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Health (Nursing, Medicine, Allied Health): Search Strategies: Framing the question (PICO)

Guide to locating health evidence. View the EBP "pyramid" and link to tools for locating relevant research.

Framing the Research Question: PICO (T)

Evidence-based models use a process for framing a question, locating, assessing, evaluating, and repeating as needed. PICO (T) elements include: Problem/Patient/Population, Intervention/Indicator, Comparison, Outcome, and (optional) Time element or Type of Study.

1. Frame the question: write out your information need in the form of a question, for example:

 

   Does hand washing among healthcare workers reduce hospital acquired infections? 

  The question above includes the PICO elements:
 

 

Example:
P (Problem or Patient or Population) hospital acquired infection
I (intervention/indicator) hand washing
C (comparison) no hand washing; other solution; masks
O (outcome of interest) reduced infection

 
 

    2. Plan a search strategy by identifying the major elements of your question, and translate natural language terms to subject descriptors, MeSH terms, or descriptors. 

 

TIP: start with the P and the I only to begin your search and keep initial search results broad:
 

natural language term mapped to database vocabulary
P (Problem/Patient/Population)
=
hospital acquired infection

cross infection [MeSH]

cross infection [CINAHL]

I (intervention/indicator)=hand washing

hand disinfection [MeSH]

handwashing [CINAHL]

 

 

A simple database search strategy should begin with the P AND I:   

cross infection
AND  (Handwashing OR Hand disinfection) 

 

Start with both CINAHL and Medline/PubMed as initial article databases for a scoping search for most health sciences questions.  If your topic has a behavioral/mental health component, also try PsycINFO.

 

Link to a detailed search:
Does hand washing among healthcare workers reduce hospital acquired infections?

   

3.  After viewing the initial search results you may decide to narrow your search with terms for the Comparison, Outcome, Time factors or Type of study. Or you may view results, abstracts, and full text of articles to view the comparison and outcome elements. Use database filters, explained in Filtering the Evidence.  

4. Filtering the evidence

 

 

 

Search Strategies--Background Information

 

Often at the beginning of a project, you will be looking for overview/background information and you will need to answer a BACKGROUND QUESTION* with  general knowledge about a disorder or topic.

 

Background information may be found in sources such as:

·      reference book entries

·      textbooks, chapters, appendices

·      drug monographs, guides to diagnostic tests

·      the library’s Bobcat catalog

·      selected electronic Reference Tools for Background information in the health sciences

 

Sample Search Strategies for Background Questions:

Question

Appropriate source type:

Sample Strategy(ies):

1. What are the side effects of Lipitor?

 

Drug reference book

From the evidence pyramid, click on Background Information.  One of the choices listed is:

  • StatRef (collection of reference tools, including drug references)  Search on drug name.

  • Another choice is: Access Medicine

2. What is Asperger Syndrome?

Textbook, monograph, review article From the evidence pyramid, click on Background Information.  One of the choices listed is:
  • StatRef (collection of reference tools, including drug references). Search on name of disease or condition.

  • Another choice is: Access Medicine

Use the Bobcat library catalog to search on Asperger and retrieve:print and electronic books, such as:  The complete guide to Asperger's syndrome (Tony Attwood)

A “Review” article in a journal may provide an up-to-date summary/overview of a broad topic. Search Medline/Pubmed or CINAHL, limit to Publication/Article type: "Review." (Journal articles are discussed in more detail in foreground questions)

 

3. Evidence of the relationship between dementia and caffeine consumption.

Article databases, both popular and scholarly

Proquest (Periodical Abstracts) (for recent popular newspaper article)

Medline/Pubmed (for scholarly biomedical research)

A “Review” article in a journal may provide an up-to-date summary/overview of a broad topic. Search PubMed, limit to Article Type: "Review."

4. I need an overview of gestational diabetes.

 

Textbook, monograph, review article

From the evidence pyramid, click on Background Information.  One of the choices listed is:

  • StatRef (collection of reference tools, including drug references)

Search on name of disease or condition.

Use the Bobcat library catalog to search on gestational diabetes and retrieve:

Title: Management of high-risk pregnancy : an evidence-based approach/  Queenan, John T., 2007.

5. The best evidence available about umbilical cord care.

Article databases, both popular and scholarly

Locating the "best evidence" might mean the most recent information that synthesizes the best research methodologies, such as a "Systematic Review" or a "Randomized Controlled Trial." 

CINAHLPlus: search Umbilical Cord, use Search Options to limit to Publication type: systematic review

Medline/Pubmed: search Umbilical Cord AND Sepsis, limited to Journal Subset: Systematic Reviews. OR use the Limits for Article Type: limit to randomized controlled trial. More about Limits here.

6. I am interested in the phenomenon of burnout in nurses.

  • Textbook
  • monograph
  • a review article
  • Locate an overview in an article (link to Burnout AND Nurses in: sample database searches )

  • Use the Bobcat library catalog to search on search for:  nurses burnout. Notice related subject headings:

    Medical personnel – Job stress
    Burn out (Psychology)

    Burnout, Professional 
  • Search the ebrary collection of electronic texts.  Start with burnout AND nurses

    Notice how it leads to the subject: medical personnel job stress

  • A “Review” article in a journal may provide an up-to-date summary/overview of a broad topic. Search Medline/Pubmed or CINAHL, limit to Publication/Article type: "Review." 

7. What research is available on the issue of privacy related to computerized patient records?

 

A Review article in a journal

A “Review” article in a journal may provide an up-to-date summary/overview of a broad topic. Search PubMed or CINAHL, limit to publication type: "Review." (Journal articles are discussed in more detail in foreground questions)

 

 A Pubmed search: privacy computerized patient records Limited to publication type: “Review article” retrieves 62 citations. Here is one example:

Agrawal R, Johnson C. Securing electronic health records without impeding the  flow of information. Int J Med Inform. 2007 May-Jun;76(5-6):471-9. Epub 2007 Jan  3. Review. PubMed PMID: 17204451.

8. What are the personal experiences of medical students?

 

Memoir, biography, diary

A BobCat search medical students biography (as query words anywhere in the record)  leads to titles with subject headings to explore for related results:

Students,  Medical  Personal  Narratives

 
Or the more specific:
  Students, Medical    United States   Personal Narratives

*Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Edinburgh ; New York: Edinburgh ; New York : Churchill Livingstone.  

Search Strategies--Foreground Questions

Foreground questions seek evidence to answer a need for clinical information related to a specific patient, an intervention or therapy. Identifying the PICO (T) * elements helps to focus your question:

 

  • P = problem/patient/population
  • I = intervention
  • C = comparison intervention
  • O = outcome

  • (T)= time factor, type of study (optional)

Sample Search Strategies for Foreground Questions:

Question

Natural language terms

Terms translated to Subject headings/MeSH terms/Descriptors  [Database]

Sample PubMed Searches

1. Does hand washing among healthcare workers reduce hospital acquired infections?

Hand washing

 

Hospital acquired infection

Hand disinfection [MeSH]

AND

Cross infection [MeSH]

Link to Handwashing AND hospital acquired infection

2. What is the effectiveness of continuous passive motion therapy (CPM therapy) following knee replacement in achieving optimal range of motion?

CPM therapy

 

Knee replacement

arthroplasty, replacement, knee   [MeSH]

 AND

motion therapy, continuous passive [MeSH]

Link to CPM Therapy AND knee replacement in sample PICO (T) searches

3. Is the incidence of ventilator-associated-pneumonia decreased by a
higher nurse-patient ratio?
ventilator associated pneumonia

nurse-patient ratio

pneumonia, ventilator associated [MeSH]

(Nursing staff, hospital [MeSH]
OR
Personnel staffing and scheduling [MeSH])

Link to Ventilator-associated Pneumonia AND nurse-patient ratios in Sample PICO (T) searches

4. What is the effectiveness of restraints in reducing the occurrence of falls in patients 65 and over?

 

Falls

 

Restraints

Accidental falls [MeSH, CINAHL]

AND

Restraint, physical  [MeSH, CINAHL]

Link to sample CINAHL search: Falls AND Restraints in Sample PICO(T) searches

5. How do universal lunch programs affect childhood obesity rates? (Policy question)

universal lunch

OR school lunch

 

childhood obesity

Food Services [CINAHL]

AND

Obesity [CINAHL]

AND

Schools [CINAHL]

in PubMed:

Schools [Mesh]

AND

Food Services [Mesh])

AND

Obesity [Mesh]

 

6. Does having access to fresh fruits and vegetables in neighborhood stores affect nutritional health of Hispanic Americans living in urban areas?
(Population question)

food shopping, grocery shopping, grocery stores, food stores, bodegas, convenience stores

fruits, vegetables

Hispanics

urban, city, cities

In PubMed, search:

"Food Supply" [Mesh]
AND
("Fruit"[Mesh] OR "Vegetables"[Mesh])

AND

"Hispanic Americans" [Mesh]

 

7. I am looking for evidence-based articles on managing acute pain in sickle cell patients?

pain

 

sickle cell

In PubMed, search:

pain/therapy AND anemia, sickle cell

then use Limits to limit to the Subset: Systematic Reviews

or,

Use Limits to limit to Article Type: Randomized Controlled Trial or Meta-analysis

 

 LINK to more Limiting strategies

8. I am looking for articles on the use of pet therapy with autistic children?

pets/animals

autism

children

Link to CINAHL

Search on:

pet therapy OR animals OR human-pet bonding [Cinahl headings]

AND

autistic disorder [Cinahl heading]

Limit to age group: ALL CHILD



 Link to more limiting strategies

*Heneghan, C., & Badenoch, D. (2002). Evidence-based medicine toolkit. London: BMJ Books.

Harvesting Search Terms

Research Question: Database Initial search term queried Added term(s) (descriptors or key words) harvested from relevant results: Other databases to try:

1. What are the best practices for reducing the incidence of catheter-associated urinary tract infection?

PubMed

catheter-associated urinary tract infection

Catheter-Related Infections [MeSH] (broader term)

OR

Urinary Catheterization
AND
Cross Infection [MeSH]

OR

UTI

OR

CAUTI

CinahlPlus


Joanna Briggs Institute EBP Database

 

 

 

2. What is the effectiveness of restraints in reducing the occurrence of falls in patients 65 and over?

PubMed

restraints

 

 

 

 

 

Restraint, physical  [MeSH)
OR
Side rails
OR
Bedside rails
OR
Bedside safety rails

 

 

CinahlPlus

 

 

 

 

 

3. Does the implementation of routine rounding increase patient satisfaction?

         

PubMed

rounding

 

 

 

 

 

 

 

Teaching rounds [MeSH]

OR

Rounds

OR

rounding

OR

patient rounds

OR

nurse rounds

OR

ward rounds

OR

staff rounds

CinahlPlus

PsycINFO

 

 

 

 

 

 

4. I am looking for information on how the health care reform bill affects the expansion of women's health providers (NP’s, midwives) to meet newly insured of 2014 and beyond.         

PubMed

Health care reform bill  

health care reform bill

OR

health care bill

 OR

(Patient Protection and Affordable Care Act)

OR

PPACA

OR

Affordable Care ACT

OR

ACA

OR

Health Care Reform/legislation & jurisprudence [MeSH]

OR

Obamacare

Proquest

CinahlPlus

 

 

 

 

5. What are the best practices for enhancing interprofessional communication among nurses using text messaging?

              

PubMed

Text messaging

 

 

 

 

 

 

 

Texting

OR

SMS

OR

text messaging

OR

short message service

OR

cellular phone [MeSH]

OR

mobile phone

OR

virtual technologies

CinahlPlus

Joanna Briggs Institute EBP Database

 

 

 

 

 

6.I am looking for articles on the use of pet therapy with autistic children?  






  


  

 

 

CINAHL

 

 

 

 

PsycINFO

 

 

 

Pet therapy  

 

 

 

 

 

 

 

 

 

pet therapy
OR
animals
OR
human-pet bonding [Cinahl headings]

 

Animal Assisted Therapy [PsycINFO descriptor]
OR
AAT
OR
Zootherapy
OR
pet care programs
OR
PCP

Proquest

PubMed

 

 

 

 

 

 

 

 

 

7. Does shared governance in nursing improve job satisfaction and retention?   

  

CINAHL

 

 

 

 

 

PsycINFO

 

 

 

 

 

 

PubMed

 

 

 

job satisfaction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Job satisfaction [CINAHL heading]
OR
work satisfaction
OR
employment satisfaction
OR
empowerment

 

Job Satisfaction [PsycINFO descriptor]
OR
Quality of Work Life [PsycINFO descriptor]
OR
Employee attitudes [PsycINFO descriptor]
OR
work satisfaction

 

Attitude of Health Personnel [MeSH]
OR
Burnout, professional  [MeSH]

8. Does exercising regularly during an inpatient hospitalization reduce weight gain among psychiatric patients?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  










 

PsycINFO

 

 

 

 

 

 

 

 

PubMed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

weight gain

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

weight gain [PsycINFO descriptor]
OR
weight loss [PsycINFO descriptor]
OR
weight control [PsycINFO descriptor]
OR
weight management
OR
fitness
OR
obesity

 

Exercise [MeSH]
OR
Physical fitness [MeSH]
OR
Sports [MeSH]
OR
Exercise therapy
[MeSH]
OR
Weight gain [MeSH]

 

 

 

 

 

 

 

 

 

 

 

 CinahlPlus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PubMed: Falls AND Exercise (2 min)