EBM Resources for Pediatrics


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EBM Resources for Pediatrics

  1. 1. CLISTA CLANTON, MSLS, AHIP JANUARY 15, 2009 EBM Resources for Pediatrics
  2. 2. Evidence-based Medicine <ul><li>&quot;Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.“ </li></ul><ul><li>-David L. Sackett </li></ul><ul><li>Professor Emeritus, Clinical Epidemiology & Biostatistics McMaster University </li></ul>
  3. 3. Haynes, RB. ACPJC Nov/Dec 2006;145(3):A8-9 Start at top and work your way down
  4. 4. Information Resources <ul><li>&quot;Evidence-based medicine is ...a set of procedures, pre-appraised resources and information tools to assist practitioners to apply evidence from research in the care of individual patients&quot;. </li></ul><ul><li>-Kathleen Ann McKibbon </li></ul><ul><li>Associate Professor , Department of Clinical Epidemiology & Biostatistics </li></ul><ul><li>McMaster University </li></ul>
  5. 5. Computer system Clinical Evidence, Dynamed, PIER, UpToDate ACP Journal Club, PedsCCM Journal Club Cochrane Library, PubMED Clinical Queries, guidelines Original Studies
  6. 6. PICO <ul><li>P=Patient or population </li></ul><ul><li>I=Intervention, Prognostic Factor or Exposure </li></ul><ul><li>C=Comparison </li></ul><ul><li>O=Outcomes </li></ul>
  7. 7. Type of Question Suggested Best Type of Study Therapy RCT > cohort > case control > case series Diagnosis Prospective, blind comparison to gold standard Etiology / Harm RCT > cohort > case control > case series Prognosis Cohort study > case control > case series Prevention RCT > cohort study > case control > case series Clinical Exam Prospective, blind comparison to gold standard Cost Economic analysis Questions of therapy, etiology and prevention which can best be answered by RCT can also be answered by a meta-analysis or systematic review.
  8. 8. Evidence Pyramid Case Series/Case Reports Case Control Studies Cohort Studies Randomized Controlled Trial Systematic Review Meta-analysis Animal Research
  9. 9. Question: In hospitalized infants with bronchiolitis , does the use of nebulized hypertonic saline help to reduce symptoms and LOS? Type of question: Type of study: Therapy RCT > cohort > case control > case series In patient with [Patient/ Problem] does [Intervention] or [Comparison, if any] affect [Outcome]
  10. 10. EBM Pediatric Resources on the Web <ul><li>PedsCCM.org: Pediatric Critical Care Medicine Evidence-based Journal Reviews http://pedsccm.org/EBJournal_Club_intro.php </li></ul><ul><li>Cincinnatti Children’s Evidence-based Care Guildelines http://www.cincinnatichildrens.org/svc/alpha/h/health-policy/ev-based/default.htm </li></ul><ul><li>University of Michigan Evidence-based Pediatrics http://www.med.umich.edu/pediatrics/ebm/ </li></ul><ul><li>PhillyEBM http://www.phillyebm.com/drupal/ </li></ul>
  11. 11. <ul><li>http://www.cebm.net/index.aspx?o=1216 </li></ul><ul><li>Prompts you for your clinical question, your search strategy and key information about the study you found </li></ul><ul><li>Provides on-line critical appraisal guides for assessing the validity and usefulness of the study </li></ul><ul><li>automates the calculation of clinically useful measures (and their 95% confidence intervals) </li></ul><ul><li>Helps you formulate clinical &quot;Bottom Lines&quot; from what you've read </li></ul><ul><li>Creates 1-page summaries (CATs) that are easy to store, print, retrieve, and share (as both text and HTML files); </li></ul><ul><li>Helps you remember when to update each CAT you create </li></ul><ul><li>Helps you to teach others how to practice EBM </li></ul>