We find the PIOC structured question invaluable in teaching
searching skills. It does however require a bit of "know how" in how
the link between questions and searching is explained
1. We find that in about 90% of clinical questions the first stage of a
literature search will be
PATIENT plus INTERVENTION/EXPOSURE
If this retrieves too many references to browse through then, and
only then would you add
EITHER the COMPARISON or the OUTCOMES
Then
You would add the appropriate EBM filters.
2. This is a more pragmatic approach and realises that (a) it is
unlikely that you will always have all four elements (b) that the
literature will not necessary sustain a classic four-part question at
the level of title, abstract and indexing only (c) that some clinical
questions are background questions and therefore outcomes or
comparisons may be beyond the ken of the person asking the initial
question. In the case of )c) it is the difference between "Is there an
alternative to drug x for disease y" (background) and "Is drug A
more effective than drug B in treating condition C with respects to
outcomes such as D,E,F).
3. Because the PIOC anatomy is a device for precision anyway the
search should be at its most sensitive i.e. you shouldn't use
subheadings and probably shouldn't use "restrict to focus" (i.e.
Major MeSH only). You certainly shouldn't use restrict to focus for
either the Outcomes or Comparison parts of the anatomy. The
PIOC anatomy and the filters are both better ways of focusing a
search than inconsistently used indexing or even more
inconsistently used subheadings.
4. We have found that it is intuitive to explain that synonyms from
WITHIN part of the anatomy e.g. diabetes or diabetic are "OR"-ed
together whereas terms from across the elements of the anatomy
are "AND"-ed (e.g. diabetes AND "tight glucose control").
5. I have yet to find a CLINICAL question that doesn't fit into the
anatomy. I always challenge any in a class whose question doesn't
fit to work through their question with the whole class and we find
that it does actually fit and it usually helps clarify a misunderstanding
that they might have about the task.
6. We have found the PIOC framework particularly useful for
answering clinical questions using the Internet. A search for a
Condition or an Intervention alone will yield too many hits. Using
Patient/Condition AND intervention will narrow down, then add
Outcome or Compariison (if necessary) AND then filter e.g.
"randomized controlled trial*". We demonstrate this on Alta Vista
Advanced queries option.
Further reading:
http://hiru.mcmaster.ca/ceb/newslett/ceb_17.htm#ON
QUESTIONS, BACKGROUND AND
Booth, A (2000). Formulating the question. In: Booth, A & Walton G
(Eds). Managing knowledge in health services. (pp.
197-206). London: Library Association.
Booth A, O'Rourke AJ, Ford NJ. (2000) Structuring the pre-search
reference interview: a useful technique for handling clinical
questions. Bulletin of the Medical Library Association Jul; 88(3):239-
46.
Adept course:
http://www.shef.ac.uk/uni/academic/R-Z/scharr/ir/adept/
How EBM principles apply to the Internet:
http://www.shef.ac.uk/uni/academic/R-
Z/scharr/ir/adept/internet/INTRCPT/index.htm
http://www.icml.org/posters/post19/poster19.htm
> 2. (A question and a request) How
> valuable do people find the process of > structuring the clinical
> question, per Sackett and others? While it makes > sense to me to have
> the residents think about the question they are asking > and focus it,
> the formal structuring of patient/problem, intervention, > comparison,
> and outcome doesn't always assist in the process of searching > for
> the answer - the search engines do not accept this structure to a >
> query. Thus the request to those of you who are working on the FPIN as
> > well as others - wouldn't it be nice if we had a database that could
> be > searched by structuring and then asking your question in this
> format, or > at least in a way that facilitated the process of moving
> from the clinical > situation to the information needs in a relatively
> direct way. > Thanks in advance for thoughts on these matters. Neil
> Korsen > > Neil Korsen, MD > Maine Medical Center Family Practice >
> Residency > 272 Congress St. > Portland, Maine 04101 >
> (207)842-7360
Andrew Booth BA MSc Dip Lib ALA
Director of Information Resources and
Senior Lecturer - Evidence Based Healthcare Information.
School of Health & Related Research (ScHARR)
Regent Court
30 Regent Street
SHEFFIELD
S1 4DA
Tel: 0114 222 5420 or 5214 Fax: 0114 272 4095
The author of Netting the Evidence:
http://www.shef.ac.uk/~scharr/ir/netting.html
and Trawling the Net:
http://www.shef.ac.uk/~scharr/ir/trawling.html
E-mail: [log in to unmask]
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