Wilkins Ch 2: Evidence-Based Dental Hygiene Practice

Evidence-based decision making (EBDM)

Making decisions grounded in the best available research, professional experience, and factors related to each patient's context, including needs and preferences

Evidence-based practice (EBP)

Application of EBDM across diverse clinical and nonclinical professions incorporates the knowledge and expertise from diverse professions (i.e., collaboration among medical, dental, and research) to provide the best quality of care to patients

Purpose of EBP

Provides care that optimizes a patient's outcomes through integration of best evidence

Need for EBP

Integrating best evidence into practice and management, being able to answer patient questions, and updating ourselves on current practices

3 major elements of EBP

• clinical expertise

• patient preferences

• best evidence

Best available research evidence

Review of relevant, current, and high-quality clinical research that identifies best-practice treatment choices

Patient preferences or values

Consider, respect, and evaluate the patient's needs, wants, expectations, and personal context (i.e., cultural, religious, capabilities, health status, and demographics)

Clinical expertise

Enhances the ability to identify the patient's health, risks, needs, and potential for various interventions

Skills for EBP

Understand EBDH practice, follow a systematic approach, read and understand research, be computer literate, embrace self-directed learning, and be a resource for others

Systematic approach

Step-by-step approach by asking questions related to clinical practice to ensure success

Read and understand research

Recognize valid and reliable information. Determine strengths and limitations of publications, journal articles, research methods, study designs, and biostatistics

Be computer literate

Develop the skill to search for scientific literature effectively and efficiently. Practice critical thinking skills to evaluate information found online

Embrace self-directed learning

Develop a plan for continuing education and reading of professional literature that will help to maintain current knowledge

Be a resource for others

Help patients and colleagues identify and value scientific support for clinical recommendations

Systematic steps

Assess

Ask

Acquire

Appraise

Apply

Audit

Assess: determine clinical issue

Completes an assessment of the patient or population.

Next step is to identify what the clinical issue or problem is for the patient or population.

Purpose is to clarify the clinical issue or problem

Ask: develop a research question

Asking the right research question is fundamental and critical to the EBP model.

Research questions should be focused, neither too broad nor too narrow.

A researchable question includes four parts, referred to as PICO.

Good research questions should also adhere to the FINER criteria.

PICO

Patient problem or population

Intervention

Comparison

Outcome

Patient problem or population

Most important issues the patient or population of interest is facing

Intervention

Plan to address the patient's or population of interest's issues

Comparison

What is the main alternative being suggested? Compare the alternative with the standard intervention for the patient or population of interest

Outcome

What is the desired measurable outcome, accomplishment, improvement, or effect from the proposed intervention on the patient or the population of interest?

FINER criteria

Feasibility

Interesting

Novel

Ethical

Relevant

Acquire: search for scientific evidence

Select appropriate resources and conduct a thorough literature review.

Scientific articles are available through library databases and by using appropriate search engines. Focus the literature review toward current and higher levels of evidence publications

Types of information sources

Primary, secondary, tertiary

Primary sources

Original accounts of events and/or publications, they provide unfiltered access to an original record of thought and/or achievement during a specific period in history

Examples of primary sources

Narratives, speeches, autobiographies, government documents, patents, raw data sets, and experimental research reports

Secondary sources

Published materials that synthesize and/or analyze original sources

Examples of secondary sources

Biographies, literature reviews, and non-experimental scholarly articles

Tertiary sources

Published materials that provide overviews of particular topics with information gathered from multiple sources

Examples of tertiary sources

Encyclopedias, textbooks, and websites

Questions when considering validity of publication

Who is sponsoring?

Is there an editorial review board?

Are the journal articles peer-reviewed?

What are the credentials of the contributors?

Are there advertisements? How many?

Are there good-quality production standards?

Textbooks

Generally accepted as credible basic-level resources.

Drawn-out publication processes can make textbooks become outdated quickly

Commercial-based journals/magazines

Often free and based on product and/or service sponsorships.

Potentially written by in-house staff members without professional credentials.

Some articles summarize recent research that may contain selective reference citations, but not include all available scientific evidence

Professional journals

Produced by professional organizations. Membership dues payment is required, or receiving publications is a benefit of being a member.

Part or all of the publication is devoted to scientific studies. Most contain articles with supporting reference citations

Peer-reviewed (refereed) publications

Subject matter experts (SMEs) critically examine all components of submitted manuscripts before recommending for or against publication.

Contributing author(s) must revise the manuscript and address all significant concerns or answer questions expressed by the reviewing SMEs before receiving approval for publication.

This helps assure the validity, reliability, and objectivity of published journal articles.

Peer-reviewed journals usually list all review board members and their respective credentials in each issue of the journal

Online information

American adults are increasingly using online resources to diagnose either themselves or others, which can lead to newspaper and magazine articles or websites that may not provide science-based and/or research-supported information.

Search engines cannot assure the validity, accuracy, and objectivity of information and display fractions of all available resources on a specific topic.

High credibility

Governmental sources (.gov) and educational sources (.edu)

Moderate credibility

Organizational sources (.org) and institutional sources (.net)

Lowest credibility

Commercial sources (.com)

CRAP test

Currency

Reliability

Authority

Purpose

Currency

Consider when the source was published and if the information is still current or relevant today (sites with outdated information should be avoided)

Reliability

Consider credibility and applicability of the information. Reliable information will come from websites that are peer-reviewed, published by dependable organizations, and provide references

Authority

Consider the reputation of the author. Authors of an information source, whether individuals or organizations, should hold appropriate academic and professional credentials

Purpose

Consider the intent of the website. Sources may have the intent to inform, educate, entertain, persuade, or provide satirical information

Some health-related information from governmental agencies & nongovernmental associations

HealthFinder

MedlinePlus

Medical Library Association

Accrediting organizations provide certification w/ objective health information

Health on the Net Foundation

URAC Health Website Accreditation Program

MEDLINE database

U.S. National Library of Medicine's (NLM) main scientific database

-Provides access to articles from more than 5,600 scientific journals, including PubMed & Cochrane Collaboration database.

Cochrane Collaboration Database

Global, independent, network working to promote access to credible and unbiased health information for practitioners and patients.

Appraise: clinically evaluate evidence

Evaluate evidence based on currency, validity, & clinical value

Descriptive statistics

Numerical data used to measure and describe characteristics of groups. Includes measures of central tendency and measures of variation

Inferential statistics

Numerical data that allows one to generalize

- infer from sample data the probability of something being true of a population

Statistical significance

Likelihood that a relationship between two or more variables is due to something other than chance

Clinical significance

Practical relevance & importance among multiple therapies. It focuses on whether the significant probability of a particular therapy has a noticeable effect on a patient or population

Apply: Integrate and apply evidence

Integrate and apply evidence with clinical expertise and the patient's preferences.

Consider the circumstances and clinician's ability to help obtain potential results.

Document interventions in the patient's chart as part of clinical progress notes

Audit: Evaluate outcomes

Determine whether:

Application of EBP model successfully helped the patient.

There is a need for additional research strategies and information, or modification in the original outcome goal.

Research designs

Qualititative, quantitative, and mixed-methods research

Qualitative research

Data are collected and reported through participant observations, interviews, open-ended questions, field notations, and narrative reflections

Quantitative research

Sample sizes are typically larger and randomly selected.

Data are collected and reported as quantifiable numbers and/or statistics

Mixed-methods research

Purpose is to combine the best of both qualitative and quantitative research approaches.

Sample sizes and random selection may vary.

Data are collected and reported as both qualitative insight and quantitative analysis

Research types

Descriptive, correlational, quasi-experimental, experimental, review

Descriptive research

Observes behavior to describe that behavior objectively and systematically (case studies, natural observations)

Correlational research

Identifies whether an association or relationship between two factors exists (ex: cohort studies, population surveys)

Quasi-experimental research

Researcher cannot assign participants to conditions or manipulate the independent variable (ex: correlational studies)

Experimental research

Designed to discover causal relationships between various factors (ex: randomized controlled trials)

Review research

-synthesizes relevant information on a particular research topic

-intended to summarize and evaluate scientific literature (ex: meta-analysis)

Levels of evidence

Hierarchal framework to determine the strength of an article

Levels of scientific evidence pyramid

Meta anaylsis

Systematic reviews, Randomized controlled trials

Cohort Studies

Case Control studies

Case Studies

Animal and Lab Preclinical Trials

Meta-analysis

A "study of studies" that combines the findings of multiple studies to conclude (Platinum)

Systematic reviews

Rigorous and systematic synthesis of research findings about a clinical problem (Diamond)

Randomized controlled clinical trials

Carefully planned experiments introduce a treatment or exposure to study its effect on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) allowing for comparison between intervention groups and control (no intervention) groups (Gold)

Cohort studies

Follow the same subject group from the present to a specified point in the future. This research design compares a group with exposure against a group without an exposure

Case control studies

Explore into the past to identify common factors between two groups, one with an exposure and the other without an exposure

Case studies

In-depth analyses and descriptions of a series of cases of an unusual or complex condition

Case reports

Professional articles describing the diagnostic, preventive, and therapeutic services rendered to one patient with an unusual or complex condition

Narrative reviews

Basic, descriptive-based literature reviews that synthesize information on a particular topic without a methodological approach

Editorials

Articles in a newspaper or magazine that express the opinion of its editor or publisher

In vitro trials

Experimental testing completed through test tubes and other similar equipment in the laboratory

In vivo trials

Experimental testing completed through test tubes and other similar equipment in the laboratory

Prospective study

Observes for outcomes, such as the development of a disease, between the present and some defined point in the future

Retrospective study

Observes established outcomes, such as an existing disease, but examines by exploring potential risk or protective factors within a specified timeframe in the past

Cross-sectional study

Examines several different samples at one specified point in time (i.e., provide a snapshot)

Longitudinal study

Examines the same sample over an extended period (i.e., several points in time). Results from longitudinal studies can indicate potential causality claims

Human subjects dental hygiene studies

Studies on extracted teeth, discarded gingiva, other tissues, saliva, blood, urine, etc.

Ethical research standards

Self-determination.

Privacy

Anonymity and confidentiality

Fair treatment

Protection from discomfort and harm

Understanding the risks and benefits of participating in the study

Informed consent

Institutional Review Board (IRB)

Committee of administrators, scientists, and community members that reviews proposals for research involving human participants

SOAP

Subjective

Objective

Assessment

Plan

Example of subjective

Chief complaint, symptoms

Example of objective

Clinical signs, patient examined, and some diagnoses

Example of assessment

Reviewing scientific literature and applying

Example of plan

Verbal and written instructions to the patient on steps to take to improve or maintain their condition