Now that you've learned the basics of searching, let's talk about how to apply those skills to evidence-based practice. Remember that in the EBP cycle, after identifying a clinical problem, the next step is to form a focused, answerable question, and then you can begin looking for information.
The PICO model was designed to help with creating a clear clinical question. PICO stands for:
P = patient or problem or population
I = intervention
C = comparison
O = outcome
Sometimes T is added for time period.
Let's create a PICO question based on the following clinical scenario: You have a female patient who is experiencing depression. You have suggested she start antidepressant medication, but she is interested in non-pharmaceutical options as she read recently that exercise could help.
P = patients with depression
I = exercise
C = antidepressants
O = reduction of symptoms
Question: In patients with depression, does exercise, compared to use of antidepressants, lead to reduction in symptoms?
You'll see that using this framework helps you think about concepts, just as we suggested when we first talked about search strategy in Section 5. You don't need to use all four concepts in your PICO statement to start searching. You may want to start with just two. If you get too many results, you can add another term. You can also be more specific in your question e.g., add gender or age of patients, use a drug name, or identify a symptom.
You can search bibliographic databases to find many types of evidence such as systematic reviews, meta-analyses, randomized controlled trials, etc. Advanced search strategies will help you search more effectively. Limiters allow you to limit the search results to show only items that meet certain criteria. For example, you can use the Publication Type limiter to find a particular type of article.
The Publication Type limiter is found in the search options on the EBSCOhost search screen:
In an article record, there is a field to show the publication type. Using the limiter searches for your choice within that field.
Another limiter in the search options is Date of Publication. You can use this one to make sure you are viewing only the most current evidence.
There are other resources for finding evidence besides bibliographic databases. To answer clinical questions quickly, when there is no time to do a full literature search, many practitioners use point of care clinical reference resources. Note that these resources themselves are NOT evidence; rather, they summarize and synthesize the evidence to make it easier to find. These tools must be used critically: their recommendations may or may not be based on the highest level of evidence and may or may not be current. It's a good idea to understand the editorial policies of these resources and to scan the references used.
Listed below are the point of care resources available via the FNU Library.
We've talked about searching the literature to answer a focused clinical question, and using clinical reference resources at the point of care to answer questions quickly. There may be other types of questions you need to find an answer for, and with so many types of information and evidence, you may not know where to start first! The chart below will provide some guidance for finding evidence-based answers to clinical questions.
| I need: | Example: | Resources: |
|---|---|---|
| point of care information |
What’s the latest on the management of panic disorder? What’s the best method of pain control in children? |
Clinical reference resource such as UpToDate or DynaMed |
| background information |
What’s the difference between depression and bipolar disorder? I have a new patient with sickle cell anemia; I need an overview of this condition. |
Clinical reference resources (see above) or textbooks (print or online) |
| answer to a focused clinical question |
In a 70 year old woman with primary insomnia and a previous adverse reaction to hypnotics, can cognitive behavior therapy improve sleep quality and duration? In a toddler with croup, do glucocorticoids reduce symptoms better than standard supportive care? |
Literature search in a database such as Medline or CINAHL |
| drug information |
What is the pediatric dosage of erythromycin for strep throat? What drugs have been approved by the FDA for the treatment of Alzheimer’s? |
Drug reference resource such as Lexicomp or Epocrates Note: FNU does not have a subscription to Epocrates. Drug information can also be found in UpToDate. |
| evidence-based information about alternative therapies |
Is melatonin safe and effective for treating insomnia? Does music therapy help surgical patients heal faster? |
Clinical reference resources, particularly Natural Medicines |
| information to share with patients | Where can I find some nutrition information for my newly-diagnosed patient with diabetes? | Consumer health website such as MedlinePlus |