Clinical (or patient-focused or foreground) questions ask for knowledge in relation to individual patients or case scenarios. They tend to be more complex than background questions,and require higher level search skills.
Example: What are the cardiovascular concerns for a 55-year old female with familial history of heart attack beginning a new regimen of exercise?
Example: Is biofeedback as or more effective than the pharmaceutical standard of care for a 48 y.o. man with a history of high blood pressure?
Example: Does the use of probiotics during antibiotic therapy reduce the likelihood of a pre-school child contracting antibiotic-associated diarrhea?
In reality, what begins as a clinical question may spill over into a background question and vice versa.
1st: Frame your patient issue in the form of a statement or question.
Example: Is there any research looking at regular exercise for depression that would benefit my patient, a 15 y.o. girl.
2nd: Identify the PICO components as specifically as possible. (See next tab.)
PICO is a mnemonic that can help you formulate a clinically-answerable question, organize your thoughts for a database search or easily identify important elements of a research study. The clearer you are about what you're searching for, the easier it will be to find it.
Patient population or Problem: For which patient, group or health condition do you need information?
Teenage females experiencing mild to moderate depression.
Intervention (or Exposure): Which medical event or therapy do you need to study the effect of?
Regular exercise.
Comparison (if known): With what will you compare the intervention's results?
No regular exercise.
Outcomes: What are the relevant effects (outcomes) you'll be monitoring?
Lower levels of depression tracked by a validated qualitative perception scale
Clinical Question: Does regular exercise reduce depression in teenage females?
You don't need to use all of the elements from your PICO and/or clinical question in the database search; in many cases, information from PICO's P and I may be sufficient. Also, some aspects of your search, such as publication date, study type, age and gender, can best be captured with the database's Limits or Filter feature.
Example: Does regular exercise reduce depression in young adult females?
Possible database search query: exercise AND depression
Set applicable filters for sex or gender, ages, publication date, type of study, etc. and run your search.
Scan results, revise search by adding or deleting terms as necessary, and rerun it.
Note: See the Database Tutorials tab for PubMed, CINAHL and Embase search examples.
One way to think about clinical resources is to ask what type of information the resource provides. You'll find RCTs, literature and systematic reviews, cohort and case-control studies in most of the clinical databases, but a few are more specialized. For example, the Cochrane Library (Cochrane Collaboration) focuses on high quality systematic reviews.
Currency is also an issue:
Research databases, such as PubMed, CINAHL, and Embase will always have the most recent clinical studies..
Point-of-care tools, such as FIRSTConsult (in ClinicalKey), Dynamed, and UpToDate, provide filtered information, i.e. overviews, expert opinion, guidelines, consensus statements, etc. Sooner or later, new study findings may or may not be incorporated, depending on percveived significance.
AND ... take the easy way! Use the Clinical Portal's categorized resources.
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