This document provides guidance on searching for evidence to answer clinical questions using the PICO (Patient, Intervention, Comparison, Outcome) framework. It includes 8 examples of clinical questions and suggested search strategies for each using PubMed Clinical Queries and MeSH (Medical Subject Headings) terms. Key steps outlined are identifying relevant search terms from the question, searching MeSH for correct terms, and entering the MeSH search number into Clinical Queries to generate focused results. The document emphasizes an evidence-based approach to clinical information retrieval.

1. Exercise 1 – Suggested solution
Question:
What is the survival rate of extremely premature infants?
1. Patient/problem
Extremely premature infants
2. Intervention or Exposure
3. Comparison
4. Outcome
Survival rate
What type of question is this?
Diagnosis
Prognosis
Etiology
Therapy
Experience
Which search terms should be used?
Use the PICO model to note all relevant search terms. Make sure to include all synonyms. It is not always
necessary or smart to search for all the different parts of the question, decide which parts are essential.
P I C O
Patient/problem Intervention/exposure Comparison Outcome
extremely premature survival rate
premature infant survival time
very low birth weight
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

2. Suggested search strategies:
PubMed Clinical Queries:
This stragegy will give more results: (extreme* premature OR very low birth weight) AND survival
rate
With MeSH database:
Identify the correct MeSH terms via MeSH database and search for these. In this case it may be
smart to search for Infant, Premature OR Infant, Very Low Birth Weight first. Then do a new search
for Survival Rate. Go to History to combine the searches with AND. Then find the number of the
combined MeSH search. Go to Clinical Queries and put in the number of the MeSH search.
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

3. Exercise 2 – Suggested soulutions
Question:
Can the use of mobile phones cause brain cancer?
1. Patient/problem
Everybody who use mobile phones
2. Intervention or Exposure
Mobile phones
3. Comparison
4. Outcome
Brain cancer
What type of question is this?
Diagnosis
Prognosis
Etiology
Therapy
Experience
Which search terms should be used?
Use the PICO model to note all relevant search terms. Make sure to include all synonyms. It is not always
necessary or smart to search for all the different parts of the question, decide which parts are essential.
P I C O
Patient/problem Intervention/exposure Comparison Outcome
mobile phone bran cancer
cellular phone brain tumor
cell phone brain tumour
cellular telephone brain neoplasms
mobile telephone intracranial cancer
intracranial tumor
intracranial tumour
intracranial neoplasms
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

4. Suggested search strategies:
PubMed Clinical Queries:
With MeSH database:
Identify the correct MeSH terms via MeSH database and search for these. Go to History and find the
number of the MeSH search. Go to Clinical Queries and put in the number of the MeSH search.
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

5. Exercise 3 - Suggested solutions
Question:
In patients with a suspected lower limb deep venous thrombosis, does the presence of Homan's sign
accurately diagnose a deep vein thrombosis?
1. Patient/problem
Patients with a suspected lower limb deep venous thrombosis
2. Intervention or Exposure
Homan's sign
3. Comparison
4. Outcome
Accurate diagnosis of deep vein thrombosis
What type of question is this?
Diagnosis
Prognosis
Etiology
Therapy
Experience
Which search terms should be used?
Use the PICO model to note all relevant search terms. Make sure to include all synonyms. It is not always
necessary or smart to search for all the different parts of the question, decide which parts are essential.
P I C O
Patient/problem Intervention/exposure Comparison Outcome
homan’s sign deep vein thrombosis
dvt
venous thrombosis
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

6. Suggested search strategies:
PubMed Clinical Queries:
Narrow, specific search will produce 0 results. Broad, sensitive search gives av few results.
Search for Homan’s sign in MeSH database gives no hits, therefore you have to use text words.
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

7. Exercise 4 – Suggested solutions:
Question:
Is paracetamol effective for reducing fever in children?
1. Patient/problem
Child with fever
2. Intervention or Exposure
Paracetamol
3. Comparison
4. Outcome
Reduction of fever
What type of question is this?
Diagnosis
Prognosis
Etiology
Therapy
Experience
Which search terms should be used?
Use the PICO model to note all relevant search terms. Make sure to include all synonyms. It is not always
necessary or smart to search for all the different parts of the question, decide which parts are essential.
P I C O
Patient/problem Intervention/exposure Comparison Outcome
paracetamol
child acetaminophen
fever acetamidophenol
hyperthermia hydroxyacetanilide
pyrexia panadol
acamol
acetaco
anacin
datril
algotropyl
acephen
tylenol
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

8. Suggested search strategies:
The Cochrane Library:
PubMed Clinical Queries:
With MeSH database:
Identify the correct MeSH terms via MeSH database and search for these. Limit to All child 0-18
years. Go to History and find the number of the limited MeSH search. Go to Clinical Queries and put
in the number of the MeSH search.
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

9. Exercise 5 – Suggested solutions:
Question:
Is acupuncture more effective than nicotine replacement therapy for smoking cessation?
1. Patient/problem
Smokers
2. Intervention or Exposure
Acupuncture
3. Comparison
Nicotine replacement therapy
4. Outcome
Smoking cessation
What type of question is this?
Diagnosis
Prognosis
Etiology
Therapy
Experience
Which search terms should be used?
Use the PICO model to note all relevant search terms. Make sure to include all synonyms. It is not always
necessary or smart to search for all the different parts of the question, decide which parts are essential.
P I C O
Patient/problem Intervention/exposure Comparison Outcome
acupuncture nicotine replacement smoking cessation
nicotine gum
nicotine patch
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

10. Suggested search strategies:
The Cochrane Library:
Combining smoking cessation AND acupuncuture AND nicotine replacement (search #4) will produce
just a few RCTs.
In this case it might be more appropriate to combine the intervention (acupuncture) and comparison
(nicotine replacement) with OR (search #5) and then combine this with the outcome (smoking
cessation) as in search #6. This will produce several systematic reviews. Two relevant titles:
Nicotine replacement therapy for smoking cessation
Acupuncture and related interventions for smoking cessation
Maybe you will find the answer to your question by reading, appraising and comparing these two.
PubMed Clinical Queries:
With MeSH database:
Identify the correct MeSH terms via MeSH database and search for these. In this case there is no
MeSH term for nicotine replacement. A possible solution is to do a text word search for the relevant
synonyms for nicotine replacement and then combine this with the MeSH terms for acupuncture and
smoking cessation.
Note: The MeSH term Acupuncture is about the dicipline (those performing acupuncture therapy)
while Acupuncture therapy is the actual treatment.
In this case the combination of smoking cessation, acupuncture and nicotine replacement only gives
7 hits. No point in taking it to Clinical Queries.
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

11. Exercise 6 – Suggested solutions:
Question:
What is the difference between Ciclesonide and other inhaled steroides for chronic asthma in children and
adults with regards to improvement of lung function and side effects?
1. Patient/problem
Asthma
2. Intervention or Exposure
Ciclesonide
3. Comparison
Other inhaled steroides
4. Outcome
Improved lung function. Side effects.
What type of question is this?
Diagnosis
Prognosis
Etiology
Therapy
Experience
Which search terms should be used?
Use the PICO model to note all relevant search terms. Make sure to include all synonyms. It is not always
necessary or smart to search for all the different parts of the question, decide which parts are essential.
P I C O
Patient/problem Intervention/exposure Comparison Outcome
asthma ciclesonide steroids
alvesco corticosteroids
omnaris corticoids
desisobutyrylciclesonide
pregnenedione
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

12. Suggested search strategies:
The Cochrane Library:
PubMed Clinical Queries:
With MeSH database:
Identify the correct MeSH terms via MeSH database and search for these. Go to History and find the
number of the MeSH search. Enter this number in Clinical Queries.
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

13. Exercise 7 – Suggested solutions:
Question:
Is group therapy effective for patients suffering from post-traumatic stress disorder (PTSD)?
1. Patient/problem
Post-traumatic stress disorder (PTSD)
2. Intervention or Exposure
Group therapy
3. Comparison
4. Outcome
Reduction of PTSD symptoms
What type of question is this?
Diagnosis
Prognosis
Etiology
Therapy
Experience
Which search terms should be used?
Use the PICO model to note all relevant search terms. Make sure to include all synonyms. It is not always
necessary or smart to search for all the different parts of the question, decide which parts are essential.
P I C O
Patient/problem Intervention/exposure Comparison Outcome
post-traumatic stress group therapy
disorder
group psychotherapy
ptsd
post-traumatic neurosis
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

14. Suggested search strategies:
The Cochrane Library:
PubMed Clinical Queries:
With MeSH database:
Identify the correct MeSH terms via MeSH database and search for these. Go to History and find the
number of the MeSH search. Enter this number in Clinical Queries.
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

15. Exercise 8 – Suggested solutions:
Question:
Is phototherapy effective in treating seasonal affective disorder?
1. Patient/problem
Seasonal affective disorder
2. Intervention or Exposure
Phototherapy
3. Comparison
4. Outcome
Reduction of symptoms of seasonal affective disorder
What type of question is this?
Diagnosis
Prognosis
Etiology
Therapy
Experience
Which search terms should be used?
Use the PICO model to note all relevant search terms. Make sure to include all synonyms. It is not always
necessary or smart to search for all the different parts of the question, decide which parts are essential.
P I C O
Patient/problem Intervention/exposure Comparison Outcome
seasonal affective phototherapy
disorder
photoradiation therapy
seasonal mood disorder
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library

16. Suggested search strategies:
The Cochrane Library:
PubMed Clinical Queries:
With MeSH database:
Identify the correct MeSH terms via MeSH database and search for these. Go to History and find the
number of the MeSH search. Enter this number in Clinical Queries.
Finding Evidence Based Clinical Information in The Cochrane Library and PubMed. EAHIL CEC June 2008
Hilde Strømme. Ullevaal University Hospital, Medical Library