This presentation describes the components of evidence-based medicine (EBM) and how clinicians can apply EBM in the care of patients who have Lyme disease. A review of critical reading skills is central to assessing which studies may inform clinical practice and which would not.
Instructor: Elizabeth Maloney, MD, Education Director, VectorWise CME
Learning objectives:
- List and describe the three elements of evidence-based medicine
- Apply critical reading skills when reading the Lyme literature
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Describe the process of shared decision-making
Accreditation Statement
This session, Evidence-based Medicine in the Setting of Lyme disease, is approved for 0.5 enduring AAFP Prescribed credits.
The AAFP has reviewed VectorWise CME, and deemed it acceptable for AAFP credit. Term of approval is from 05/15/2025 to 05/14/2026. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.
Evidence-based bibliography for further study
• Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-72. doi:10.1136/bmj.312.7023.71
• Sackett D, Straus S, Richardson W, et al. Evidence-based medicine: how to practice and teach EBM. Churchill Livingstone; Edinburgh, London: 2000.
• Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Review Anti-Infective Therapy. 2014 Sep;12(9):1103-35.
• NICE guideline [NG95], Lyme disease (Published date: April 2018). https://www.nice.org.uk/guidance/ng95.
• Hayes E, Mead P. Lyme disease. Clin Evid. 2004;(12):1115-1124.
• Cadavid D, Auwaerter PG, Rumbaugh J, Gelderblom H. Antibiotics for the neurological complications of Lyme disease. Cochrane Database Syst Rev. 2016;12(12):CD006978. Published 2016 Dec 8. doi:10.1002/14651858.CD006978.pub2.
• Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021;72(1):1-8. doi:10.1093/cid/ciab049.
• Mansfield L. The reading, writing, and arithmetic of the medical literature, part 1. Ann Allergy Asthma Immunol. 2005; 95:100–108.
• Mansfield L. The reading, writing, and arithmetic of the medical literature, part 2: critical evaluation of statistical reporting. Ann Allergy Asthma Immunol. 2005;95:315–322.
• Mansfield L. The reading, writing, and arithmetic of the medical literature, part 3: critical appraisal of primary research. Ann Allergy Asthma Immunol. 2006;96:7–16.
• Nadelman RB, Nowakowski J, Fish D, et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med. 2001;345(2):79-84. doi:10.1056/NEJM200107123450201
• Strle F, Ružić-Sabljić E, Logar M, et al. Comparison of erythema migrans caused by Borrelia burgdorferi and Borrelia garinii. Vector Borne Zoonotic Dis. 2011;11(9):1253-1258. doi:10.1089/vbz.2010.0230
• Krupp LB, Hyman LG, Grimson R, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology. 2003;60(12):1923-1930. doi:10.1212/01.wnl.0000071227.23769.9e
• Dattwyler RJ, Wormser GP, Rush TJ, et al. A comparison of two treatment regimens of ceftriaxone in late Lyme disease. Wien Klin Wochenschr. 2005;117(11-12):393-397. doi:10.1007/s00508-005-0361-8
• Delong AK, Blossom B, Maloney EL, Phillips SE. Antibiotic retreatment of Lyme disease in patients with persistent symptoms: a biostatistical review of randomized, placebo-controlled, clinical trials. Contemp Clin Trials. 2012;33(6):1132-1142. doi:10.1016/j.cct.2012.08.009
• Maloney EL. Evidence-Based, Patient-Centered Treatment of Erythema Migrans in the United States. Antibiotics (Basel). 2021;10(7):754. Published 2021 Jun 22. doi:10.3390/antibiotics10070754.
• Wormser GP, Ramanathan R, Nowakowski J, et al.. Duration of antibiotic therapy for early Lyme disease: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2003; 138:697–704
• Logigian EL, Kaplan RF, Steere AC. Successful treatment of Lyme encephalopathy with intravenous ceftriaxone. J Infect Dis 1999;180:377-383.
• Kravitz RL, Duan N, Braslow J. Evidenced-based medicine, heterogeneity of treatment effects, and the trouble with averages. Milbank Q. 2004; 82(4):661-87.
• Fallon BA, Keilp JG, CorberaM, et al. A randomized, placebo-controlled trial of repeated iv antibiotic therapy for Lyme encephalopathy. Neurology 2008; 70: 992–1003.
• Caddick, Z.A., Fraundorf, S.H., Rottman, B.M. et al. Cognitive perspectives on maintaining physicians’ medical expertise: II. Acquiring, maintaining, and updating cognitive skills. Cogn. Research 8, 47 (2023). https://doi.org/10.1186/s41235-023-00497-8
• Lee YK, Low WY, Ng CJ. Exploring patient values in medical decision making: a qualitative study. PLoS One. 2013;8(11):e80051. Published 2013 Nov 25. doi:10.1371/journal.pone.0080051
• Agency for Healthcare Quality and Research. Shared Decision-making available at https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/communication/strategy6i-shared-decisionmaking.html.(Last accessed Aug 31, 2025)
About the Instructor
Elizabeth L. Maloney, MD
Education Co-Director, VectorWise CME; Partnership for Tick-borne Diseases Education
Dr. Elizabeth Maloney is a Minnesota family physician. She received her medical degree from the University of Minnesota in 1986 and completed her residency in family medicine at the University in 1989. Early in her career, she practiced in Guam, where lab and other testing modalities were often unavailable. It was here that she honed her clinical skills and learned to translate history and exam findings into clinical diagnoses and treatment plans. Dr. Maloney began reviewing the scientific literature on tick-borne diseases in earnest in 2006. Her initial review was an attempt to understand why some patients did not present or respond as described in review articles and conference lectures. When she discovered that Borrelia burgdorferi, the agent of Lyme disease, is a complex organism, the immune response to it is nuanced and there are gaps in the clinical understanding of Lyme disease, Dr. Maloney changed her focus towards educating medical professionals about tick-borne illnesses. Dr. Maloney began providing accredited continuing medical education courses on Lyme disease for physicians in 2007 and continues to do so. She has also developed similar education for nurses and mental health providers. She has published several papers in peer-reviewed medical journals and is frequently invited to speak to medical professionals across the US. She has served as a consultant to private organizations and government agencies in the US and Canada. In February 2018 she was selected to serve on the Pathogenesis, Transmission and Treatment subcommittee of the federally mandated Tick-borne Disease Working Group. Additionally, she recently accepted an invitation to serve on a peer review committee for the Canadian Institutes of Health Research.