Evidence Based Dentistry EBD

1. Evidence Based DentistryEBD Dr.FEslamipour DDS.MS Orthodontist Associated professor Department of Oral Public Health Isfahan University of Medical Science

3. Medical Publishing Annually: • 20,000 journals • 17,000 new books MEDLINE: • 4,000 journals • 6 Million references • 400,000 new entries yearly

5. For General Physicians to keep current: Read 19 new articles per day which appear in medical journals 19 x 2 hrs (Critical Appraisal) = 38 hrs per day Davidoff F et al. (1995) EBM; A new journal to help doctors identify the information they need. BMJ 310:1085-86.

6. Knowledge Gap Knowledge Gap Amount of Information is rising Time to meet information needs decreasing

7. What is Evidence? • Evidence is anything used to determine or demonstrate the truth of an assertion. • Scientific evidence is evidence which serves to either support or counter a scientific theory or hypothesis. • In scientific research evidence is accumulated through observations of phenomena occur in the natural world, or created as experiments in a laboratory

8. What is ‘level of evidence’? • The extent to which one can be confident that an estimate of effect or association is correct(unbiased).

9. Levels of Evidence Adapted from: Sackett DL et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Churchill Livingstone; 2000.

10. What is Evidence-Based Medicine? “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values” - Sackett & Straus

11. What is EBD? • The conscientious,explicit & judicious use of current best evidence in making decisions about the care of individual patients. • In other words; EBD is sometimes described as doing the right thing,for the right patient, at the right time

12. By best research evidence • clinically relevant research • Unbiased research • Reproducible research • often from the basic sciences of medicine • especially from patient centered clinical research

13. By clinical expertise • We mean the ability to use our clinical skills and past experience to rapidly identify each patient’s unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations.

14. By patient values • We mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient.

15. When these three elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life

16. Clinical Expertise Research Evidence Patient Preferences EBD - What is it? EBD

17. Traditional medicine Experiences Pathophysiology, references,… Patient value

18. EBP vs traditional practiceSimilarities: • Clinical skills & experience • Integrating evidence with patient values

19. EBP vs traditional practicedifferences

20. Advantages & disadvantages of EBD

21. The usefulness of EBD • Treatments & diagnostic test are being used at a time when their effectiveness is approved • EBD prevent using ineffective treatment methods, so it will probably decrease charges

22. The usefulness of EBD • It help us updating our knowledge continuously instead of reading lots of irrelevancy & unreliable literature, so time saving. • It helps policy makers through development of clinical guidelines', providing them with enough documents & evidence

23. The usefulness of EBD • Instead of teaching students current standard treatment method, it teach them how to find the best current therapy for their disease • EBM promote evidence instead of persons authority • It decreases medical errors

24. What are the limitations of EBD? • First, the need to develop new skills in searching and critical appraisal can be daunting, although (as we pointed out above) evidence-based care can still be applied if only the former has been mastered and directed toward pre-appraised resources

25. Second, busy clinicians have limited time to master and apply these new skills, and the resources required for instant access to evidence are often woefully inadequatein clinical setting.

26. EBD Steps • Ask your clinical question • Search your literature for answer • Appraise the retrieved documents • Apply your findings • Evaluate the performance

27. How to make a focused question? (PICO) • Problem/patient • Intervention • Comparison • Outcome

28. Question in a PICO format • P: moderate / heavy smokers • I: bopropion • C: nicotine replacement therapy • O: quit rates adverse effects example

29. Problems with focused questions • The question is too specific • Patient with multiple problems

30. Where and how to find evidences? • Articles • Textbooks & literature reviews • Systematic reviews • Electronic database • Hand searching

31. Was it clear enough !