Evidence Based Practice Guidelines for Otitis Media
Evidence Based Practice Guidelines for Otitis Media
Assignment: Analysis of Current Evidence Based Practice Guidelines for the Treatment of OM
First, carefully review the case. Then, using the Internet, find a current (no older than 4 years old) relevant evidence based practice guideline for the treatment of otitis media for this particular pediatric patient.
Make sure to address the following in your paper:
- Briefly explain your search strategy. For example, how did you find the correct guideline?
- Who developed the guideline?
- Is this a revision of a previous guideline or an original? What is the date of publication?
- Explain the concept of “systematic review of current best evidence.”
- How was conflict of interest managed in the development of these guidelines?
- How is quality of evidence defined?
- Explain differences among strong recommendation, recommendation, and option
- What are “key Action statements?”
- For this particular child, what are the specific treatment recommendations including any diagnostics, medications (include exact dosage, frequency, length of treatment), follow-up, referral, prevention, and pain control.
Case:
A 5-year-old male is brought to the primary care clinic by his mother with a chief complaint of bilateral ear pain for the last three days. The mother states that the child has been crying frequently due to the pain. Ibuprofen has provided minimal relief. This morning, the child refused breakfast and appeared to be “getting worse.”
Vital signs at the clinic reveal HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. The mother reports no known allergies. The child has not been on antibiotics for the last year. The child does not have history of OM. The child is otherwise healthy without any other known health problems.
After your questioning and examination, you diagnose this child with bilateral Acute Otitis Media.
SAMPLE ANSWER
Evidence Based Practice Guidelines for Otitis Media
The research strategy involved searching for content relevant to the subject in the various online journal databases. In the research, I used key words related to the condition, which yielded some results. Furthermore, I also added various filters when conducting the research to ensure that the guideline met a certain criterion. These filters included year of publication and needed to be peer reviewed.
Evidence Based Practice Guidelines for Otitis Media
The guideline is developed by the American Academy of Otolaryngology, The American Foundation of Pediatrics, Head, and Neck Surgery Foundation, and the American Academy of Family Physicians. Various researchers and medical practitioners are involved in the development of the guide. This involved include medical practitioners who may be involved in the treatment of Otitis media. Furthermore, the guideline is a revision of a guideline that was developed by the same organizations in 2004. The article was published on February 1, 2016, and it provides evidence-based recommendations for the management and treatment of otitis media (Rosenfeld et al., 2016).
The concept of systematic review of the current best practice applies in the context of the guideline. A systematic review includes a summarization of the results of carefully designed controlled trials or healthcare studies. Furthermore, they provide a high level of evidence regarding the effectiveness of the healthcare interventions that are used (Harmes et al., 2013). The researchers make judgments regarding the interventions and the outcomes, thus informing their recommendations. The changes that the researchers incorporated in the guideline included 20 new systematic reviews, evidence clinical practice guidelines, and 49 randomized control trials (Rosenfeld et al., 2016). Therefore, one can see the applicability of the concept of systematic review of current best practice, whereby the researchers combined the findings of various evidence based studies to recommend updated practices for addressing the problem.
Evidence Based Practice Guidelines for Otitis Media
To manage conflicts of interest, various strategies were employed. One of these was ensuring that the AAO-HNSF fully funded the entire research project. This ensured that no individual company or organization that may benefit from the research influenced it (Rosenfeld et al., 2016). Furthermore, the potential conflicts of interest for the various members who were involved in the research were compiled. After a review of the potential conflicts of interest, the panel set some conditions for the individuals who had conflicts of interest to remain in team. These included recusing themselves from discussions related to the areas that have conflict of interest, agreeing not discuss aspects related to the guideline to industry players before its publication, and ensuring that personal experiences of the panelists does not cause conflict of interest (Rosenfeld et al., 2016).
Quality of evidence may be described as the confidence that the estimates that are reported are sufficient to support specific recommendations. The quality of evidence can be described as high, moderate, low, or very low based on grading quality of evidence and strength of recommendations (GRADE) (Chonmaitree et al., 2016). High tends to have the best quality, while very low tends to have the least quality. Some of the key considerations when determining the quality of evidence include publication bias, imprecision, indirectness of evidence, risk of bias, inconsistency of results between different studies. In the guideline, these elements were considered to ensure that the quality of evidence was high.
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A strong recommendation implies that a review panel or committee believes that the benefits associated with the recommended approach exceed the harms of the same approach. Recommendation, on the other hand, means that the magnitude of the benefits is relatively small, or when benefits are there, by offset by other adverse consequences. Moreover, an option means that the evidence quality is suspicious, or the properly conducted studies have shown that there is little advantage of one approach over the other (Schilder et al., 2016).
For the particular child, one of the elements in the diagnosis is the symptoms. The child has been experiencing bilateral year pain during the last three days, which tends to be one of the symptoms for the condition. However, additional tests would be required to ascertain whether the child in indeed having the condition. One of these tests is otoscope, which involves looking into the child’s year and checking elements such as pus, redness, and swelling. A tympanometry test may also be conducted to determine the air pressure in the child’s eardrum. Furthermore, reflectometry may also be conducted to determine if the child has fluid in his years (Harmes et al., 2013). Treating the condition may include observation or antibiotic therapy. Studies have shown that two in every three children may heal without using antibiotics. Furthermore, the American Academy of Physicians suggests not prescribing antibiotics for treating the condition for children aged between 2 and 12 years particularly if their symptoms are not severe (Rosenfeld et al., 2016).
If observation does not work within 48 to 72 hours, it is imperative for the patient to take antibiotics. The first antibiotic that needs to be used is Amoxicillin, but if it does not work, Cefdinir can be used as an alternative. Furthermore, analgesics are also recommended for addressing symptoms such as irritability, fever, and year pain. The analgesics are particularly important for addressing the symptoms that can make parents alarmed. The recommended analgesics include acetaminophen and ibuprofen. Benzocaine can also be used. However, ibuprofen needs to be the fast option considering it is less toxic in the event of overdose and it has a longer duration (Rosenfeld et al., 2016).
Therefore, the selected article is an update of a 2004 guideline related to the diagnosis, management, and treatment of otitis media. The guideline is developed by the American Academy of Otolaryngology, The American Foundation of Pediatrics, Head, and Neck Surgery Foundation, and the American Academy of Family Physicians. It was published in 2016. To find the guideline, I searched online journal databases using the appropriate keywords and using filters to ensure that the article is timely and relevant. In the development of the guideline, the issue of conflicts of interest is thoroughly addressed. Furthermore, the researchers ensure that the quality of evidence is high. For the 5-year-old male, the first in his treatment is analyzing his symptoms. Thereafter, various tests need to be conducted to ascertain whether he is suffering from acute otitis media. These tests may include otoscope, tympanometry, and reflectometry. If the results are positive, the observation may be one of the interventions. However, if there are no improvements, antibiotics therapy can be used. Some of the antibiotics that can be used include amoxicillin and Cefdinir. Furthermore, analgesics also need to be used to alleviate some of the symptoms associated with acute otitis media such as fever and pain.
References
Chonmaitree, T., Trujillo, R., Jennings, K., Alvarez-Fernandez, P., Patel, J. A., Loeffelholz, M. J., … & McCormick, D. P. (2016). Acute otitis media and other complications of viral respiratory infection. Pediatrics, 137(4), e20153555.
Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Van Harrison, R., & Passamani, P. P. (2013). Otitis media: diagnosis and treatment. Children, 100(8), 10.
Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., Coggins, R., Gagnon, L., Hackell, J. M., … Corrigan, M. D. (2016). Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology–Head and Neck Surgery, 154(1_suppl), S1–S41. https://doi.org/10.1177/0194599815623467
Schilder, A. G., Chonmaitree, T., Cripps, A. W., Rosenfeld, R. M., Casselbrant, M. L., Haggard, M. P., & Venekamp, R. P. (2016). Otitis media. Nature Reviews Disease Primers, 2, 16063.
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