All newborns should be screened with pulse oximetry prior to discharge; it increases detection of congenital heart defects.

For many smokers, the benefits of quitting will outweigh the risks associated with varenicline.

Early insertion of the etonogestrel implant does not affect lactogenesis, and fosters contraceptive compliance.

Do-it-yourself ear wax removal is safe and simple—and a timesaver for patients as well as physicians.

Taken alone or together, these 2 supplements don’t relieve the pain of hip or knee osteoarthritis.

Many doctors stopped prescribing rosiglitazone in 2007, when a study linked it to an elevated MI risk. An update to that study underscores the need to switch patients still taking it to another drug.

A 2-question tool can achieve reasonably accurate results, and takes minimal time or training.

For patients with atrial fibrillation, more relaxed heart rate control is as effective as stricter control—with fewer adverse effects.

This OTC analgesic is as effective as acetaminophen with codeine and better tolerated, a new study of children with arm fractures shows.

Rather than increasing cardiac complications, as previously feared, the perioperative use of statins appears to lower the risk.

Two new studies suggest that this widely used procedure should be used less often—and more cautiously.

Monitoring bone density within the first 3 years of therapy does not provide useful information—and it is costly besides.

The combination of an ACE inhibitor and an ARB reduces proteinuria, but leads to worse renal outcomes

Antibiotics in sequence is a more formidable ally than the standard treatment regimen

A clever twist on presenting spirometry results can boost smoking cessation rates

Outcomes support chlorthalidone despite its metabolic profile

Evidence supports use of tamsulosin, nifedipine

Objective

To describe the obstacles encountered when attempting to answer doctors' questions with evidence.

Design

Qualitative study.

Setting

General practices in Iowa.

Participants

9 academic generalist doctors, 14 family doctors, and 2 medical librarians.

Main outcome measure

A taxonomy of obstacles encountered while searching for evidence based answers to doctors' questions.

Results

59 obstacles were encountered and organised according to the five steps in asking and answering questions: recognise a gap in knowledge, formulate a question, search for relevant information, formulate an answer, and use the answer to direct patient care. Six obstacles were considered particularly salient by the investigators and practising doctors: the excessive time required to find information; difficulty modifying the original question, which was often vague and open to interpretation; difficulty selecting an optimal strategy to search for information; failure of a seemingly appropriate resource to cover the topic; uncertainty about how to know when all the relevant evidence has been found so that the search can stop; and inadequate synthesis of multiple bits of evidence into a clinically useful statement.

Conclusions

Many obstacles are encountered when asking and answering questions about how to care for patients. Addressing these obstacles could lead to better patient care by improving clinically oriented information resources.

What is already known on this topicDoctors are encouraged to search for evidence based answers to their questions about patient care but most go unansweredStudies have not defined the obstacles to answering questions in a systematic mannerA comprehensive description of such obstacles has not been presentedWhat this study addsFifty nine obstacles were found while attempting to answer clinical questions with evidence; six were particularly salientThe obstacles were comprehensively described and organised