CASE 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.
P: 72 year old woman
with osteoarthritis of the knee and moderate hypertension
I: COX-2 Inhibitor
C: Other
NSAIDS
O: Less GI Bleeding, Pain
Control
PICO 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?
|
CASE 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?
P: 54 year old woman
with exacerbation of periodontal disease
I: doxycyline
C: no
treatment
O: Less gum bleeding, stop
recession
PICO Question
For a 54 year old woman with
periodontal disease, how effective is the therapeutic use of doxcyline
decrease gum bleeding and recession compared to no treatment?
|
CASE 3.
A 28-year-old male presents with
recurrent furunculosis (skin boils) for past 8 months; these episodes have
been treated with drainage and several courses of antibiotics but keep
recurring. He asks if recurrences can be prevented.
P: patients with recurrent furunculosis
I: prophylactic
antibiotics
C: no
treatment
O: reduction in
recurrence rate of furunculosis
PICO Question
In patients with recurrent
furunculosis, do prophylactic antibiotics, compared to no treatment, reduce
the recurrence rate?
|
CASE 4.
George wants to discuss the
possibility of a vasectomy. He says he has heard something about vasectomy
causing an increase in testicular cancer later in life. You know that the
risk of this is low but want to give him a more precise answer.
P: adult males
I: vasectomy
C: no
vasectomy
O: testicular cancer
PICO Question
In men, does having a vasectomy
(compared to not having one) increase the risk of getting testicular cancer
in the future?
|
CASE 5.
Mabel is a 6-week-old baby at her
routine follow-up. She was born prematurely at 35 weeks. You want to tell the
parents about her chances of developing hearing problems.
P: infants
I: premature
C: full-term
O: sensorial deafness
PICO Question
In infants born prematurely,
compared to those born at full term, what is the subsequent lifetime
prevalence of sensory deafness?
|
| CASE 6. Julie is pregnant for the second time. She had her first baby when she was 33 and had amniocentesis to find out if the baby had Down's Syndrome. The test was negative but it was not a good experience as she did not get the result until she was 18 weeks pregnant. She is now 35, one month pregnant and asks if she can have a test that would give her an earlier result. The local hospital offers serum biochemistry plus nuchal translucency ultrasound as a first trimester test for Down's Syndrome. You wonder if this is as reliable as conventional amniocentesis. P: pregnant women I: nuchal translucency ultrasound plus serum biochemistry (first trimester) C: conventional amniocentesis O: accurate diagnosis (measured by sensitivity and specificity) of Down's Syndrome (trisomy21) PICO Question For pregnant women, is nuchal translucency ultrasound plus serum biochemistry testing in the first trimester as accurate (ie with equal or better sensitivity and specificity) as conventional amniocentesis for diagnosing Down's Syndrome? |
| CASE 7. A 64-year-old man with gastric ulcer with bleeding Past medical history: DM, hypertension, hypercholesterolemia Medications:
I: aspirin + proton pump inhibitor C: clopidogrel O: Re-bleeding, Cardiovascular events (MI and stroke) PICO Question After gastric ulcer bleeding stops, how to prevent cardiovascular events? |
| CASE 8. A 17 year old male with drug overdose it brought into the ER. He's taken paracetamol, tylenol, & sleeping pills. Do recommend using activated charcoal or not? P: patient with drug overdose I: Activated charcoal C: Nothing or Placebo O: Therapeutic effectiveness PICO Question In patients with drug overdose, is activated charcoal an effective therapy? |
| CASE 9. A 46 year old male had been moving rocks for his rock garden when he felt a twinge and his low back became excruciatingly painful. He's come into the Emerg and is extremely unhappy and demanding an MRI. You thought CT was the standard for diagnosis. P: patient with acute low back pain I: MRI C: CT Scan O: Diagnostic effectiveness PICO Question In patients with low back pain, is MRI more effective than CT scanning for diagnostic purposes? |
| CASE 10. The Health and Wellness Clinic sees many first-year students who suffer badly from the after-effects of excessive alcohol consumption. The clinic staff want to warn students and parents about the long-term effects of binge drinking. P: [adolescent] binge drinking I: no drinking/abstinence C: [drinking] O: long term mortality PICO Question Does adolescent binge drinking affect long term mortality? |
| CASE 11. Ms. Crosbie 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 needle 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 PICO Question In 18 month old children, does receiving the MMR vaccine increase the risk of developing autism? |
| CASE 12. Hogarth, a 26 year old botanist, has been diagnosed with depression. Reluctant to take prescribed medication he prefers to try alternative medicines which he feels are better for the body and work just as well. You feel that his disorder would improve more effectively with an SSRI, but he feels strongly that St. John's Wort will be equally as effective. P: adult male with depression I: SSRI C: St. John's Wort O: reduce depressive symptoms PICO Question In adult males with depression, are SSRI's more effective than St John's Wort in reducing depressive symptoms? |
| CASE 13. A 2 year old female with burns on 10% of body is rushed into the ER. You've read recently that honey had been used in such cases, but the more common treatment is Silvadene dressing. Is there any literature supporting one over the other? P: Child with burns I: Honey C: Silvadene dressing O: Therapeutic effectiveness; Harm/causation/etiology PICO Question In children with burns, is honey more effective than silvadene dressing? In children with burns, is honey more likely to cause harm (scaring, complications) than Silvadene dressing? |
| CASE 14. A 22 year-old male presents with a corneal abrasion that he received while hiking. In the past you would not have hesitated to put a patch on the damaged eye, but you recall seeing an article recently suggesting that patches are unnecessary for corneal abrasions. P: adult with corneal abrasion I: patch C: no patch O: Relief of symptoms; healing of abrasion PICO Question In adults with corneal abrasions, is patching the damaged eye preferable to not patching to relieve symptoms and encourage healing? |
| CASE 15. Maude is 68 years of age and has recently been diagnosed with high blood pressure. She is otherwise healthy and active. You need to decide whether to prescribe her a beta-blocker or an ace-inhibiter. P: adult hypertensive female I: beta-blocker C: ace inhibitor O: relief of symptoms; controlled blood pressure PICO Question In middle aged adult females with hypertension, are beta blockers more effective than ace inhibiters in controlling blood pressure? |
| CASE 16. Your patient is a 50 year old male with non-variceal upper GI bleed and you need to lower his stomach acidity. Should you use PPIs or antacids? P: non-variceal upper GI bleed I: Proton Pump Inhibitors (omeprazole, esomeprazole, pantoloc) C: Antacids O: Therapeutic effectiveness PICO Question In patients with non-variceal upper GI bleeds, are proton pump inhibitors more effective than antacids in the reduction of stomach acid? |
