![]() In the Weber test, the tuning fork is placed in the middle of the skull, and the patient determines on which side the sounds can be heard most clearly. In conductive hearing loss, bone conduction is better than air conduction, and the sound is therefore heard better with the tuning fork on the mastoid process this is known as a negative Rinne test. In a normal ear, air conduction is better than bone conduction, and the patient can therefore hear the sound again when the tuning fork is moved from the mastoid process (bone) to outside the ear (air) this is known as a positive Rinne test. The fork is then immediately placed just outside the ear. The Rinne test is performed by placing a vibrating tuning fork on the mastoid process until sound is no longer heard. The most likely cause of conductive hearing loss in a nursing-home resident with debris in the ear is cerumen impaction. Key Learning Point View Case Presentation Learning Resources and Clinical Tools for Pain Management and Opioids.State Requirements for Pain Management CME.Pain Management and Opioids CME & Disclosures.Physician Remediation and Continuing Professional Development. ![]() Pediatrics – CME Disclosures & Objectives.NCCPA Certification Maintenance Requirements.AAPA CME – Earn Self-Assessment Credits.ABFM Family Medicine Board Review Resources.ABFM Continuous Certification Requirements.ABIM Internal Medicine Review Resources.Taking the Internal Medicine Board Exam.How NEJM Knowledge+ Improves Exam Scores.We now have search terms we might use continue on to Step 2: Accessing/acquiring information. Utilization of the PICO framework to improve searching PubMed for clinical questions. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P.Evaluation of PICO as a knowledge representation for clinical questions. Read more about PICO in these journal articles: The terms we might use to look up information based on the PICO model: fever, acetaminophen, ibuprofen. Use PICO to create a searchable question. Did the mother give the right dose of acetaminophen for the child's weight? Could there be something other than otitis media causing the child's symptoms? One question is whether ibuprofen might be better for fever control than acetaminophen? ![]() You have many questions in mind as you talk with the mother. The mother is concerned, her child seems miserable and she wants to know what to do. The child received acetaminophen one hour ago for a fever of 102 degrees F orally the fever has not changed. ![]() Amoxicillin was prescribed and the parents gave a first dose this afternoon. The child was seen and diagnosed by another physician today with a middle ear infection. The mother of a 23 month old female with a history of prematurity and recurrent ear infections calls in to ask about fever control. In practice, well-built clinical questions usually contain four elements, summarised below. The questions must be refined to make them searchable in information resources. The healthcare provider must identify questions from amid the complexity of clinical care. In patient care often the first inkling of trouble is a vague uneasines about some issue of diagnosis, treatment, or prognosis. The first challenge faced by an EBP clinician is to identify an information gap. The PICO model is used in Evidence-Based Practice to assist in formulation of searchable clinical questions. ![]() PICO is a mnemonic used to describe the four elements of a good clinical foreground question. ![]()
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