Angkor Hospital for Children Faculty Development Course

Module Summary

Objectives: Explore electronic and online resources Discuss ways to incorporate the use of technology into teaching rounds Learn to model using EBM in clinical decision-making Lecture: Information Technology and Medicine (February 25th) Workshop: Online and Electronic Resources, Incorporating EBM into Teaching Rounds (March 4th) One-on-one: Review cases below Assignment: One participant will prepare a 3 minute clinical pearl See The Well-Built Clinical Question handout

Technology & Evidence-Based Medicine

EBM Cases (read the handout first) Review the case, develop a clinical question (PICO) and see what evidence you can find to support a decision. Complete Case #1 and choose one or two others to try.

Case #1: Ms. Tes has been asked to schedule an appointment for her baby's 18 month needle (MMR). She is very concerned about this as she has heard reports that the MMR immunization causes autism. She asks you whether or not there is a link between the MMR vaccine and an increased risk of autism in children? P: 18 month old child I: MMR vaccine C: no MMR vaccine O: autism / autistic spectrum disorder Answerable question: In 18 month old children, does receiving the MMR vaccine increase the risk of developing autism? MeSH: autistic disorder/etiology; Measles-Mumps-Rubella Vaccine/*adverse effects PubMed keyword: (mmr OR measles mumps rubella) AND autis* Case #2: You are seeing a beautiful 1 month old girl for a WCC. Her exam is notable for thrush. You are about to prescribe nystatin orally, your standard practice, when the mom comments that she could never do anything four times a day, and wonders whether she could use a once-daily medicine like fluconazole, which she had taken once for a yeast infection. Case #3: You are in Same Day Clinic, seeing a 5 yo boy with an asthma exacerbation. He has some impressive increased work of breathing, enough so that you think he may eventually need to be admitted. You order oral prednisolone and albuterol, and are wondering whether you should give ipratroprium (Atrovent) as well. Case #4: You are seeing a 2 month old baby girl for a well-baby exam. In your discussion about feedings, the parents report that their daughter spits up after every feeding. It is non-projectile, nonbilious, and non- bloody. They are breast- feeding, but this occurs after bottles also. The baby has otherwise been well and was born full-term. On exam, the babys weight is just below the 10th percentile, height at 50th and head circumference at the 50th. The baby generally looks nourished, but smallish. Well-hydrated. Lungs are clear. Abdominal exam is normal. You believe this infant's GE reflux may be interfering with her growth. You recall that many kids are being sent home from the NICU on cisapride and ranitidine and wonder how effective those measures are.