8 y/o female, accompanied by father
Presented to the pediatrics ED with c/o red itchy eyes with discharge x2 days. Pt's father reports that daughter's eyes were crusting every morning and needed to be cleaned out. This is their second time in the pediatric ED within the last two days.
Question: In pediatric patients with viral conjunctivitis, are ophthalmic antibiotics more effective than symptomatic treatment in reducing the duration of illness and clinical course?
Now let's practice parsing the question into terms of PICO(T)
The Scenario:
A 13-year-old male who is otherwise healthy presents to the emergency department after an impressive bout of epistaxis precipitated by a sneezing spell while at home. Mom took the the child to the ED without hesitation, but because it was 10 am in the morning, the physician, after packing the nose with a ‘Rhinorocket’, pleaded that the patient be seen by an ENT specialist for definitive care.
On arrival, the ENT doctor noticed Mom was anxious and asked if her son would be alright. She volunteered that prior to the visit the child had been having sensation of a stuffy with occasional sentinel bleeds. This occurred over the past several weeks, before what she called, “a gusher” came from both nostrils after her son sneezed. There were no preceding traumatic events other than the sneeze, and he denied placing any objects up his nostrils. His past medical history is essentially unremarkable except for mild Iron deficiency anemia for which he takes iron supplements sporadically. He sees his PCP/Peds for well-checks, on schedule and has no blood dyscrasias, or bleeding disorders.
The ENT doctor had a lucky break with cessation of bleeding, allowing for a focused examination. After slowly removing the Rhinorocket packing, and spraying Afrin inside the nose, she quickly reached for a nasal endoscope. On passage of the endoscope beyond the nasal vestibule, there was a “beefy red mass” centered high in the nasal vault on the right. She carefully removed the scope and ordered a CT scan of the maxillofacial complex and paranasal sinuses, with and without contrast. The CT scan showed a ‘high signal intensity blush’ consistent with a vascular mass. The mass appeared to be pushing the septum and the medial wall of the maxillary sinus on one side and extending to nasopharynx. The doctor diagnosed a Juvenile Nasopharyngeal Angiofibroma.
Mom was flabbergasted and asked if her other 2 daughters could have the same tumor, and should be worried about this?
Given this scenario, what would be your question? How would you go about searching for the answer?
1. Parse the question into concepts
2. List terms for each concept, including both textwords/keywords and MeSH subject headings
3. Use terms to create search strategies and run them in PubMed
4. Look at the results:
a. How many abstracts did you get?
b. How can you increase the yield?
c. How can you decrease the yield?
d. How relevant are your results
|
