Guidelines and the killer Bs.
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Dentistry↗
Biomedical subjects
Derek Richards
Publications and source records attributed to Derek Richards.
Protocol-driven search strategies and systematic reviews of complex evidence.
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Comment↗
Integrating evidence-based teaching into to clinical practice should improve outcomes.
DATA SOURCES: Sources used were Medline, Embase, the Education Resources Information Centre , Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Best Evidence, Best Evidence Medical Education and Science Citation Index, along with reference lists of known systematic reviews. STUDY SELECTION: Studies were chosen for inclusion if they evaluated the effects of postgraduate evidence-based medicine (EBM) or critical appraisal teaching in comparison with a control group or baseline before teaching, using a measure of participants' learning achievements or patients' health gains as outcomes. DATA EXTRACTION AND SYNTHESIS: Articles were graded as either level 1 (randomised controlled trials (RCT)) or level 2 (non-randomised studies that either had a comparison with a control group), or a before and after comparison without a control group. Learning achievement was assessed separately for knowledge, critical appraisal skills, attitudes and behaviour. Because of obvious heterogeneity in the features of individual studies, their quality and assessment tools used, a meta-analysis could not be carried out. Conclusions were weighted by methodological quality. RESULTS: Twenty-three relevant studies were identified, comprising four RCT, seven non-RCT, and 12 before and after comparison studies. Eighteen studies (including two RCT) evaluated a standalone teaching method and five studies (including two RCT) evaluated a clinically integrated teaching method. CONCLUSIONS: Standalone teaching improved knowledge but not skills, attitudes or behaviour. Clinically integrated teaching improved knowledge, skills, attitudes and behaviour. Teaching of EBM should be moved from classrooms to clinical practice to achieve improvements in substantial outcomes.
Comment↗
Evidence-based dentistry: concepts and implementation.
Evidence-based dentistry is the use by dentists of best research evidence, clinical judgment and patient values to guide practice. This article focuses on methods dentists can use to collect the best relevant evidence. Using the examples of systemic fluoridation and fluoridated dentifrices, the authors illustrate a five-step process of: 1) asking answerable questions; 2) conducting a systematic search; 3) critically appraising the literature; 4) applying results to practice; and 5) evaluating outcomes.
Cariostatic Agents↗
The quality of systematic reviews in dentistry.
DATA SOURCES: Sources of reviews were the Database of Reviews of Effectiveness (DARE) and completed systematic reviews registered by the Cochrane Oral Health Group in the Cochrane Library. STUDY SELECTION: All systematic reviews that examined the effectiveness of interventions for oral, dental and craniofacial disorders and diseases were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS: A quality assessment checklist was completed for each study. RESULTS: A total of 115 studies were identified, of which 65 were relevant to the review. The area most frequently evaluated within the reviews was pain relief or prevention (20 out of 65, ie, 31%) followed by caries, and oral medicine. The quality assessment of the systematic reviews identified highlighted key areas where improvements could be made. One major weakness was that the search strategies employed in reviews were not always adequate: only 12 reviews (19%) demonstrated an attempt to identify all relevant studies. Other areas of weakness include the screening and quality assessment of primary studies, the pooling of data and examination of heterogeneity, and the interpretation of findings. CONCLUSIONS: The quality of systematic reviews in dentistry could be improved. If future clinical decisions are to be based upon systematic reviews, it is imperative that reviews address clinically-relevant, focused questions, and follow a transparent, well-designed protocol.
Comment↗
Centre for Health Information Quality.
The Centre for Health Information Quality (CHIQ; www.hfht.org/chiq), was established in 1997 by the UK government's Department of Health. CHIQ acts as a clearing house for all aspects of patient information, providing practical advice to the UK National Health Service (NHS) and others about the production of good quality information for patients.
Humans↗
International standards for clinical trial conduct and reporting.
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Clinical Trials as Topic↗
Evaluation of a pilot hands-on course in surgical dentistry for primary care dental practitioners in Oxfordshire.
OBJECTIVES: To evaluate the impact of a course in surgical dentistry on the confidence of 32 general dental practitioners, each of whom attended a one-day hands-on course. DESIGN: Questionnaire survey. SETTING: General dental practitioners attending a course on surgical dentistry, which was run over a day, for eight participants per day. RESULTS: The course was rated highly by participants. The hands-on component was particularly well received. Confidence scores increased for several surgical procedures, particularly for removal of impacted teeth and for apicectomies of single-rooted teeth. There were concomitant decreases in the proportion of participants who said that they would refer patients requiring these surgical procedures. Confidence scores remained low for complex procedures such as molar apicectomies. However, it would be appropriate to refer these cases for specialist care. CONCLUSIONS: The results of this pilot study indicated that a course in surgical dentistry was successful in increasing the confidence of a small group of general dental practitioners. More research is needed to determine whether this is the most effective way of helping practitioners maintain and improve skills and confidence in surgical dentistry.
Apicoectomy↗