Evidence Based Medicine Pediatrics

1. Using PubMedUsing PubMed
to search forto search for
Evidence-Based MedicineEvidence-Based Medicine
Reference SectionReference Section
Conrado F. Asenjo LibraryConrado F. Asenjo Library
UPR-MSCUPR-MSC

2. ObjectivesObjectives
Define Evidence-Based Medicine (EBM)Define Evidence-Based Medicine (EBM)
Based on a patient problem, construct a well-Based on a patient problem, construct a well-
built clinical questionbuilt clinical question
Identify searching strategies that could improve Identify searching strategies that could improve
MEDLINE retrievalMEDLINE retrieval

3. Evidence-Based MedicineEvidence-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.

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

5. Clinical Encounter- CarlitosClinical 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.

6. Anatomy of a FocusedAnatomy of a Focused
Clinical QuestionClinical Question
Patient or ProblemPatient or Problem
How would I describe a group of patients or problem similar How would I describe a group of patients or problem similar
to mine?to mine?
Intervention, Prognostic factor, ExposureIntervention, Prognostic factor, Exposure
Which main intervention, prognostic factor, or exposure are Which main intervention, prognostic factor, or exposure are
you considering? you considering?
ComparisonComparison
What is the main alternative to compare with the What is the main alternative to compare with the
intervention? intervention?
OutcomeOutcome
What will the exposure, intervention affect?What will the exposure, intervention affect?

7. Focused Clinical QuestionFocused Clinical Question
In pediatric patients with strep throat, is amoxicillin
as effective as penicillin for relief of symptoms?
relief of symptomsOutcome
penicillinComparison
amoxicillinIntervention, Prognostic
factor, Exposure
pediatric patients with strep
throat
Patient or problem

8. Most common types of questionsMost common types of questions
DiagnosisDiagnosis- how to select and interpret diagnostic tests - how to select and interpret diagnostic tests
TherapyTherapy- how to select treatments, expected outcomes, - how to select treatments, expected outcomes,
quality of life.quality of life.
PrognosisPrognosis- how to estimate the patient's likely clinical - how to estimate the patient's likely clinical
course over timecourse over time
Harm/EtiologyHarm/Etiology- how to identify causes for disease- how to identify causes for disease

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

10. Case Series and Case Reports Case Series and Case Reports

11. Case Control Studies Case Control Studies

12. Cohort StudiesCohort Studies

13. Randomized Controlled TrialsRandomized Controlled Trials

14. Systematic ReviewsSystematic Reviews
and Meta-Analysisand Meta-Analysis

15. Preferred Study DesignsPreferred Study Designs
RCT>cohort study > case control > case
series
Prevention
RCT>cohort>case-control>case seriesEtiology
Longitudinal cohort study>case
control>case series
Prognosis
RCT>cohort>case control>case seriesTherapy
Cross-sectional study (compared with a
gold standard)
Diagnosis

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

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

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