Evidence-Based Otitis Media offers one-stop shopping for the best current evidence to guide management decisions at the individual, organizational, and societal levels. This text details the importance of evidence-based data in interpreting the ever-enlarging body of literature on otitis media. The editors have assembled an impressive group of experts on all aspects of otitis media and addressed comprehensively many issues related to methodology, clinical management, and consequences of this disease. The eight chapters comprising the methodology section provide the necessary background and detail to allow physicians and other health professionals to understand and appreciate the value of evidence-based medicine. Updates include: the incorporation of new original research, systemic reviews, and evidence reports to existing chapters. New chapter topics include: evidence-based medicine, professional evidence reports, molecular and translational research, complementary and alternative medicine, bacteriologic efficacy of antimicrobials, vaccine prevention, international management perspectives, meta-analysis of speech and language sequelae, suppurative complications, host susceptibility to sequelae, and judicious use of systemic and topical antimicrobials. FEATURES: *Maturation of evidence-based medicine as a foundation for clinical care is reflected throughout the text. *Extensive evidence tables summarize study characteristics and quantitative outcomes for clinically relevant endpoints *Internationally distinguished contributors selected based on both their clinical expertise and their ability to write for an evidence-based text
The ultimate guide to the evidence-based clinical encounter "This book is an excellent source of supported evidence that provides useful and clinically relevant information for the busy practitioner, student, resident, or educator who wants to hone skills of physical diagnosis. It provides a tool to improve patient care by using the history and physical examination items that have the most reliability and efficiency."--Annals of Internal Medicine "The evidence-based examination techniques put forth by Rational Clinical Examination is the sort that can be brought to bear on a daily basis – to save time, increase confidence in medical decisions, and help decrease unnecessary testing for conditions that do not require absolute diagnostic certainty. In the end, the whole of this book is greater than its parts and can serve as a worthy companion to a traditional manual of physical examination."--Baylor University Medical Center (BUMC)Proceedings 5 STAR DOODY'S REVIEW! "Physical diagnosis has been taught to every medical student but this evidence-based approach now shows us why, presenting one of medicine's most basic tenets in a new and challenging light. The format is extraordinary, taking previously published material and updating the pertinent evidence since the initial publication, affirming or questioning or refining the conclusions drawn from the data. "This is a book for everyone who has studied medicine and found themselves doubting what they have been taught over the years, not that they have been deluded, but that medical traditions have been unquestionably believed because there was no evidence to believe otherwise. The authors have uncovered the truth. "This extraordinary, one-of-a-kind book is a valuable addition to every medical library."--Doody's Review Service Completely updated with new literature analyses, here is a uniquely practical, clinically relevant approach to the use of evidence in the content of physical examination. Going far beyond the scope of traditional physical examination texts, this invaluable resource compiles and presents the evidence-based meanings of signs, symptoms, and results from physical examination maneuvers and other diagnostic studies. Page after page, you'll find a focus on actual clinical questions and presentations, making it an incomparably practical resource that you'll turn to again and again. Importantly, the high-yield content of The Rational Clinical Examination is significantly expanded and updated from the original JAMA articles, much of it published here for the first time. It all adds up to a definitive, ready-to-use clinical exam sourcebook that no student or clinician should be without. FEATURES Packed with updated, new, and previously unpublished information from the original JAMA articles Standardized template for every issue covered, including: Case Presentation; Why the Issue Is Clinically Important; Research and Statistical Methods Used to Find the Evidence Presented; The Sensitivity and Specificity of Each Key Result; Resolution of the Case Presentation; and the Clinical Bottom Line Completely updated with all-new literature searches and appraisals supplementing each chapter Full-color format with dynamic clinical illustrations and images Real-world focus on a specific clinical question in each chapter, reflecting the way clinicians approach the practice of evidence-based medicine More than 50 complete chapters on common and challenging clinical questions and patient presentations Also available: JAMAevidence.com, a new interactive database for the best practice of evidence based medicine
Otitis media with effusion is one of the most common problems of infancy and early childhood. Because the prevalence, incidence, and management of this condition varies with age, this guideline focuses on the group at high risk for long-term effects: children ages 1-3 years. These recommendations are based on an extensive review of medical and health-related literature and expert opinion. They are given for diagnosis and hearing evaluation; control of environmental factors; and sequencing of interventions, including observation, use of antibiotics and other medications, and the appropriateness and timing of surgery.
About 40% of children experience one or more episodes of acute otitis media (AOM) by the age of one year and about 70% by the age of two years. It is normal that some middle ear effusion persists after AOM, even for several weeks. This must not be interpreted as a new episode of AOM.
Treatment is based on careful diagnosis . If acute otitis media (AOM) is only suspected antimicrobial drugs are not indicated.Treatment is always individual: antimicrobials will hasten recovery and relieve ear-related symptoms, but AOM can also resolve without antimicrobials .
"Acute otitis media (AOM) is the most common reason children are prescribed antibiotics in the US. While the evidence-based practice (EBP) guidelines from the American Academy of Pediatrics and American Academy of Family Physicians provide guidance on the diagnosis and management of AOM, adherence to the guidelines remains low and the overall use of antibiotics remains high. The overprescribing of antibiotics and the use of broad-spectrum antibiotics for AOM treatment contributes to the growing problem of antimicrobial resistance. A comprehensive literature review showed that educational interventions increased provider knowledge and adherence to guidelines and reduced antibiotic use for the management of AOM. This EBP project aimed to increase the knowledge levels of providers and improve provider intent to utilize the EBP guidelines for the diagnosis and management of AOM. The target population was nurse practitioners and physician assistants working in retail clinics of a large organization in South Texas. A total of eighteen providers participated in the project. A self-developed tool was used to measure the success of the educational intervention. Participants completed a pretest, education session, and a posttest. Additional education sessions were offered to the participants and a second posttest for retention of information was done after eight weeks. The results showed that the knowledge levels of the providers increased by 43% in the first posttest and 56% in the second posttest, while the benchmark was a 15% increase. Similarly, provider intent to utilize EBP guidelines increased by 33%, more than the benchmark of 15%. The success of this EBP change project makes it appropriate for practical use in nursing practice. Key words: acute otitis media, antibiotics, antimicrobial resistance, educational intervention, evidence-based practice " -- Abstract
Patients with suspected or diagnosed cholesteatoma or permanent perforation of the eardrum in a dry ear should be referred to an ENT specialist. Adequate local treatment should be provided while the patient is waiting for the appointment with an ENT specialist.
Diagnosis is based on ear-related signs and symptoms. The child should not unnecessarily be labelled as a ”chronic ear patient”. The criteria for acute otitis media (AOM) are middle ear effusion bulging, cloudy, yellowish tympanic membrane with distorted or absent light reflex (pictures ) signs and symptoms of an acute infection. Redness alone is not a diagnostic finding (picture ). Diagnostic accuracy is greatly improved with the use of pneumatic otoscopy and tympanometry . It is normal that some middle ear effusion persists after AOM, even for several weeks . This must not be interpreted as a new episode of AOM. Wrong and uncertain diagnoses result in unnecessary courses of antibiotics and tympanostomy tube insertions.
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