What type of clinical scenario would you like to consider?

Therapy – Systematic Review

You admit a 75 year old man with a stroke (left sided weakness) who is having trouble ambulating, feeding, bathing and dressing himself. He has hypertension but it is well controlled with a diuretic. He is otherwise well and now that he is medically stable you decide after discussion with him to transfer him to a stroke unit. His family asks to see you because they are concerned about this transfer. They live very close to the acute care hospital and wonder why he can’t stay on the general medical ward where he currently is. You arrange to meet with him and his family to discuss their concerns. In the meantime, you decide to review the evidence for the use of stroke units.

What clinical questions could you ask? Write your question down on a piece of paper.

Compare your answer to the question we formulated:

Patient or Problem
75 year old man with a stroke and residual weakness
Intervention
Admission to a stroke unit
Comparison Intervention
General care
Outcome
Functional status

In an elderly man with a stroke, does admission to a stroke unit decrease the risk of death and dependency?

Prognosis – Seizure Post-Stroke

You see a 70 year old man in your outpatient clinic 3 months after he was discharged from your service with an ischemic stroke. He is in sinus rhythm, has mild residual left-sided weakness but is otherwise well. His only medication is ASA and he has no allergies. He recently saw an article on the BMJ website describing the risk of seizure after a stroke and is concerned that this will happen to him.

What clinical questions could you ask? Write your question down on a piece of paper.

Compare your answer to the question we formulated:

Patient or Problem
70 year old man
Intervention
Stroke
Comparison Intervention
None
Outcome
Seizure

In a 70 year old man does a history of stroke increase his risk for seizure?

Diagnosis – Iron Deficiency Anemia

You admit a 75 year old woman with community-acquired pneumonia. She responds nicely to appropriate antibiotics but her hemoglobin remains at 100 g/l with an MCV of 80. Her peripheral blood smear shows hypochromia, she is otherwise well and is on no incriminating medications. You contact her family physician and find out that her Hgb was 105 g/l 6 months ago. She has never been investigated for anaemia. A ferritin has been ordered and comes back at 10 mmol/l. You admit to yourself that you’re unsure how to interpret a ferritin result and aren’t sure how precise and accurate it is.

What clinical questions could you ask? Write your question down on a piece of paper.

Compare your answer to the question we formulated:

Patient or Problem
Elderly woman with anaemia
Intervention
Ferritin
Comparison Intervention
None
Outcome
Iron deficiency anaemia

In an elderly woman with hypochromic, microcytic anaemia, can a low ferritin diagnose iron deficiency anaemia?

Harm – Sotalol

You see a 50 year old man who asks for a repeat prescription of sotalol which he has been taking for extrasystoles for several years. He has a remote history of an MI. You haven’t seen him previously and are concerned about the proarrhythmic properties of sotalol given what is known about other antiarrhythmics.

What clinical questions could you ask? Write your question down on a piece of paper.

Compare your answer to the question we formulated:

Patient or Problem
Man with extrasystoles
Intervention
Sotalol
Comparison Intervention
Placebo
Outcome
Death

In a man with extrasystoles and a remote history of MI, does treatment with sotalol increase his risk of death?