Whether a clinical question (looking for patient treatment information) or creating an experiment, it all starts with forming the best question for your project. Equally, when it is time to critically evaluate literature, you should be able to identify the question or hypothesis.
Clinical questions help you make decisions for patient treatment. Hypothesis help you test in a laboratory an idea you think is possible.
Clinical Questions
PICO - Patient, Intervention, Comparison, Outcome
This question works best if you are looking for therapy related interventions.
P - Patients or Population:
Who are the relevant patients?
I - Intervention(s) or Exposure(s):
For example, diagnostic tests, foods, drugs, surgical procedures, time, or risk factors. What are the management strategies we are interested in comparing or the potentially harmful exposures about which we are concerned?
C - Comparator:
For issues of therapy, prevention, or harm, there will always be both an experimental intervention or putative harmful exposure and a control, alternative, or comparison intervention or state to which it is compared.
O - Outcome:
What are the patient-relevant consequences of the exposures in which we are interested? We may also be interested in the consequences to society, including cost or resource use. It may also be important to specify the period of interest.
Example: In critically-ill patients with COVID-19, who are either ventilated or in prone positions, what is the efficacy and tolerability of three enteral formulas (a) immunomodulatory (IMM), b) ω3 (ω3) and c) maltodextrins (MD).
Qualitative Questions include PIC or SPIDER
PIC - Population, phenomena of Interest, Context
SPIDER - Sample, Phenomena of Interest, Design, Evaluation, Research type
Sample - the group of people you are studying
Phenomena of Interest - topic of research, for example the intervention. Example question: "What are the barriers felt by clinicians that lead to the reluctance to use EBP in practice?" Phenomena of interest is use of EBP in practice.
Design - how was the qualitative data gathered: interviews, focus group, observation.
Evaluation - outcome of the study
Research type - qualitative study, ethnography, grounded theory, case study, phenomenology
Questions about etiology or risk (most likely match epidemiology project)
PEO - Population, Exposure,Outcomes
Hypothesis
Hypothesis are used to support scientific research. Through observation, a researcher;s reasonable expectations based on factual information are tested under strict rules.
Example: "In order to cause phenotypic change, tumor suppressor genes require both alleles be inactivated through either mutations or epigenetic slicing."
References:
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qualitative health research, 22(10), 1435-1443.
Misra DP, Gasparyan AY, Zimba O, Yessirkepov M, Agarwal V, Kitas GD. Formulating Hypotheses for Different Study Designs. J Korean Med Sci. 2021 Dec 27;36(50):e338. doi: 10.3346/jkms.2021.36.e338. PMID: 34962112; PMCID: PMC8728594.
Moola, Sandeep; Munn, Zachary; Sears, Kim; Sfetcu, Ralucac; Currie, Marian; Lisy, Karolina; Tufanaru, Catalin; Qureshi, Rubab; Mattis, Patrick; Mu, Peifanf. Conducting systematic reviews of association (etiology), International Journal of Evidence-Based Healthcare: September 2015 - Volume 13 - Issue 3 - p 163-169.
https://researchguides.gonzaga.edu/qualitative/spider
Consider how you can specify the main concepts that are part of your topic. For example, if you are interested HIV transmission prevention programs for prisoners, you can think about the “building blocks” of your question as:
A search like this will find results about HIV prevention programs for prisoners. Doing a broad search at first and then adding more terms or using the limiters in a database to narrow your results down often makes for much less frustration.
Keep in mind that there may be more than one term that means the same thing, or something very similar.
For example:
You will also find keywords to try in your readings and in your notes from class. Making a list of synonyms for your search terms is often a good strategy for searching, to be prepared in case you don’t get as many results as you had hoped.
Many databases also use specific keywords or terms called descriptors that are assigned to articles on that topic. Once you know the descriptors for your topic it can make it easier to pull all articles on the same topic together at the same time. In many cases the descriptor will be the medical term – just be aware that terminology changes. You will find descriptors (often called Subject Headings) in database search results by looking at the individual records for articles. Many databases for the health sciences (PubMed, CINAHL) use the Medical Subject Headings (MeSH terms), so becoming familiar with the MeSH terms associated with your topic will be useful.
Here are a few examples of keywords and their MeSH terms (some terms are more obvious than others!)
| Everyday language | MeSH |
| Cardiovascular disease, CVD | Cardiovascular diseases |
| Breast cancer | Breast Neoplasms |
| Health disparities | Healthcare disparities OR Health status disparities |
| AIDS | Acquired Immunodeficiency Syndrome (“HIV Infections” would be the broader term) |
| Elderly | Aged |
Once you identify the terms (keywords or descriptors) applicable to your question or topic, put them together with Boolean operators such as AND (for more precision in your search), OR (to enlarge the pool of results when more than one situation is concerned), or NOT (to exclude possible elements that might jeopardize quality for quantity in your results. (Be careful using NOT though, as you may exclude useful results!)
Tip: Each database has its own thesaurus to organize articles on certain topics. Take a look at the database’s thesaurus to see if it uses a different term if your search does not yield enough results on your topic.
Tip: Put quotes around search terms that are phrases (contain more than one word). For example, placing quotes around “Mediterranean diet” will locate articles for you in the databases containing the phrase “Mediterranean diet” and should weed out all the articles where those words appear separately from each other (for example, an article about trying to be on a diet while on a cruise ship on the Mediterranean Sea!). THIS IS NOT TRUE FOR PUBMED.
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