PICO is a device to help ask good clinical questions, and it can also be used to help focus and search databases for peer-reviewed articles that answer those questions.
Most clinical research develops from an idea or scenario like the following:
You are a nurse working with a mother and her daughter, who suffers from epilepsy. The mother is aware that North Dakota has legalized medical marijuana and wants to know if that would be a safe option for her daughter. Apart from basic news stories, you haven’t heard much about medical marijuana and decide to investigate.
We can use PICO to pull out the keywords that will help us search.
On the table below, you can see what each letter in PICO stands for, and how to use that to develop keywords from the scenario above. Once keywords are identified, it is important to also think about some synonyms or related concepts to also try when searching.
| P | I | C | O | |
| Stands for: | Patient, Population or Problem | Intervention | Comparison | Outcome |
| Keywords: | Female, child, epilepsy | Medical Marijuana | NA | Safety |
| Synonyms: | Pediatric, seizures, seizure disorder | Cannabis, cannabidiol | NA | Adverse Effects |
Not all questions are about therapeutic interventions. If you’re asking an etiology question, for example, “Do mothers who smoke compared to mothers who don’t smoke have babies with different birth weights?” the I keyword will be smoking and C would be not smoking. It may be easier in those instances to think of I and C as experimental and control variables. Comparisons may not always exist, as in the table above. Or they may be something understood, like standard of care. Or it may be placebo. Outcome should be something that can be measured, so instead of “efficacy,” think of how that can be measured: days in the hospital? Tolerance? A particular result from a lab test? Patient satisfaction? If you can’t think of any synonyms right away, look for other terms that come up as you are searching and then add them to the list of search terms.
Once you have your keywords, the next step is putting them together in a way a database will understand. The key to doing that is simply to use AND, OR & a few other tools for getting the most relevant results.
Start searching with a basic search string, like epilepsy AND "medical marijuana" AND safety and evaluate your results for relevancy. You can then change or add keywords to refine or expand results. You can also use database filters to do the same; for example, PubMed has a filter for age range, which could be used to narrow down to articles about children. In other databases, the keywords (child OR children) would need to be added to the search string.
CINAHL stands for the Cumulative Index to Nursing and Allied Health Literature; therefore it is a great database for finding articles from nursing journals, as well as articles related to disciplines like public health, social work and physical therapy.
To do a basic keyword search in CINAHL, follow the suggestions in the "Developing Keywords & Creating a Search String" tutorial. One thing to note is that when you go to the CINAHL database, you'll have the option to use multiple separate search boxes; you can use those boxes to separate out your different key concepts or you can put your search string all in a single search box--either way will work!
Watch the short video below for a couple of searching tricks specific to CINAHL that can help focus your searches:
MEDLINE indexes authoritative medical information on medicine, nursing, dentistry, veterinary medicine, the health care system, pre-clinical sciences, and more. While it is available on a variety of platforms, I recommend first trying it on the EBSCOhost platform. This is the same platform that CINAHL is on, so it will look and work pretty much the same.
This video demonstrates how to create a basic search in any EBSCOhost Database, such as MEDLINE. You can also view the video on YouTube.
This video demonstrates the features of the results list in EBSCOhost Databases, such as MEDLINE. You can also view the video on YouTube.
If you want to save a link to your search, or specific article records in MEDLINE, do NOT use the URL in the browser address bar, as those are only temporary and will not work if you try to use it later. Instead, use the permalink option. The video below demonstrates how to save a link to article records or searches in EBSCOhost databases. You can also view the video on YouTube.
PubMed is a leading database for health sciences research. Because it is developed by the National Library of Medicine, it is freely available on the web, and as such, is a key resource for health professionals throughout their careers.
While PubMed is easy to access from Google, NDSU Libraries have customized parts of PubMed to make searching and accessing articles easier for students and faculty. Therefore, it is highly recommended that you navigate to PubMed through the library website to access these features.
Things to Remember:
Things to Remember:
What is MeSH?
MeSH stands for Medical Subject Headings; think of them as sort of "official" keywords used by PubMed. They are helpful when a concept, such as strength training, may be described using a number of different terms. For example, let's say three different authors write articles about strength training; Author 1 uses the term "resistance training," Author 2 uses the term "weight lifting," and Author 3 uses the term "strength training." If you were searching for articles on this topic and only searched with the term "strength training," you could easily miss the other two articles, even though they could be useful.
Using MeSH is a way to avoid this problem. The MeSH term for the concept "strength training" is "resistance training," which means that ALL articles about that topic are assigned that term--even when the authors use other terms, such as "strength training" or "weight lifting," like our authors 2 & 3 did above. And by searching using the MeSH term, you should be able to find all of the articles by the three authors in just one search.
Things to Remember:
