The CaseWe will focus on the following patient case: Mr. J. is a 70-year-old African American man with a history of acute myocardial infarction (MI) six weeks ago. He appears to be doing well on medical therapy (including aspirin, beta blocker, ACE inhibitor, and statin), though post-MI echocardiography has shown a low left ventricular ejection fraction (LVEF) of 30%. (Ventricular dysfunction is a condition in which the ventricle of the heart is functionally impaired. It may be associated with a diminished ejection fraction, the proportion of blood ejected from the left ventricle during a heartbeat. An LVEF < 40% indicates dysfunction of the left ventricle.) Mr. J. is very close to his grandchildren and reports that his eldest granddaughter just got into law school. He is concerned that, given the state of his heart, he will not survive to see her graduate. Mr. J's physician tells you that several studies have investigated whether prophylactic placement of an implantable defibrillator can reduce mortality in patients such as Mr. J. who have problems with ejection fraction following an MI. She tells you to find evidence that would indicate whether or not Mr. J. might benefit from implantation of a defibrillator. You are asked to do a PubMed search and bring the answer to morning rounds. Formulating your QuestionOne of the most important steps in doing a PubMed search is creating a focused question. PubMed includes over 18 million citations, but not all of them will meet your information needs. Think about your topic and formulate a specific question that will help you retrieve and identify relevant information. The following framework, often referred to as PICO or PICOTT, helps you to identify the important elements of a question (the who, what and why). Patient Problem – Describe the primary condition or patient's problem. |
