Practice Corner: Setting EBM in motion

Rao, Mark; Genova, Noel J.
November 2003
ACP Journal Club;Nov/Dec2003, Vol. 139 Issue 3, pA-13
Academic Journal
In addition to time pressures that is encountered when searching for evidence to support care decisions for individual patients, it may be difficult to apply the evidence that is found. The rate-limiting step may not be doing the search, but the steps needed in setting evidence-based medicine (EBM) in motion. This article presents an example of a search for evidence by a physician assistant (PA) student that highlights this challenge. During an internal medicine rotation, a PA student encountered a common clinical practice un-supported by current evidence — administration of nebulized albuterol in patients with community-acquired pneumonia (CAP). While this practice may be justified in patients with underlying chronic obstructive pulmonary disease (COPD) who also present with CAP, this student questioned the grounds for its use in patients with CAP who do not have COPD. Recognizing that searching and appraising the literature are not the only important aspects of practicing EBM, an experienced pulmonologist who practices and teaches using the EBM model was consulted.


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