Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Submit Manuscript
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Topic/Program Collections
    • Blog
  • Multimedia
    • Teaching Slides
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Submit Manuscript
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Topic/Program Collections
    • Blog
  • Multimedia
    • Teaching Slides
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
American Academy of Pediatrics
Article

Evidence-based Medicine

Applying Valid Evidence

Gary M. Onady
Pediatrics in Review August 2009, 30 (8) 317-322; DOI: https://doi.org/10.1542/pir.30-8-317
Gary M. Onady
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Comments
Loading

This article has a correction. Please see:

  • Clarification - December 01, 2009

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF
  1. Gary M. Onady, MD, PhD*
  1. *Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
  • ADP: adenosine diphosphate
  • EBM: evidence-based medicine
  • EBP: evidence-based practice
  • Epi: epinephrine
  • FD: factor deficiency
  • LR: likelihood ratio
  • PFA: platelet factor analyzer
  • PT: prothrombin time
  • PTT: partial thromboplastin time
  • vWb: von Willebrand disease

Introduction

This fifth article in the evidence-based medicine (EBM) series integrates the first three steps of EBM introduced previously (asking an answerable question, searching the literature, critical evaluation of the literature) into a fourth step that applies valid evidence discerned in those steps to medical decision-making. Integration of EBM with medical decision-making constitutes the foundation of what has been termed evidence-based practice (EBP). By definition, EBP is the integration of best research evidence with patient values and clinical circumstances to make clinical decisions. (1) Developing an EBP involves conscientious decision-making based on evidence combined with knowledge of patient characteristics, situations, and preferences, and requires three additional tasks:

  • Define the problem

  • Identify a rational differential diagnosis

  • Develop an action plan

This contribution to the EBM series applies previously introduced components from the EBM tool box to convert a problem presented by a patient into a set of rational diagnoses. Additional tools are used for judicious selection of diagnostic testing that prioritizes the diagnoses effectively. Finally, methodology that allows the choice of a definitive action plan is described so a clear decision point can be reached confidently, once a single working diagnosis is given priority. A case referred by an otolaryngologist for preoperative clearance illustrates these points.

A 4-year-old girl scheduled for tonsilloadenoidectomy has a history of chronic rhinitis, pharyngitis, and recurrent epistaxis. Family history reveals a grandfather who has type I von Willebrand disease (vWb). Physical examination of the girl reveals multiple bruises in various stages of resolution.

Step 1: Define the Problem

The question posed by the surgeon is, “Can you clear this patient for surgery?” The process of defining a problem begins by rephrasing the surgeon's question into a question whose answer facilitates achievement of the real goal, which is to minimize surgical risk. The best initial problem-defining EBM question becomes, “What is the likelihood …

Individual Login

Log in
You will be redirected to aap.org to login or to create your account.

Institutional Login

via Institution

You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.

Log in through your institution

If your organization uses OpenAthens, you can log in using your OpenAthens username and password. To check if your institution is supported, please see this list. Contact your library for more details.

Pay Per Article - You may access this article (from the computer you are currently using) for 2 days for US$25.00

Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.

Offer Reprints

PreviousNext
Back to top

Advertising Disclaimer »

In this issue

Pediatrics in Review: 30 (8)
Pediatrics in Review
Vol. 30, Issue 8
August 2009
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Evidence-based Medicine
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Evidence-based Medicine
Gary M. Onady
Pediatrics in Review Aug 2009, 30 (8) 317-322; DOI: 10.1542/pir.30-8-317

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Evidence-based Medicine
Gary M. Onady
Pediatrics in Review Aug 2009, 30 (8) 317-322; DOI: 10.1542/pir.30-8-317
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents

Jump to section

  • Article
    • Introduction
    • Step 1: Define the Problem
    • Step 2: Identify a Rational Differential Diagnosis
    • Step 3: Develop an Action Plan
    • Applying Evidence-based Medicine Tools
    • A Generalized Evidence-based Practice Plan for Pediatric Patients Who Have Recurrent Epistaxis
    • Conclusions
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • Comments

Related Articles

  • Clarification
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Review of Scabies Infestation and Selected Common Cutaneous Infections
  • Pediatric Ingestions: New High-Risk Household Hazards
  • Iron Deficiency: Implications Before Anemia
Show more Articles

Similar Articles

Subjects

  • Medical Education
    • Research Methods & Statistics
    • Medical Education
  • Evidence-Based Medicine
    • Evidence-Based Medicine
  • Journal Info
  • Editorial Board
  • ABP Content Specifications Map
  • Overview
  • Licensing Information
  • Authors
  • Author Guidelines
  • Submit My Manuscript
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Contact Us
  • Subscribe
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • AAP.org
  • shopAAP
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
American Academy of Pediatrics

© 2021 American Academy of Pediatrics