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Peoria Medical Students

Resources and curriculum support for UICOM Peoria medical students

Steps of EBM

  1. Assess the Patient

  2. Ask a Clinical Question

  3. Acquire Information

  4. Appraise of Evidence

  5. Apply to Patient


The book Users' Guides to the Medical Literature can guide you through the entire Evidence-based Medicine process.  For this activity within the Internal Medicine Clerkship, you will want to reference the "Therapy" section of the text.  You can access the book through the database JAMAEvidence using the link below.


The following pyramid represents a hierarchy of evidence based on research methodology.  This hierarchy represents the content you will find in PubMed/MEDLINE.

For more definitions for study types, visit the Glossary page on the Evidence-based Practice Guide from the Library of the Health Sciences.


 

Case Example:

A 55 year old woman, previously diagnosed with cirrhosis secondary to chronic hepatitis C infection, was admitted to our department with fever. She seemed well and had no focal symptoms or signs of infection. As ascites was present, she had paracentesis. This yielded a Gram negative clear fluid with a polymorphonuclear count of 700 cells/mm3. We thought that secondary peritonitis was unlikely and diagnosed spontaneous bacterial peritonitis. She had had no previous episodes or prophylactic antibiotic treatment. Empirical treatment with cefotaxime (2 g every 8 hours) was started.

On the morning after her admission, there was a lively discussion at the departmental meeting. The main question was whether the patient could have started taking oral ofloxacin, given her excellent clinical condition. Other questions were raised about the strength of the evidence supporting the standard treatment with cefotaxime and the ideal dose and duration of treatment.

For empiric antibiotic therapy for SBP, which is more effective?


Based on the following paper: Soares-Weiser K, Paul M, Brezis M, Leibovici L. Evidence based case report. Antibiotic treatment for spontaneous bacterial peritonitis. BMJ. 2002 Jan 12;324(7329):100-2. Review. PubMed PMID: 11786457; PubMed Central PMCID: PMC1121993.


Forming a Clinical Question

Framework

Element Represented

Example

 P

Patient, Population, or Problem

 Female diagnosed with Spontaneous Bacterial peritonitis

 I

Intervention, Prognostic Factor, or Exposure

Cefotaxime

 C

Comparison or Intervention (if appropriate)

Oral Ofloxacin

 O

Outcome (Is it measurable?)

Resolution of SBP; mortality

Question Type

Therapy, Diagnosis, Etiology/Harm, Prognosis, Prevention

Therapy

Study Type

Best research methodology/study design

SR > RCT > Cohort


Clinical Question:

In females diagnosed with SBP caused by complications from cirrhosis and ascites, which therapy, cefotaxime or ofloxacin, supports better outcomes of the resolution of the SBP and mortality rates?