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Knowledge Check
Read this case study and select the best clinical question.

A 65 year old male with a long history of type 2 diabetes and obesity wants to lose weight. He had knee surgery 10 years ago but no other major medical problems. He does not smoke and otherwise his medical history is unremarkable. He has tried numerous diet and exercise programs to reduce his weight but has not been very successful. His granddaughter just started high school and he wants to see her graduate and go on to college. He understands that his diabetes puts him at a high risk for heart disease and is frustrated that he cannot lose the necessary weight. His neighbor told him about a colleague at work who had his stomach stapled and as a result not only lost over 100 lbs. but also "cured" his diabetes. He wants to know if this procedure really works.


A) What is the best way for an obese older male with diabetes and an elevated risk of heart disease to lose weight?

B) In male patients with type 2 diabetes and obesity, is bariatric surgery more effective than standard therapy at increasing the probability of diabetes remission?

C) Will bariatric surgery cure diabetes in an an obese older male at high risk of heart disease with no smoking history?