by Carmen Howard
Last Updated Aug 24, 2017
164455 views this year
Steps of EBM
Assess the Patient
Ask a Clinical Question
Appraise of Evidence
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.
Evidence-based medicine (EBM) integrates the best available evidence with clinical experience that allows clinicians to recommend, and their patients to make, informed choices consistent with their values. JAMAevidence helps decision makers identify the best available evidence by providing guides to the systematic consideration of the validity, importance, and applicability of claims about the assessment of health problems and the outcomes of health care.
The following pyramid represents a hierarchy of evidence based on research methodology.This hierarchy represents the content you will find in PubMed/MEDLINE.
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?