如何形成可回答的临床问题(PICO)背景问题(Backgroundquestions):意指与疾病相关的知识性问题,问题的结构通常包括有带有动词的疑问句(who、what、where、when、how、why)与疾病。Who:病患特性、危险因子等What:自然病程、症状学等Where:影响的器官与系统、疾病分布的区域等When:疾病好发的年龄、时间、季节等How:病理生理学Why:病因举例:急性心肌梗塞Who:老年人、男性、家族史What:胸痛、心电图的变化等等Where:冠状动脉阻塞的位置、程度等等When:气温低、心肌耗氧量高之活动等How:动脉硬化斑块破裂、血栓形成Why:动脉硬化危险因子、糖尿病、高血压、高血脂症、抽菸,肥胖,少运动前景问题(Foregroundquestions):指与治疗病患相关的特殊性问题,问题的架构通常包括有4个项目:与病患相关的问题(Thepatientand/orproblemofinterest)主要的治疗措施,包括诊断、治疗、预后、及病患的观点(Themainintervention(definedverybroadly,includinganexposure,adiagnostictest,aprognosticfactor,atreatment,apatientperception,andsoforth))parisonintervention(s),ifrelevant)相关的临床成效(e(s)ofinterest)PICO问题P:patientand/orproblem(病患)I:intervention(处理)parisonofintervention(对照)O:e(临床结果)LevelsofEvidenceLevelsofEvidence(March2009)LevelTherapy/Prevention,Aetiology/HarmDiagnosis1aSystematicReview(SR)ofRCTsSRofLevel1diagnosticstudies;ClinicalDecisionRule(CDR)with1bstudiesfromdifferentclinicalcentres1bIndividualRandomizedcontrolledtrial(RCT)Validatingcohortstudywithgoodreferencestandards;orCDRtestedwithinoneclinicalcentre1cAll-or-noneAbsoluteSpPinsandSnNouts2aSystematicreviewofcohortstudiesSRofLevel>2diagnosticstudies2bIndividualcohortstudyExploratorycohortstudywithgoodreferencestandards;CDRafterderivation,orvalidatedonlyonsplit-sampleordatabases2c"es"Research;Ecologicalstudies3aSystematicreviewofcase-controlstudiesSRof3bandbetterstudies3bIndividualCase-
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