Developing a Clinical Question and Appropriate Search Strategy
Foreground Questions: Very specific knowledge to inform clinical decisions or actions to your clinical scenario Information not easily and quickly located in a general textbook Have four essential components (PICO) o Patient or Problem o Intervention or exposure o Comparison intervention or exposure, if relevant o Clinical outcomes
Typology of Question Building: Clinical Findings how to interpret findings from the history and examination Etiology the causes of diseases Diagnosis what tests are going to aid you in the diagnosis Prognosis the probable course of the disease over time and the possible outcomes Therapy which treatment are you going to choose based on beneficial outcomes, harms, cost and your patients values Prevention primary and secondary risk factors which may or may not lead to an intervention Cost-effectiveness is one intervention more cost effective than another Quality of life what effect does the intervention have on the quality of your patients life Phenomena the qualitative or narrative aspects of the problem
Population (patient problem /condition) How would you describe a group of patients similar to yours? What are the most important characteristics?
I ntervention (drug, procedure, diagnostic test, prognostic factor, exposure) Which main intervention, prognostic factor, or exposure are you considering?
Comparison of Intervention (if relevant or appropriate) What is the main alternative to compare with the intervention?
Outcome you would like to measure or achieve What can you hope to accomplish measure, improve or affect?
2 Types of Question Types of Study/Methodology MeSH Headings Therapy
Meta-analysis>Systematic Review>RCT Meta-analysis [PT] Drug Therapy [SH] Therapeutic Use [SH] Systematic [ST] Randomized Controlled Trial [PT ] Diagnosis RCT>Clinical Trial Clinical Trial [PT] Diagnosis [SH] Sensitivity and Specificity [MH] Prognosis Cohort Studies>Case Control>Case Series Cohort Studies [MH] Prognosis [MH] Survival Analysis [MH] Etiology Cohort Study>Case Control>Case Series Cohort Studies [MH] Case Control Studies [MH] Prevention Meta-analysis>Systematic Review<RCT>Cohort Prevention and Control [SH]
3
Systems integrated into EMR Summaries DynaMed, ACPs PIER Synopses ACP Journal Club Syntheses Cochrane Library
PubMed: A Web-based retrieval system developed by the National Center for Biotechnology Information (NCBI) at NLM Providing access to MEDLINE Over 19 million records representing articles in the biomedical literature Most PubMed records--MEDLINE citations
MEDLINE NLMs premier bibliographic database Formerly called the Index Medicus, a printed index to articles Containing citations and author abstracts from approximately 5,400 biomedical journals Containing over 18 million references to journal articles dating back to 1947 About 92% are from English-language sources or have English abstracts New material is added weekly
Medical Subject Heading (MeSH Terms) Acronym for Medical Subject Headings A controlled vocabulary, a specific set of terms used to describe each article Indexing journal articles for MEDLINE Uniformity and consistency to the indexing of biomedical literature Arranged in a hierarchical categorized manner called MeSH Tree structures and updated annually Searching with the MeSH Database Refining a search Combining MeSH terms MeSH tree and explosion Using subheadings Major topic headings Automatic Term Mapping Terms entered in the search box are matched against o Subjects o Journals o Authors and investigators
4
Boolean Operators AND Refined search All search terms will appear in articles retrieved. This will narrow your search results.
OR Broadened search Articles retrieved will contain at least one of the search terms. It will broaden your search results.
NOT Narrowed search Narrowing a search by removing all references that contain a particular word or phrase. USE WITH CAUTION.
= exact words * = truncation sign [ti] = title [au] = author
PubMed Single Citation Search if know citation
PubMed Clinical Queries
Searching with MeSH Headings/Terms Searching with Keywords When to Use Established concept, common disease, condition, procedure, or any common topic Focused and precise searches New or cutting-edge concept, device, instrument, drug, procedure, etc. Quick searches
Precision Relevant and focused results Relevant plus irrelevant results Retrieval
Records in MEDLINE Records in MEDLINE and those in different stages of processing