Evidence Based Medicine Pediatrics

Using PubMed to search for Evidence-Based Medicine Reference Section Conrado F. Asenjo Library UPR-MSC

Objectives
Define Evidence-Based Medicine (EBM)
Based on a patient problem, construct a well-built clinical question
Identify searching strategies that could improve MEDLINE retrieval

Evidence-Based Medicine Judicious incorporation of the best available evidence, in conjunction with the values and preferences of those involved and with the circumstances of care in clinical decision-making. Evidence along is not enough.

Steps of EBM
Clinical encounter *
Focused clinical question *
Search of “best evidence” *
Determine the validity of the evidence
Extract the clinical message
Incorporate patient values/preferences
Make a clinical decision about care
* What we will be talking about today.

Clinical Encounter- Carlitos Carlitos is an active 5 year old boy. His mother brought him in for a check-up because Carlitos has had a fever and a sore throat for several days. You suspect Strep and take a throat culture. The standard treatment for Streptococcal Pharyngitis is oral Penicillin three times a day. However, for Carlitos and his mother, you are concerned about compliance and the expense of this medication. You recall that a drug representative recently told you that a daily dose of amoxicillin is just as good as penicillin, but costs less. You want to review the literature before you decide on amoxicillin for Carlitos and possibly changing your standard practice.

Anatomy of a Focused Clinical Question
Patient or Problem
How would I describe a group of patients or problem similar to mine?
Intervention, Prognostic factor, Exposure
Which main intervention, prognostic factor, or exposure are you considering?
Comparison
What is the main alternative to compare with the intervention?
Outcome
What will the exposure, intervention affect?

Focused Clinical Question In pediatric patients with strep throat, is amoxicillin as effective as penicillin for relief of symptoms? relief of symptoms Outcome penicillin Comparison amoxicillin Intervention, Prognostic factor, Exposure pediatric patients with strep throat Patient or problem

Most common types of questions
Diagnosis - how to select and interpret diagnostic tests
Therapy - how to select treatments, expected outcomes, quality of life.
Prognosis - how to estimate the patient's likely clinical course over time
Harm/Etiology - how to identify causes for disease

Type of Study Meta-Analysis Systematic Reviews Randomized Controlled Trials Cohort Studies Cross Sectional Studies Case Control Studies Case Series/ Case Reports Animal Research In vitro (‘test tube’) research

Case Series and Case Reports

Case Control Studies

Cohort Studies

Randomized Controlled Trials

Systematic Reviews and Meta-Analysis

Preferred Study Designs RCT>cohort study > case control > case series Prevention RCT>cohort>case-control>case series Etiology Longitudinal cohort study>case control>case series Prognosis RCT>cohort>case control>case series Therapy Cross-sectional study (compared with a gold standard) Diagnosis

Clinical Encounter
Focused Clinical Question: In pediatric patients with strep throat, is amoxicillin as effective as penicillin for relief of symptoms?
This is a therapy question , and the best evidence would be a randomized controlled trial .

PubMed- Search Strategies
Combining keywords using boolean operators (AND, OR, NOT) and applying limits.
Using NLM’s controlled vocabulary (MeSH ) and applying limits.
Using Clinical Queries filters.

Accessing PubMed
Directly: http://www.pubmed.gov
From the library’s electronic webpage: http://rcm-library.rcm.upr.edu
Click on NLM PubMed link
An icon indicates MSC Library’s print holdings.

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Evidence Based Medicine Pediatrics

by Pedro Antonio Del-Valle-Lopez on Feb 27, 2008

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