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Search Methods for Finding Academic Literature: Clinical Questions

Types of Clinical Questions

There are two main types of clinical questions: Background questions and Foreground questions.

Background questions are generally posed towards the basic understanding of a topic. These types of questions generally have only 2 parts: A question root (who, what, when, where, how, why) and a disorder, test, treatment, or other aspect of health care. Often these questions can best be answered by using a textbook or consulting a clinical database. Some sample background questions:

  • What patient populations are most likely to be affected by colon cancer?
  • What are the symptoms of bacteremia?
  • What are some common treatments for low back pain?

Background questions can be answered by using secondary resources such as informational articles, reference books, or clinical databases, and authoritative answers can be found in a short amount of time.

Creating a Clinical Question (the PICO method)

PICO is an acronym that can help you create a well-built clinical question by identifying the key aspects of a complex patient presentation:
 

  • P=Patient or Population and Problem;

  • I=Intervention or Indicator;

  • C=Comparison or Control (optional);

  • O=Outcome

 

EXAMPLE:
In older adults (P) does Tai Chi (I) compared to other forms of exercise (C) reduce fall risk (O)?


There are a couple of other letters you can also add to this mnemonic to ask different types of questions (i.e., PICOTT)

  • Timeframe: Time it takes to demonstrate a clinical outcome or how long patients are observed.

  • Type of Study: What kind of study would best answer this question (i.e., RCT, Case Series, etc.)

 

EXAMPLE:
Does telemonitoring blood pressure (I) in African-Americans with hypertension (P) improve blood pressure control (O) within 6 months of initiation of the medication (T)?

Watch this video to learn how to use the PICO method to create a searchable clinical question. On your own, practice coming up with some ideas for searchable questions.

Foreground questions, on the other hand, are much more complex. They often include a broad range of topics including biological, psychological and sociological issues. Some examples of foreground questions include:

  • What are the causes of surgical wound infection following hip replacement?
  • What factors influence parents' decisions regarding the refusal to immunize their children?
  • Does the use of cell phones increase the incidence of brain cancer?


Due to the complexity of the question, foreground questions generally require the use of scientific studies to answer, and may take much more research and time to answer.

Turning PICO into a Literature Search

PICO is a search strategy formula. The components of PICO help pinpoint keywords that you will be able to directly input into a database to find research. If you are unable to find articles that utilize that intervention, try using alternate terms. If that still does not work, this may mean you have stumbled upon a gap in the evidence -- it is possible that research has not been done or published on this particular topic. If you are having trouble finding literature on your topic, you can always ask a library for help.

So let’s look back at our earlier example of Tai Chi helping to reduce risk of falling

  • P=The patient is older adults. Keywords could include elderly, geriatric, aging. The MeSH subject heading for this is aged, but databases like PubMed also allow you to utilize filters for patient information. So you can try out some of these keywords, but you could also try leaving out this keyword and adding a filter.
  • I=The Intervention is Tai Chi. Tai Chi is spelled a number of ways -- Tai chi chüan, Tàijí quán. So you may want to include alternate spellings  (“Tai chi” OR Taiji OR “Tai ji”)
  • C=The Comparison intervention is other forms of exercise. This is pretty vague, using the term “usual care” can also be useful. You could try both terms by using  (exercise OR usual care).
  • O=Finally, the Outcome is reducing fall risk. The generic MeSH term that covers risk of fall is Accidental Falls, but there is also a sub-term that is prevention & control*. So you could use Accidental Falls/prevention & control*

 Your boolean search could look something like this:

(elderly OR  geriatric OR aging OR aged) AND (“Tai chi” OR Taiji OR “Tai ji”) AND  (exercise OR usual care) AND (Accidental Falls/prevention & control*)

Pro tip:

PICO is focused around an intervention. If you are not including an intervention in your literature search, you may spend a lot of time combing through results just to discover what kinds of interventions are available, and then having to narrow down your results. This can be avoided and time can be saved by doing some background research first, understanding what types of interventions are available, and incorporating that into your search.

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