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University Library, University of Illinois at Urbana-Champaign

Medical Students

Carle Illinois medical student guide to library resources

Introduction to Evidence-Based Medicine (EBM)

The Patient

  • 9 year old boy
  • With abdominal pain (constant dull pain) and tenderness
  • Some vomiting
  • Loss of appetite
  • Suspected Appendicitis
     

Treatment

  • Standard of care is surgical removal of appendix
  • Parent saw an article in USNews where antibiotics can be used to treat uncomplicated appendicitis; does not want surgical option.

…the study published in the Journal of the American Medical Association last month found that 73 percent of patients with uncomplicated appendicitis who were treated with antibiotics alone did not need surgery within the study's one-year follow-up period.

Researchers were not able to definitively prove that antibiotics weren't inferior to surgery. Researchers noted that they fell short of an anticipated 75 percent success rate for antibiotic therapy, given that 27 percent of patients ultimately required surgery in the year after initially being diagnosed with appendicitis and treated with drugs alone.

An appendectomy, on the other hand, has a roughly 99 percent success rate. As with any operation, however, it's not without risk.

Given that…

•Any surgery has risks
•And a longer recovery
•And is more expense
•And that 1 in 4 patients require surgery after antibiotic treatment anyway…
 
•What would you recommend?
•Need to know more?

 

4. YOUR TURN - Develop a PICO

5. ACQUIRE Secondary Evidence

6. ACQUIRE Primary Evidence

7. YOUR TURN - ACQUIRE & ASSESS Evidence

Your group is assigned three resources to search to find recommendations related to this case and your PICO question. Within your group, decide how to divide the work. You will need to:

  • Search each of the three resources assigned to your group
  • Discuss the questions below and record your findings on this PICO form
  • Email the PICO form with your results to phburn@illinois.edu at the end of today’s session.
  • The output for your group can be one PICO form with the all findings or a seperate PICO form for each of the three resources.

GROUP ASSIGNMENTS:

A –Essential Evidence Plus (STAT!Ref), UpToDate, AND PubMed

B –Essential Evidence Plus (STAT!Ref), UpToDate, AND PubMed Clinical Queries

C –UpToDate, PubMed, AND AAFP Conditions A-Z (STAT!Ref)

D –AAFP Conditions A-Z (STAT!Ref), Essential Evidence Plus (STAT!Ref), AND PubMed Clinical Queries

E – Essential Evidence Plus (STAT!Ref), AAFP Conditions A-Z (STAT!Ref), AND PubMed

QUESTIONS TO ADDRESS

What three resources did you consult?

  1. _______________________ 2. ___________________________ 3. _____________________
  • What recommendations did you find for treatment of pediatric appendicitis?
  • Were there conflicting recommendations?
  • What was the quality of the underlying evidence? (consult checklist for Therapy study)
  • What will you tell the patient?


RESOURCES LINKS

8. DISCUSSION & TAKEAWAYS

  • EBM begins with a focused clinical question (PICO)
  • Specific tools and search strategies are used to find “the best” medical evidence
  • Evidence is only part of the knowledge base that informs decision making
    • What works in a controlled setting may not perform the same way in the real world
    • Evidence is just part of decision making; experience and patient values are equally important