A 35-year-old woman has scheduled a follow-up visit at an outpatient clinic after a recent doctor's appointment. During her previous visit, she reported experiencing persistent fatigue and asked if she might be anaemic. She is a non-smoker with no known chronic health conditions. Blood tests were ordered which showed low ferritin levels but no anaemia. Her well-meaning friends suggested she take iron supplements to address the fatigue. However, the prescribing doctor is unsure about potential adverse effects since she isn't anaemic. The doctor wants to determine if the risks of taking oral iron supplements outweigh the benefits.
How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This should include the primary problem, disease, or co-existing conditions. Sometimes the sex, age or race of a patient might be relevant to the diagnosis or treatment of a disease. You should be specific enough so that you can apply the information from the study to your case.
Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug or therapy? Order a test or surgical procedure? What factor may influence the prognosis of the patient? Age? Co-existing problems? What was the patient exposed to?
What is the standard treatment or alternative to compare with the intervention? Are you trying to decide between two therapies or two drugs, a drug and no medication or placebo, or two diagnostic tests? Your clinical question may not always have a specific comparison.
What can you hope to accomplish, measure, improve or affect? What are you trying to do for the patient? Relieve or eliminate specific symptoms? Reduce the number of adverse events? Improve function or test scores?
In women with uncomplicated fatigue, do iron supplements compared to no supplements, reduce fatigue without any major side effects?
This is a therapy question.
Therapy questions aim to evaluate the effectiveness of different interventions in improving specific outcomes. In this case, the question evaluates the effectiveness of iron supplements compared to no supplements in reducing fatigue without major side effects
The best types of studies to answer therapy questions are those that provide high levels of evidence on the effectiveness of interventions. These include:
Randomized Controlled Trials (RCTs)
Systematic Reviews and Meta-Analyses:
Cohort Studies
Case-Control Studies
Patient/Problem |
Intervention |
Comparison |
Outcome |
| Women with uncomplicated fatigue - low ferritin results | Iron supplements | No supplements | Reduce fatigue with no major adverse effects |
|
Fatigue Concept Fatigue Subject headings Fatigue/ Low Ferritin Concept low ferritin iron deficiency non anaemic non anemic uncomplecated unexplained Subject headings ferritin blood level/ iron deficiency/
|
Iron Supplements Concept iron with: supplements, tablets, capsules, liquid, drops, oral*, dietary, intake Subject headings iron therapy/ |
No terms needed |
May not be needed unless results are too numerous. Could include: Adverse effects, outcomes |
In this example the Map Term to Subject Heading function was used in Emcare (Ovid) to investigate relevant subject headings.
Emcare (Ovid)
Patient/Problem |
Intervention |
Comparison |
Outcome |
| Women with uncomplicated fatigue - low ferritin results | Iron supplements | No supplements | Reduce fatigue with no major adverse effects |
|
Search 1 fatigue OR fatigue/ Search 2 ("low ferritin" OR "iron deficien*" OR "non anemi*" OR "non anaemi*" OR uncomplicated OR unexplained) Search 3 ferritin blood level/ OR iron deficiency/ Search 4 Search 2 OR Search 3 Search 5 Search 1 AND Search 4 |
Search 6 Iron AND (supplement* OR substitut* OR tablet* OR capsule* OR liquid OR drop* OR oral OR dietary OR intake) Search 7 iron therapy/ Search 8 Search 6 OR Search 7
Results (Search 9) Search 5 AND Search 8 |
No terms needed as there is no comparative treatment |
If the combined results of Search #1 and #2 with filters are too numerous, add terms such as: "adverse effect*" or outcome* |
|
Limits Limit to Women (Search 10) Limit to randomized controlled trial or systematic review (Search 11) |
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CASP Randomised Controlled Trial Checklist PDF Download
Centre for Evidence-Based Medicine Critical Appraisal Worksheet - Randomised Controlled Trials PDF Download
See more information and tools on the Appraise the evidence page