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Problem-based Learning & Finding the Evidence: Case 2: Tiffany Smails -- One tough kid


The following are textbooks of possible interest and most are available online but a few are print only -- they are still helpful.  

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Week 2: Tiffany Smails -- One tough kid

Resources for this case include:


Textbook Suggestions (look left)

National Organizations - cancer organizations

Finding Pediatric Growth Charts

PubMed Search Tips -- Finding the Evidence on Prognosis

Lab Tests Info

Survivorship Resources

Favorite Resources

Access Medicine Medscape Up to Date

Introducing you to a new (and hopefully, favorite) resources, DynaMed.

National Organizations

Cancer Organizations

Knowing the national organizations that provide information on a particular disease can be a good way to quickly get to authoritative information that has a broad perspective.  

For the topic of cancer, the key government organization is the National Cancer Institute.  You may have looked at the PDQ (Physician's Data Query) information previously and they also have quick overview Fact Sheets.  Additionally, the key non-government organization is the American Cancer Society which is a little more patient-centric but does put out some great stats and research information for physicians.  They also have a Fact Sheet series of publications.

Finding Pediatric Growth Charts

Growth Charts

If you need a blank form to chart a child's growth patterns, where can you get a copy?  You may try to Google this and it will be hit & miss as to what you might find.  I've heard from previous searchers that some have been found but are not downloadable for individual use.  So, here are a few tips for finding them.

1)  Who would have an interest in making these freely available?  

Perhaps government organizations -- maybe even international health-oriented organizations.  So make Google help you more with a site:gov  search or include the organization's name in your search (e.g., world health organization).


2)  Find a textbook that has this in it.  

Because we catalog many of our textbooks with chapter headings, a search of Roger for growth chart or developmental milestones might give you some good leads.  Not all of the possible good sources will be electronic, so don't throw out the print ones.  (Oh look, there's the Roger search box below.)


3)  There's an app for that.

A tool that you might find helpful in your rotation years is  It will give you a chance to put in patient data and generate a chart based on the CDC charts.  The product will be an image that you can print out - perhaps in a Word document so you can plot out the patient's historical trend.

4)  A Relate Resource -- What to expect at different ages of a child

This website provides a quick view of what to expect with child development.  Designed for the general public, but has great information and is recommended by Dr. Goldberg.  You could pair this information with what you glean from the textbooks.

PubMed Search Tip: Finding the Evidence on Prognosis

Finding the Evidence on Prognosis

Last year's guide provided some information on parsing your question into a PICO format which is a first step in evidence-based medicine (EBM) searching - developing a good, answerable clinical question.  PICO questions cover diagnosis, therapy, etiology, and prognosis.  Most practioners of EBM, acknowledge that it takes practice to develop that well-formulated clinical question.  

This week's case has many good topics for a PubMed search, including treatment and prognosis.

The doctors had a difference of opinion as to Tiffany's prognosis.  How do you quickly find evidence to confirm or refute Dr. McCall's conclusions?

What does your PICO look like?

Patient, Problem:   ___________

Intervention:   _______________

Comparison:   _______________

Outcome:   __________________


If you were looking up the prognosis for this patient, what would your PICO look like?  Mine looks like this:

  1. 3 yo African-american female, possible neuroblastoma (stage, when known would be good to add)
  2. Prognosis

Why does it look like this?  Curious? See why ...


What is your search strategy?  Clinical Query? Keywords or MeSH terms (or both, maybe)? Apply filters? Use Cancer Lit subset?

Results:  Search gave me about 20 articles, the first few include:


  • Treatment outcomes in black and white children with cancer: results from the SEER database and St Jude Children's Research Hospital, 1992 through 2007.
  • Replication of neuroblastoma SNP association at the BARD1 locus in African-Americans.
  • Disparities in cancer outcomes: lessons learned from children with cancer.
  • Racial and ethnic disparities in risk and survival in children with neuroblastoma: a Children's Oncology Group study.
  • Ethnic group and survival from childhood cancer: report from the UK Children's Cancer Study Group.


It was a quick search.  Curious to see what 2 things I did?

Lab Tests Info

Looking up information about the results of lab tests are mostly background questions.  The following resources are easy to use tools to find very reliable information about the normal values, reference ranges, and more.

Cancer Survivorship Resources

Patient Survivorship Resources

For this topic, the MedlinePlus Childhood Cancer page has some resources for parents about survivorship and understanding procedures (and associated anxiety).  Also, look for the link to pre-formatted searches in PubMed.

Another helpful resource about survivorship is the ASCO Survivorship Clinical Care Tools & Resources.  In addition to the adult info, they have some resources for "Special Populations" which includes pediatric info.  Click on that box.

Patients will often have questions and want explanations of so many different procedures, conditions, and general health topics.  Don't just push them to "google it" - have a short list of worthwhile sites for them to start looking for more information.  Here are a couple specific to this case and the meta-search enging MedlinePlus.