Skip to main content

WHSL Asking the Clinical Question: Examples

A guide to creating a successful search strategy for EBM searching

Analysis of the Topic

Constructing a good clinical question in order to use it to seach the literature effectively is challenging, and a fundamental skill that needs to be learnt alongside all other clinical skills.

A useful way to analyse or dissect the topic into its core components is to use parts of PICO, namely the patient (or population), the exposure (or intervention) and the outcome (which may be explicit, or implicit). However, as you have been shown, it is not always necessary to include all  four facets (components) in your PICO search statement, especially if you can find suitable MeSH terms to use in your search. By using the prognosis  filter in your Clinical Query search on binge drinking, for example, you will automatically include the prognosis for long-term mortalilty, as well as other outcomes, so you do not need to add all other possible outcomes to your search strategy initially. Sometimes your search will yield too few results if your search strategy is too specific.

  • An example of an explicit (certain or stated) outcome could be the cost of a particular intervention. 
    • Question: What is the cost of treatment for multidrug resistant tuberculosis?
  • An example of an implicit (uncertain or implied) outcome for binge drinking includes the prognosis for long-term mortalilty, in addition to other outcomes.
    • Question: What is the long term prognosis for teenage binge-drinking?

Practice Makes Perfect

The ONLY  way to become skilled in analysing the topic, and being able to construct a good search strategy is to practise as often as possible. 

Use the following examples to practise analysing the topic:

1. Scenario There is a difference of opinion about treatment for teenage girls with UTI. One option is to use bactrim; the other is to use macrodantin. Find the strongest evidence for the use of either treatment.

    Formulate a searchable question using this scenario.

    Patient/Population:   Who is the patient/what is the condition being investigated?
    Intervention:  Which treatment can be used?
    Is there a comparative intervention? If so, what is it?
    Is the outcome implicit (and thus not necessary to search for this facet), or explicit (and thus it must be searched)?
[Note: Comparative interventions are used most often in questions about therapy.]
 
2. Scenario: Thabo Baloyi is a five year old with frequent episodes of acute otitis media. Some of these episodes have required antibiotic treatment, and his mother is worried that he might develop a resistance to antibiotics if these continue to be prescribed.
 
      Formulate a searchable question using this scenario.
 
      Patient/Population:   Who is the patient/what is the condition being investigated?
      Intervention:  Which treatment can be used?
      Is there a comparative intervention? If so, what is it?
      Is the outcome implicit (and thus not necessary to search for this facet), or explicit (and thus it must be searched)?
 
3. Scenario: Annie Pretorius is a 38 year old postpartum woman who has gained considerable weight during her last pregnancy (her third). She wants to know if diet is better than exercise for weight loss and continued control of her weight.
 
Formulate a searchable question using this scenario.
 
      Patient/Population:   Who is the patient/what is the condition being investigated?
      Intervention:  Which treatment can be used?
      Is there a comparative intervention? If so, what is it?
      Is the outcome implicit (and thus not necessary to search for this facet), or explicit (and thus it must be searched)?
 
4. Scenario: George Wembley is a seventy-two year old in good physical health, who runs about twenty km a week to keep fit. Lately however, he has been experiencing quite severe back and lower extremity joint pain during and after running. He wants to know if wearing arch supports will help in reducing his pain.   
 
Formulate a searchable question using this scenario.
 
      Patient/Population:   Who is the patient/what is the condition being investigated?
      Intervention:  Which treatment can be used?
      Is there a comparative intervention? If so, what is it?
      Is the outcome implicit (and thus not necessary to search for this facet), or explicit (and thus it must be searched)?