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Evidence-Based Practice

Example questions

Example 1

Your next patient is a 72-year-old woman with osteoarthritis of the knees and moderate hypertension, accompanied by her daughter, a lab tech from the hospital. The daughter wants you to give her mother a prescription for one of the new COX-2 inhibitors. She has heard that they cause less GI bleeding. Her mother is concerned that the new drugs will mean more out-of-pocket costs each month.

 
Patient/Problem Intervention Comparison Intervention Outcome
72-year-old woman with osteoarthritis of the knee and moderate hypertension COX-2 Inhibitor other NSAIDS
  • less GI bleeding
  • pain control

 

Specific Question:

In a 72-year-old woman with osteoarthritis of the knee, can COX-2 Inhibitor use decrease the risk of GI Bleeding compared with other NSAIDs?


Example 2

You have been treating a 54-year-old woman for many years and despite the excellence of your fixed partial denture restorations, the intense routine maintenance by her periodontist, and good homecare, she has been experiencing a continued deterioration of her periodontal tissues. Her attempts to quit smoking have been unsuccessful; otherwise she is in good health and taking no medications. Because you are her primary care dentist, she has questioned you about her current dilemma. The periodontist has suggested a 3-week course of doxycycline therapy to control her latest exacerbation of periodontal disease, but she is concerned about Food and Drug Administration (FDA) reports asking for prudent use of antibiotics. How do you advise this patient?

 
Patient/Problem Intervention Comparison Intervention Outcome
54-year-old woman with exacerbation of periodontal disease doxycyline no treatment
  • less gum bleeding
  • stop recession

 

Specific Question:

For a 54-year-old woman with periodontal disease, how effective is the therapeutic use of doxcyline in decreasing gum bleeding and recession compared with no treatment?

Case study: complementary & alternative medicine

Case Study Scenario: Diabetes and Fenugreek

 Mrs. Hernandez, a 45-year-old Spanish-speaking woman, has been recently diagnosed with Diabetes Type 2.

  • She is admitted to UWMC with uncontrolled hypertension.
  • She takes fenugreek.
  • Prescribed medications include Lisinopril, Clonidine, and Metformin.

Search the databases below for evidence-based information on fenugreek used for diabetes.

For more information on each database, see Find Articles/Databases.

Databases to search

PubMed    

Filter to Article Type

Case Study example:

  • In the PubMed Search box, type: (fenugreek OR trigonella) AND diabetes
  • Then filter from left sidebar to: English, Human
  • For evidence-based articles, filter by Article Type to: Randomized controlled trial, meta-analysis, clinical trial

Filter to Subject

Case Study example:

  • In the PubMed Search box, type:  Diabetes Mellitus, Type 2/th
  • Then filter to: Complementary Medicine and/or Dietary Supplements under Subjects.
  • This strategy will produce results about alternative treatments for diabetes.
  • For evidence-based articles, filter under Article Type to: Randomized controlled trial, meta-analysis, clinical trial

Search PubMed Clinical Queries

Search By Clinical Study Category

Case Study example:

  • Type: (fenugreek OR trigonella) AND diabetes
  • Select Therapy and Narrow (specific) search.

Find Systematic Reviews

Case Study example:

  • Type: (fenugreek OR trigonella) AND diabetes

 

CINAHL Complete: Nursing and Allied Health      

Limit to Research Article

Case Study example:

  • Type in the Search box: (fenugreek OR trigonella) and diabetes
  • Click on Research Article under Limit your Results.

Limit by Publication Type

Case Study example:

  • Type in Search box: (fenugreek OR trigonella) and diabetes
  • In Limit your Results, select Clinical Trial or Systematic Review or Research under Publication Type.

Limit by Clinical Query

Case Study example:

  • Type in Search box: (fenugreek OR trigonella) and diabetes
  • Select any of the choices under Clinical Queries limits.

Limit by Journal Subset

Case Study example:

  • Type in Search box: (fenugreek OR trigonella) and diabetes
  • In Limit your Results, select Alternative/Complementary Therapies under Journal Subset.

Limit by Evidence-Based Practice

Case Study example:

  • Type in Search box: (fenugreek OR trigonella) and diabetes
  • Click on Evidence-Based Practice under Limit your Results.

 

Cochrane Database of Systematic Reviews (CDSR)   

Case Study example:

  • In the Search box, type: fenugreek AND diabetes
  • In this case, there are no systematic reviews on this topic. You do retrieve, however, some citations to clinical trials.

 

Natural Medicines    

Case Study example:

  • Type fenugreek in Search box and then click on Professional Monograph: Fenugreek.
  • Note the diabetes evidence grade under Clinical Bottom Line/Effectiveness.

 

DynaMed     

Case Study example:

  • Go to Diabetes mellitus type 2 and
    • look under Treatment>Diet for use of fenugreek
    • OR, click on Search Within Text link and follow directions to find fenugreek

 

EMBASE     

Case Study example:

  • Type in Search box: fenugreek and diabetes and ('clinical trial'/exp or 'controlled study'/exp or 'controlled clinical trial' or 'randomized controlled trial')