03/07/2012 Dr.Ilham Youssry, MD-JMHPE-CT 1 Student assignment EBM process Dr. Ilham Youssry, MD-IBCT-JMHPE professor of pediatrics, Pediatric Hematology Member of EBM unit, MEDC, Cairo University Master degree Health Profession Education, JMHPE Certified trainer, IBCT [email protected]2012 What are your expectations about Evidence-based medicine (EBM)?
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03/07/2012
Dr.Ilham Youssry, MD-JMHPE-CT 1
Student assignment
EBM process
Dr. Ilham Youssry, MD-IBCT-JMHPEprofessor of pediatrics, Pediatric Hematology
• Your patient is a three years old male, presented to the ER with Purpura, mild gum bleeding
• The patient is clinically stable, and his physical examination is otherwise normal
• Complete blood count is totally normal apart from severe thrombocytopenia ( platelet count<10000/mm).
• You decided to admit the child and start treatment with intravenous immunoglobulin.
• One student asked you if treatment with pulsed high dose methyl-prednisolone would result in similar improvement at much lower cost for the hospital?
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Types of questions raised
• What causes idiopathic thrombocytopenic
purpura?
• What is the symptoms of ITP?
• How can we diagnose ITP?
• What are the treatment options for ITP?
Back ground questions
• When you need to know more information
about the disease
To fill your knowledge gap
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Types of questions raised
• In child suffering from ITP does treatment
with steroids, compared to IVIG results in
rapid cure
• In children suffering from ITP is complete
blood picture as accurate as bone marrow
aspirate in diagnosis.
Foreground questions
• When you need to know information that you
will:
– Tell your patient about
– Usually related to
–Diagnosis
–Therapy
–Prognosis
–harm
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Patient/
PopulationOutcome
Intervention/
ExposureComparison
IVIG SteroidsRapid cure
Child withacute ITP
Your Therapy Question
The PICO
Patient/Population
OutcomeIntervention/
ExposureComparison
Blood
pictureBone
marrow
Accurate
diagnosisChild withAcute ITP
Your Diagnosis PICO Question
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Patient/
PopulationOutcome
Intervention/
ExposureComparison
Risk ofbeing chronic
ITP
Child withAcute ITP
Your Prognosis PICO Question
Patient/
PopulationOutcome
Intervention/
ExposureComparison
IVIGHypersensitivity
reactions
Child with
Acute ITP
Your Harm PICO Question
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Clinical Question
Background Q Foreground Q
Types of clinical questions
Experience with condition
ForegroundBackground
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How could we move from clinical
question to search for the answer ?
• Extract the search terms
• Choose the sites that you will visit
searching for the answer
Basic Search Terms
• Pick up important elements in your question
– ITP
– IVIG
– Steroids
– child
Start your search
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Group Exercise on question
formulation from clinical scenarios
Scenario 1 (harm, therapy)
• 8 weeks old boy is brought for his first set
immunization - DPT+ oral Polio - His
mother is concerned that her baby may be at
greater risk of convulsion after his
immunization. She also asked is the
acellular pertussis vaccine better for her
son?
BackgroundQ Foreground Q
Searching key words
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Online Resources
• Cochrane abstracts
• Best practice
• Guidelines websites
• Trip database
• Pub Med
www.cochrane.orgwww.cochrane.org
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www.cochrane.org
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Ask PICO therapy• In 6 month child with bronchiolitis does
addition of antibiotic therapy compared to regular care alone result in rapid cure