Seguin Aurélie, Haynes Robert Brian, Carballo Sebastian, Iorio Alfonso, Perrier Arnaud, Agoritsas Thomas
Division of General Internal Medicine, Department Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
JMIR Med Educ. 2020 Apr 20;6(1):e16777. doi: 10.2196/16777.
Staying up to date and answering clinical questions with current best evidence from health research is challenging. Evidence-based clinical texts, databases, and tools can help, but clinicians first need to translate their clinical questions into searchable queries. MacPLUS FS (McMaster Premium LiteratUre Service Federated Search) is an online search engine that allows clinicians to explore multiple resources simultaneously and retrieves one single output that includes the following: (1) evidence from summaries (eg, UpToDate and DynaMed), (2) preappraised research (eg, EvidenceAlerts), and (3) non-preappraised research (eg, PubMed), with and without validated bibliographic search filters. MacPLUS FS can also be used as a laboratory to explore clinical questions and evidence retrieval.
Our primary objective was to examine how clinicians formulate their queries on a federated search engine, according to the population, intervention, comparison, and outcome (PICO) framework. Our secondary objective was to assess which resources were accessed by clinicians to answer their questions.
We performed an analytical survey among 908 clinicians who used MacPLUS FS in the context of a randomized controlled trial on search retrieval. Recording account log-ins and usage, we extracted all 1085 queries performed during a 6-month period and classified each search term according to the PICO framework. We further categorized queries into background (eg, "What is porphyria?") and foreground questions (eg, "Does treatment A work better than B?"). We then analyzed the type of resources that clinicians accessed.
There were 695 structured queries, after exclusion of meaningless queries and iterations of similar searches. We classified 56.5% (393/695) of these queries as background questions and 43.5% (302/695) as foreground questions, the majority of which were related to questions about therapy (213/695, 30.6%), followed by diagnosis (48/695, 6.9%), etiology (24/695, 3.5%), and prognosis (17/695, 2.5%). This distribution did not significantly differ between postgraduate residents and medical faculty physicians (P=.51). Queries included a median of 3 search terms (IQR 2-4), most often related to the population and intervention or test, rarely related to the outcome, and never related to the comparator. About half of the resources accessed (314/610, 51.5%) were summaries, 24.4% (149/610) were preappraised research, and 24.1% were (147/610) non-preappraised research.
Our results, from a large sample of real-life queries, could guide the development of educational interventions to improve clinicians' retrieval skills, as well as inform the design of more useful evidence-based resources for clinical practice.
ClinicalTrials.gov NCT02038439; https://www.clinicaltrials.gov/ct2/show/NCT02038439.
紧跟健康研究的最新进展并用当前最佳证据回答临床问题具有挑战性。循证临床文本、数据库和工具虽有帮助，但临床医生首先需要将其临床问题转化为可搜索的查询。MacPLUS FS（麦克马斯特高级文献服务联合搜索）是一个在线搜索引擎，它允许临床医生同时探索多个资源，并检索出一个单一的结果，该结果包括以下内容：（1）来自综述的证据（如UpToDate和DynaMed），（2）预先评估的研究（如EvidenceAlerts），以及（3）未经预先评估的研究（如PubMed），可使用或不使用经过验证的书目搜索过滤器。MacPLUS FS也可作为一个实验室来探索临床问题和证据检索。
我们的主要目的是根据人群、干预措施、对照和结局（PICO）框架，研究临床医生如何在联合搜索引擎上制定他们的查询。我们的次要目的是评估临床医生为回答问题而访问了哪些资源。
我们对908名在搜索检索的随机对照试验背景下使用MacPLUS FS的临床医生进行了一项分析性调查。记录账户登录和使用情况，我们提取了6个月期间执行的所有1085个查询，并根据PICO框架对每个搜索词进行分类。我们进一步将查询分为背景问题（如“什么是卟啉症？”）和前景问题（如“治疗A比治疗B效果更好吗？”）。然后我们分析了临床医生访问的资源类型。
排除无意义的查询和相似搜索的迭代后，有695个结构化查询。我们将其中56.5%（393/695）的查询分类为背景问题，43.5%（302/695）为前景问题，其中大多数与治疗问题相关（213/695，30.6%），其次是诊断（48/695，6.9%）、病因（24/695，3.5%）和预后（17/695，2.5%）。研究生住院医师和医学教师之间的这种分布没有显著差异（P = 0.51）。查询中搜索词的中位数为3个（四分位距2 - 4），最常与人群和干预措施或测试相关，很少与结局相关，且从不与对照相关。访问的资源中约一半（314/610，51.5%）是综述，24.4%（149/610）是预先评估的研究，24.1%（147/610）是未经预先评估的研究。
我们从大量现实生活中的查询得出的结果，可为改进临床医生检索技能的教育干预措施的开发提供指导，并为临床实践中更有用的循证资源的设计提供参考。
ClinicalTrials.gov NCT02038439；https://www.clinicaltrials.gov/ct2/show/NCT02038439
