http://tinyurl.com/nyuframing
CONTENTS:
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.
Does hand washing among healthcare workers reduce hospital acquired infections?
The question above includes the PICO elements:
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Example: |
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P (Problem or Patient or Population) |
hospital acquired infection |
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I (intervention/indicator) |
hand washing |
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C (comparison) |
no hand washing; other solution; masks |
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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:
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natural language |
term mapped to database vocabulary |
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P (Problem/Patient/Population) |
cross infection [MeSH] cross infection [CINAHL] |
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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.
Tips for expanding your search
Tips for narrowing your search
Download a Boolean Worksheet to help plan your database search
*Heneghan, C., & Badenoch, D. (2002). Evidence-based medicine toolkit. London: BMJ Books
Beginning a literature search, you may be looking for overview/background information.
A BACKGROUND QUESTION asks for general knowledge about a disorder, disease, policy issue, etc.
Background information may be found in sources such as:
· reference book entries or selected Ebooks/Encyclopedias in the health sciences
· textbooks, chapters, appendices
· drug monographs, guides to diagnostic tests, ebook drug guides like these https://guides.nyu.edu/drugs
· the library’s Bobcat catalog
Sample Search Strategies for Background Questions:
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Question |
Appropriate source type: |
Sample Strategy(ies): |
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1. What are the side effects of Lipitor?
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Drug reference book |
START WITH:
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2. What is Asperger Syndrome? |
Textbook, monograph, review article | START WITH:
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)
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3. Evidence of the relationship between dementia and caffeine consumption. |
Article databases, both popular and scholarly |
START WITH: 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." |
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4. I need an overview of gestational diabetes.
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Textbook, monograph, review article |
START WITH:
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. |
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5. The best evidence available about umbilical cord care. |
Article databases, both popular and scholarly |
Locating the "best evidence" might mean locating a synthesis 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. |
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6. I am interested in the phenomenon of burnout in nurses. |
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7. What research is available on the issue of privacy related to computerized patient records?
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A Review article in a journal
A book or an ebook on medical ethics and legal issues |
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 >190 citations. Here is one example: Security Techniques for the Electronic Health Records. Kruse CS, Smith B, Vanderlinden H, Nealand A. J Med Syst. 2017 Aug;41(8):127.
Search the Ebook Central collection of electronic texts. Or search the Bobcat catalog. Browse the Nurse's Legal Handbook |
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8. What are the personal experiences of medical students?
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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 |
| 9. I am looking for overviews or background information for best practices regarding nurse "rounding." |
look for a Review article look for an evidence synthesis or summary |
Search CINAHL: (MH "Patient Rounds") limited to publication type: Review Search PubMed: Limit to "review" articles Search the Joanna Briggs EBP database, on (rounds OR rounding). Next, limit to publication type: Evidence Summaries Search Nursing Reference Center Plus (NRC) : |
| 10. I am looking for evidence summaries on the topic of nurses "self-care" or reasons for neglecting self care. | Search a nursing-focused aggregation of evidence. The summary, synthesis, or reference list may lead to more evidence. |
Search the Joanna Briggs EBP database, on burnout. Search Nursing Reference Center Plus (NRC) on: nurses AND "self care." Limit on left menu to "evidence based care sheets." One sample result : |
| 11. I am looking for overviews on nursing leadership roles and transition from staff nurse to a leadership role. | A large topic, perhaps encompassed in a book length treatment of the subject nursing leadership. |
Browsing the Bobcat catalog or EbookCentral, notice the subject terms: Leadership. that describe many titles. Try an advanced search using the subjects: Browse book indexes, look for chapters on transition or succession planning, etc. Or mentorship or mentoring. |
*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.
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:
Sample Search Strategies for Foreground Questions:
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Question |
Natural language terms |
Terms translated to Subject headings/MeSH terms/Descriptors [Database] |
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1. Does hand washing among healthcare workers reduce hospital acquired infections? |
Hand washing
Hospital acquired infection |
Hand disinfection [MeSH] AND Cross infection [MeSH] |
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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] |
Link to Ventilator-associated Pneumonia AND nurse-patient ratios in Sample PICO (T) searches |
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4. What is the effectiveness of restraints in reducing the occurrence of falls in patients 65 and over?
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Falls
Restraints |
Accidental falls [MeSH, CINAHL] AND |
Link to sample CINAHL search: Falls AND Restraints in Sample PICO(T) searches |
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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]) |
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6. Does having access to fresh fruits and vegetables in neighborhood stores affect nutritional health of Hispanic Americans living in urban areas? |
food shopping, grocery shopping, grocery stores, food stores, bodegas, convenience stores fruits, vegetables Hispanics urban, city, cities |
In PubMed, search: "Food Supply" [Mesh] AND "Hispanic Americans" [Mesh] |
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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 |
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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
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*Heneghan, C., & Badenoch, D. (2002). Evidence-based medicine toolkit. London: BMJ Books.
| Research Question: | Database | Initial search term queried | Added term(s) (descriptors or key words) harvested from relevant results: | Other databases to try: |
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1. What are the best practices for reducing the incidence of catheter-associated urinary tract infection? |
catheter-associated urinary tract infection |
Catheter-Related Infections [MeSH] (broader term) OR Urinary Catheterization OR UTI OR CAUTI |
CinahlPlus
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2. What is the effectiveness of restraints in reducing the occurrence of falls in patients 65 and over? |
restraints
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Restraint, physical [MeSH)
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3. Does the implementation of routine rounding increase patient satisfaction? |
rounding
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Teaching rounds [MeSH] Rounds OR rounding OR patient rounds OR nurse rounds OR ward rounds OR staff rounds |
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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. |
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 |
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5. What are the best practices for enhancing interprofessional communication among nurses using text messaging? |
Text messaging
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Texting OR SMS OR text messaging OR short message service OR cellular phone [MeSH] OR mobile phone OR virtual technologies |
CinahlPlus
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6.I am looking for articles on the use of pet therapy with autistic children?
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Pet therapy
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pet therapy
Animal Assisted Therapy [PsycINFO descriptor] |
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7. Does shared governance in nursing improve job satisfaction and retention? |
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job satisfaction
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Job satisfaction [CINAHL heading]
Job Satisfaction [PsycINFO descriptor]
Attitude of Health Personnel [MeSH] |
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8. Does exercising regularly during an inpatient hospitalization reduce weight gain among psychiatric patients?
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weight gain
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weight gain [PsycINFO descriptor]
Exercise [MeSH]
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