رای جستجوي اطلاعات مناسب، یافتن بهترین شواهد موجود در کمترین زمان ممکن بسیار مهم و حیاتی می باشد. از این رو آشنایی با روشهای صحیح جستجو، نحوه طرح سوال قابل پاسخ (PICO ) و پایگاههای اطلاعاتی مناسب ضروری به نظر می رسد استراتژی عمومی جستجو در بالین مرحله اول: طراحی PICO در مرحله اول جستجوی اطلاعات، چند دقیقه وقت بگذارید و به خوبی در مورد سوال خود و آنچه که می خواهید در مورد آن جستجو کنید فکر کنید. جستجوگر بایستی مشکل و سوال خود را بخوبی بررسی و تجزیه و تحلیل کند. يكي از بهترين توصيه ها در این زمینه براي كادر بالینی، طرح سوال قابل پاسخ و یا به اصطلاح PICO است مرحله دوم: تعیین کلیدواژه ها و مترادفات پس از طراحی PICO ، کلیدواژه های جستجو بر اساس P ، I ، C و O در سوال موردنظر تعیین می شوند. واژه های مترادف و مرتبط این کلیدواژه ها از قبیل اختصارات، واژه های با دامنه وسیع تر و یا دامنه محدودتر، رسم الخط های متفاوت و ... نیز در صورت نیاز تعیین می شوند و جستجو آغاز می شود مرحله سوم: انتخاب پایگاه اطلاعاتی مناسب انتخاب پایگاه اطلاعاتی مناسب و مرتبط با موضوع جستجو یکی از کلیدی ترین مراحل جستجو است. با توجه به اینکه بسیاری از پایگاههای اطلاعاتی بویژه در حوزه پزشکی براساس نوع اطلاعات و مطالعات در حال تخصصی شدن هستند، آشنایی با دامنه موضوعی و کاربردهای آنها موجب بازیابی اطلاعات مناسب تر و صرفه جویی در زمان خواهد شد. مرحله چهارم: طراحی روش جستجو جستجو در اینترنت و پایگاه اطلاعاتی با بکارگیری روشهای ساده و در عین حال صحیح جستجو بسیار آسان و لذت بخش خواهد بود. برعکس، عدم آشنایی با این روشهای آسان ممکن است موجب شود که یا اطلاعات غیرمرتبط بازیابی کنید و یا بسیاری از اطلاعات مفید را از دست بدهید.

2. ‫جو‬ ‫ادی‬‫ر‬‫م‬ ‫محمد‬
‫سالمت‬ ‫ی‬‫سیاستگذار‬ ‫ی‬‫دکتر‬ ‫ی‬‫دانشجو‬
‫ان‬‫ر‬‫ته‬ ‫پزشکی‬ ‫علوم‬ ‫دانشگاه‬
‫آبان‬1396

4. WHY do we need Clinical Questions?
Well-developed clinical questions help to focus
on evidence that is relevant to the consumers
and clinicians, making the searching more
efficient.

5. Type of clinical question
• Background questions are those which have been answered in the
past and are now part of the “fiber of medicine .” Answers to these
questions are usually found in medical textbooks. The learner must
beware, since the answers to these questions may be inaccurate
and not based upon any credible evidence. Typical background
questions relate to the nature of a disease or the usual cause,
diagnosis, or treatment of illnesses.
• Foreground questions are those usually found at the cutting edge
of medicine. They are questions about the most recent therapies,
diagnostic tests, or current theories of illness causation. These are
the questions that are the heart of the practice of EBM. A four-part
clinical question called a PICO question is designed to easily search
for this evidence.

6. background vs. foreground
Background information is sought when a learner has general
clinical questions regarding a topic such as what is the
disorder; what causes it; how does it present; what are
some treatment options. These questions can be answered
by using "background" resources such as textbooks (both in
print and electronic) and narrative reviews in journals
which give a general overview of the topic.
Foreground information answers specific questions a clinician
has regarding a specific patient. Foreground resources can
be divided into primary sources such as original research
articles published in journals; and secondary sources such
as systematic reviews of the topic, and synopses and
reviews of individual studies.

7. The relationship between foreground and background
questions and the clinician’s experience
Background Questions
Foreground Questions
Clinical Experience
Student Experienced Clinician

8. Background vs. Foreground
• Background Questions
– General knowledge
– Who, what, how?
• Foreground Questions
– PICO Model

9. Asking the Question: PICO
• Every foreground clinical question should include description
of population, intervention, comparison, and outcome
measures.
Patient Problem or Population (P)
Intervention (I)
Comparison (C)
Outcome (O)

10. Addresses specific knowledge to inform clinical
decisions or actions.
Foreground question
P
I
C
O

11. Addresses specific knowledge to inform clinical
decisions or actions.
Foreground question
Patient/
Population
Intervention/
Exposure
Comparison
Outcome

12. Addresses specific knowledge to inform clinical
decisions or actions.
Patient/
Population
How would I describe a patient or group of
patients similar to mine?
Intervention/
Exposure
Which main intervention (exposure, finding,
test, risk factor) am I considering?
Comparison What is the main alternative to the
intervention?
Outcome What can I hope to accomplish?
What could this exposure really affect?
Foreground question

13. PICO Example
P (Problem or Patient or
Population)
hospital acquired infection
I (Intervention/indicator) hand washing
C (Comparison)
no hand washing; masks ;
other solution
O (Outcome) reduced infection

14. 14
Fundamentals of Searching
P
I
C
O
Population
Intervention
Comparison
Outcome
Question Formulation Using PICO

15. Develop a search strategy
Using OR then AND
to broaden then focus the search
P I O
Sore throat*
or
tonsillitis
or
pharyngitis
Antibiotic*
or
antibacterial*
or
penicillin
Symptom
relief
or
Symptom
alleviation
and and

16. Boolean Search

17. Combine terms with
OR
pharyngitis
Sore
throat
Pharyngitis OR sore throat – either term can be
present

18. Combine terms with
AND
Antibiotics AND sore throat – both terms must be
present
sore
throatantibiotics

21. Type of Clinical Question and Study Design
• Two additional important elements of the well-built clinical question to
consider are the type of foreground question and the type of study
(methodology). This information can be helpful in focusing the question
and determining the most appropriate type of evidence.
• Foreground questions can be further divided into questions that relate to
therapy, diagnosis, prognosis, etiology/harm
• Therapy: Questions of treatment in order to achieve some outcome. May
include drugs, surgical intervention, change in diet, counseling, etc.
• Diagnosis: Questions of identification of a disorder in a patient presenting
with specific symptoms.
• Prognosis: Questions of progression of a disease or likelihood of a disease
occurring.
• Etiology/Harm: Questions of negative impact from an intervention or
other exposure.

22. Questions
Diagnosis
Etiology? Risk
Factors?
Prognosis
Therapy

23. Question type – Study design
Question domain Best feasible study
design
Diagnosis Cross-sectional study
Etiology /Harm Cohort or RCT
Prognosis Cohort
Treatment Systematic review or
RCT

26. Structured questions for systematic reviews and relations between
question components in a comparative study

27. Thank you