Module 2.2 Converting your clinical question into a search strategy

Your well-built clinical question acts as a structured check-list for concepts to include in your search.

To search effectively and efficiently it is helpful to use a search strategy construction tool such as PICO which, as you have already found out in Module 1, stands for Patient, Intervention, Comparison and Outcome. Consider this scenario as a refresher to what you learnt in Module 1.

You are in an Emergency Department and an elderly patient presents to the hospital with an inflamed left foot. You want to ascertain what treatment will alter the patient’s outcome and reduce the patient’s foot inflammation. You decide to investigate which treatment would produce the best outcome for the patient. You want to investigate 2 drugs: meloxicam compared with naproxen – you want to ascertain which will be more effective, to alter the patient’s outcome and reduce the swelling.

A good way to investigate this health issue, is to create a PICO table, that outlines the key concepts of the scenario. This will help guide your research and / or decision-making, regarding the use of the drugs in the context of the patient with the swollen foot, and what drug will be more effective in reducing the swelling. Below is an incomplete PICO table. Complete the table, by dragging and dropping the correct description to the correct PICO term.

Here is a different scenario that uses the PICO framework.

In obese patients with Type 2 Diabetes, is bariatric surgery more effective than drug therapy at increasing the probability of remission of diabetes.

Step 1. 

Break your question down to the main concepts and identify keywords and synonyms from the clinical question.

What other terms could represent these concepts? Googling terms and checking the MeSH Medical Subject Headings in PubMed https://www.ncbi.nlm.nih.gov/mesh/  can help you do this. Think about what the concept would be called in other countries and British vs American spelling variations eg esophagus / oesophagus , pediatric / paediatric.

Think about how the concept is described in lay language and medical terminology. Eg heart attack / myocardial infarction. It is useful to list the most general terms first, working down to the most specific. This way you have options for narrowing your search.

For example:

Step 2.

You need to tell the clinical resource or database you are searching, how you want it to look for your terms. Link these keywords, and synonyms, in a meaningful way, in order to perform an effective search.

A Search Strategy Planner is a useful tool to gather terms.

This is done by using the Boolean Operators (AND, OR, NOT) between your terms.

Boolean Operators:

AND    Results contain both terms. Using AND generally limits the search

OR       Just one of these terms in the results is okay. Using OR broadens the search

NOT   Results exclude the subsequent term. Using NOT limits the search – use with caution

Where do the operators go?

AND is placed between each of your major concepts, to ensure they are all present in your results.  OR is used between synonyms, so that all variants are included in the search (brackets are used to group variants together). Think of OR meaning more of the same.

For example:

The search string would look like this:

(Type 2 Diabetes OR Obesity) AND (“Bariatric Surgery” OR “Stomach Stapling” OR “Gastric bypass surgery”) AND (Ozempic OR “Drug Therapy”)

For more information about Boolean Operators see Module 2.3 Effective and efficient searching.

More Resources :

PubMed’s Using PICO to frame a clinical question

Duke University Medical Centre Library’s Intro to EBP