dhyg 122: ch. 3 - evidence-based decision making (EBDM)

purpose of EBDM?

make clinical decisions using the highest level of evidence

EBDM helps clinicians do what?

answer clinical questions and choose best patient care

example of an EBDM clinical question?

evaluating claims like “oil pulling cures cavities”

EBDM integrates what three things?

• best research evidence

• clinical expertise

• patient values/circumstances

what skills are required for EBDM?

• online searching

• evaluation skills

• understanding research design

is EBDM unique to dentistry or medicine only?

no

EBDM closes the gap between what two things?

what is known and what is practiced

is evidence alone enough to make decisions?

no

evidence is only what portion of decision-making?

one component

what exists within research?

levels (hierarchy) of evidence

moving up the hierarchy decreases what?

number of studies

moving up the hierarchy increases what?

relevance and reliability of outcomes

higher-level evidence reduces outcomes due to what?

chance

where are in-vitro studies located in the hierarchy?

bottom

where are in-vivo studies located?

above in-vitro but still low

what type of research sits above lab studies?

primary research

what type sits above primary research?

secondary research

what is at the very top of the hierarchy?

clinical practice guidelines (CPGs)

what is primary research?

original research conducted by investigators

experimental research tests what?

cause and effect

experimental research tests what?

cause and effect

experimental research does what to variables?

intervenes/controls them

what does experimental research test?

a hypothesis

strongest experimental design?

randomized controlled trial (RCT)

RCTs demonstrate what?

cause and effect, not chance

does observational research involve intervention?

no

data is gathered how?

without controlling variables

two types of observational studies?

cohort and case-control

what is secondary research?

pre-appraised/filtered analysis of existing studies

what do systematic reviews (SRs) do?

combine/synthesize studies on same topic

what do meta-analyses (MAs) do?

statistically pool data from SRs

what are critical summaries?

1-2 page reviews with expert commentary

where are CPGs on the hierarchy?

top

type of evidence are CPGs?

secondary

CPGs are created by whom?

panel of experts

are CPGs static?

no, they evolve/change

purpose of CPGs?

support clinical practice using best evidence

reliable professional organization for evidence?

• AAPD

• AAP

• ADA

• CDC

• Cochrane

which organization is considered the gold standard for systemic reviews?

cochrane collaboration

two major databases used for evidence searches?

• PubMed

• Cochrane Library

PubMed provides what type of articles?

peer-reviewed scholarly journals

what PubMed feature helps clinical searches?

clinical queries

five steps of EBDM?

ask a focused clinical question

tool used to form questions?

PICO

PICO stands for?

P - patient/problem/population

I - intervention

C - comparison

O - outcome

access step means?

conduct computerized search

appraise step means?

critically evaluate evidence

first appraisal question?

are results valid?

what determines validity?

study methodology

poor methodology leads to what confidence?

low/no confidence

what else should be considered besides numbers?

benefits, harms, patient preferences

statistical significance measures what?

likelihood results occurred by chance

statistical significance is represented by what value?

P - value

meaning of p < 0.05

less than 5% probability due to chance

meaning of p < 0.001?

less than 0.1% probability due to chance

p > 0.05 indicates what?

not statistically significant

clinical significance refers to what?

real-world importance of results

is clinical significance based on numbers alone?

no

can results be statistically significant but not clinically significant?

yes

example of clinically insignificant result?

0.5-1.0 mm attachment change (measurement error)

apply step means?

use evidence in patient care

what must be discussed with patient?

findings and preferences

final step of EBDM?

evaluate process and performance