Clinical questions and evidence based medicine

[FBurnaby]

I'm an MS1 seeking ideas for a literature review and am hoping someone here has advice. Are there clinical questions that are perhaps well covered in adult medicine but poorly reviewed in pediatrics? Is there any practices that are common but poorly supported by literature?

I'm interested in a wide range of fields, general pediatrics, peds cardiology, neonatology, rural medicine, as well as topics of physiology, biochem, pharm, vaccines. Any help is appreciated!

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[BigRedBeta]

Sure there are all sorts of things that we as pediatricians try to adapt for our purposes but have not been fully studied in children.

In the PICU some things that don't have clear evidence:

Appropriate tidal volumes for ventilated pediatric patients - ARDSNet trial in adults used 6ml/kg, and so most PICU's use that, but no real clear data supporting it that I'm aware of,
HFOV in the PICU - recent study in adults said there was no benefit, but we continue to use it all the time in kids
Degree of glycemic control - the 2012 or 2013 guidelines released for critically ill patients were like over 100 pages long, and there were about 6 paragraphs dedicated to children


Now, not sure what you're really looking for, but in phrasing your question as "adults have evidence, peds doesn't", you have to remember that Peds cardiology is VERY DIFFERENT than adult cardiology, and Neonatology really has no correlate, as those former fetuses have their own set of problems.

 

[FBurnaby]

Thanks @BigRedBeta I haven't found any clinical research opportunities with mentors, so I'm considering finding something that needs summarizing and doing a literature review myself (obviously won't be published in Nature but hey worth trying out). I have broad peds interests but don't have a pulse on what narrow issues could be researched, exactly like the examples you mentioned. Perhaps @oldbearprofessor has some wisdom?

 

[oldbearprofessor]

Thanks @BigRedBeta I haven't found any clinical research opportunities with mentors, so I'm considering finding something that needs summarizing and doing a literature review myself (obviously won't be published in Nature but hey worth trying out). I have broad peds interests but don't have a pulse on what narrow issues could be researched, exactly like the examples you mentioned. Perhaps @oldbearprofessor has some wisdom?

You really need to narrow it down a bit. One way would be to peruse the abstracts of one or two leading pediatric journals from the last few months such as "Pediatrics" or "Journal of Pediatrics" and see what interests you. Also, you can scan through the recent Cochrane reviews to see what has been done recently. In general, clinical research in pediatrics involves fewer subjects than similar research in adults and is less commonly a double-blind controlled trial. I'm not sure that is the distinction you are looking for. Rather, I suggest you start by focusing on your interests based on a review of recent clinical research and then see what topics in those areas are worth your time to look into further.