A mother brings her 18-month-old daughter into your office for evaluation. Her daughter has been waking through the night, crying, and guarding her right ear. The mother thinks it is an ear infection, since her child was seen 3-4 times already the past year for the same problem. Each time, the child was given antibiotics, with successful resolution of her pain. The mother is concerned about the constant use of antibiotics and seeks your thoughts.
You are practicing as an evidence-based practitioner. What do you do?
With your knowledge of evidence-based practice, you recognize the need for finding current literature about a patient's condition and incorporating that information into your approach to management (and education) of your patient. The familiar Venn diagram (right) is a reminder that evidence-based care involves an intersection of patient preferences, clinical experience, and research evidence.
You conduct a quick search on Google Scholar for "chiropractic" and "otitis media." The top finding is a 1999 feasibility study (published in JMPT) comparing chiropractic adjusting to sham manipulation for otitis media with effusion (OME). The study, conducted by Sawyer et al., has no results but also reports no side effects. (1) When you narrow your search to the most recent year and "sort by date," you locate a literature review by Pohlman and Brown in the Journal of Chiropractic Medicine, published in 2012. (2) This review appears thorough, searching 6 separate databases for relevant articles, and giving inclusion criteria for the articles reviewed. The authors assess the articles for quality (rated poor, fair, good, or excellent) according to percent adherence to research quality checklists (Canadian Medical Association Journal checklist for case reports, Yang et al. for case series, CONSORT for dinical trials, and QUORUM for review articles). (34-6) Of 1489 papers, 49 were ultimately reviewed, including 15 case reports, 5 case series, 4 clinical trials, 8 reviews, and various commentaries, letters to editors, crosssectional surveys, and protocols. The authors find limited quality of evidence and a broad variety of interpretations, ranging from "promising" or "inconclusive" to "no credible solid evidence" and "insufficient evidence."
In an evidence-based approach to care, we place significant emphasis on "best research evidence." We must consider...