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Developing a Clinical Question and Appropriate Search Strategy

Foreground Questions:
Very specific knowledge to inform clinical decisions or actions to your clinical
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
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

(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

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?

Types of
Types of Study/Methodology MeSH Headings

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
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
Prevention and Control [SH]


Systems integrated into EMR
Summaries DynaMed, ACPs PIER
Synopses ACP Journal Club
Syntheses Cochrane Library

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

NLMs premier bibliographic database
Formerly called the Index Medicus, a printed index to articles
Containing citations and author abstracts from approximately 5,400 biomedical
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


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
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

Records in MEDLINE Records in MEDLINE and those in
different stages of processing