LO 1 Flashcards
List the types of research from least to most trustworthy
- In vitro (test tube) studies
- Animal research
- Ideas, editorials, opinions
- Case reports
- Case Series
- Case control studies
- Cohort studies
- Randomized controlled double blind studies
- Systemic reviews and meta-analyses
What is the purpose of the evidence-based decision making approach?
- A systematic approach to caring for clients
- Provision of optimal care while reducing variations in treatment
- To close the gap between what is known and it is practiced
Without evidence-based decision making, knowledge may be _________
lacking, out of date, or inaccurate
Why is evidence-based decision making needed in healthcare?
- Variations in practice patterns - wealth of info/new treatment options now available
- Slow assimilation of research findings into practice - implementing EBDM can help practitioners apply latest knowledge
- To help manage information overload - We now have technology to access relevant clinical findings; Public is learning how to better evaluate research
- Changing educational requirements
Describe the dental knowledge base
- collection of information known about oral health disease and treatment methods/outcomes
- foundation of dental professions
- principle determinant of how dental professionals practice
- informs professional decision making
List the 4 eras of the dental knowledge base
- The age of the expert
- The age of professionalism
- The age of science
- The age of evidence
Describe the age of the expert
- Belief that ‘tooth worms’ cause toothaches
- Ancient Roman, Greek, Egyptian and Asian cultures all have examples of dental technology (restorative, etc.)
- Early middle ages – extraction of teeth for pain relief
- Knowledge is experiential (learn by doing) – apprenticeships
- Knowledge dissemination was minimal - Incorrect knowledge was slow to be discredited/discarded; This method of knowledge dissemination contributed to today’s tradition of respect for expert opinion
Describe the age of professionalism
- Began middle of 18th century
- Pierre Fauchard – Comprehensive Dentistry Textbook (Based on practical experiences in hospital)
- Creation of better access to knowledge created by others
- No protocol-based, controlled experimentation - “tinkering” vs. well-controlled research
- First dental society journal in 1840’s
- “tooth worm” belief persisted
Describe the age of science
- Dawn of 20th century
- University based educational institutions
- Scope of inquiry broadened, acceleration of protocol-based, controlled experimentation
- The “literature review” prominent – bias
Author selection of studies, selective interpretation
Describe the age of evidence
- Attention to strength of evidence is heightened
- Characterized by dominance of randomized control trials
- Much of information in dental hygiene from observational study
- Note: not all clinicians have embraced this approach to practice
- self-directed life-long learning skills»_space; problem-based
Systematic Review
1. Inclusion of all relevant evidence
2. De-emphasize role of the expert
3. Minimize bias through strict protocol
4. Objectivity and transparency in review process
5. Evidence based clinical guidelines, evidence summaries
Who are the 2 drivers of the evidence-based movement?
- Archie Cochrane
- David Sackett
Describe Archie Cochrane
- Scottish physician/epidemiologist
- Advocated for application of scientific methods
- Cochrane Collaboration - organization that helps people make well-informed decisions
Describe David Sackett
- Coined term “evidence based medicine”
- McMaster University, 1990
The first systematic review addressing a clinical dentistry topic appeared in _________
1989
What are the 3 foundations of evidence-based decision making?
- Scientific evidence - Highest quality of clinically relevant research
- Patient’s needs and preferences - Unique preferences, concerns, and expectations that each client brings to a clinical encounter (culture, communication, religion, etc.)
- Clinician’s expertise - The ability to use clinical skills and past experience to rapidly identify each client’s unique health state, individual risks and benefits of potential interventions, and personal values and expectations
What does and does not scientific evidence achieve?
Does
1. Provide another dimension to the decision-making process
2. Provides the evidence - It is a “concise” way of referring to the application of evidence to the decision making process
Does Not
1. It does not tell the practitioner what to do
2. It does not replace clinical expertise
3. It does not replace input from the client
What type of evidence are practitioners encouraged to use?
- current best evidence
- best research evidence
- systematic assessments of clinical relevant scientific evidence
The best evidence has the correct ratio of __________
- Validity
- Bias
- Reliability
*obviously want to minimize bias
* Best evidence = Best available, it may not be perfect
Describe validity
- Measures how accurately the evidence reflects what is true
- Is an essential characteristic of evidence
- Bias = principal enemy of validity
Describe bias
- The existence of factors or processes that can influence the results of a trial, or a study
- How subjects/groups are treated/observed
- How data is measured/analyzed
Describe reliabilty
- Degree to which the result of a measurement or calculation can be depended on to be accurate
- Hierarchy of study design to minimize risk of bias
What are the 5 steps of evidence-based decision making in clinical practice?
- Frame your clinical question
- Gather evidence
- Appraise the evidence
- Make your clinical decision/ apply evidence
- Evaluate the result
Describe systematic reviews
- Secondary research
- Focus on specific questions (PICO)
- Narrow focus
- Exhaustive search
What are the benefits of a systematic review?
- Reduces bias
- Includes only clinically relevant information
- Follows strict protocols
- Requires prior determination of search methods
- focuses on specific clinical questions
- Has evaluation criteria
- Evaluates the strength of the available evidence
What are the 5 As?
- Ask a clinical question (PICO)
- Systematically access the most current evidence
- Appraise the identified literature
- Apply the evidence to practice
- Assess changes in outcomes as a result of application
