intro to evidence based practice

Question 1

what are the four types of evidence based sections we are going to learn

Answer 1

evidence based medicine
healthcare
practice
dentistry

Question 2

what is evidence based medicine

Answer 2

the conscientious explicit and judicious used of best evidence in making decisions about care of individual patients

Question 3

what is evidence based medicine composed of

Answer 3

best research evidence with clinical expertise and patient values

Question 4

why do we need EBM

Answer 4

Change in disease levels
• Advancement of technology
• Different treatment philosophies • Increased patient expectation
• Ethical, legal implications
• Emphasis on cost-effectiveness
• Resource constraints

Question 5

what is evidence based dentistry

Answer 5

it is an approach to oral healthcare that requires judicious intergration of
systematic assessments of clinical relevant scientific evidence
dentists clinical expertise
the patients treatment and needs

Question 6

what is the definition of evidence based dentistry

Answer 6

The process of making decisions based on known evidence

Question 7

what are the advantages of evidence based dentistry

Answer 7

• Improves the effective use of research in clinical practice
• Uses resources more effectively
• Relies on evidence rather than authority for
clinical decision making
• Enables practitioner to monitor and develop clinical performance

Question 8

what is the five step model of evidence based practice

Answer 8

ask the question
find the evidence 
appraise the evidence 
act on the evidence
evaluate your performance

Question 9

where do we find the evidence

Answer 9

eg medline
the cochrane library
database of abstracts if reviews of effectiveness (DARE)

Question 10

how do we find the evidence

Answer 10

develop a search stratergy

Question 11

how do we appraise the evidence

Answer 11

validity
clinical importance
clinical relevance

Question 12

what is the definition for validity

Answer 12

is the degree to which the results of the study are likely to be true believable and free of bias

Question 13

what is the definition for bias

Answer 13

is any factor( other than experimental) that could change the study results in a non random way

Question 14

what is internal validity

Answer 14

the extent to which the findings can sustain the conclusions- eg A causes B, the treatment has caused benefit

Question 15

what is external validity

Answer 15

the extent to which the conclusion can be generalised to a wider population

Question 16

what can threaten internal validity

Answer 16

information/observational bias
 detection bias
observer bias (within and between observers) 
 measurement bias
interview bias
recall bias
reporting bias (obsequiousness bias)
bias due to confounding factors

Question 17

what threatens external validity

Answer 17

selection bias
sampling bias
non response bias

Question 18

how do we appraise the evidence

Answer 18

types of studies

levels of evidence- eg 1,2,3,4,

Question 19

what does it mean if the quality of evidence is a I

Answer 19

evidence from at least one properly randomised controlled trials

Question 20

what does it mean if the quality of evidence is a II-1

Answer 20

evidence from well designed controlled trials without randomisation

Question 21

what does it mean if the quality of evidence is a II-2

Answer 21

evidence from well designed cohort or case controlled analytic studies- from one or more research group

Question 22

what does it mean if the quality of evidence is a II-3

Answer 22

Evidence from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments.

Question 23

what does it mean if the strength of the evidence was 1

Answer 23

strong evidence from at least one published systematic review of multiple well designed randomised controlled trials

Question 24

what is the gold standard of trials

Answer 24

randomised controlled trials

Question 25

why are randomised controlled trials gold standard

Answer 25

prevent selection bias
control of confounding
power and sample size

Question 26

what dow e use to help appraise quality of evidence

Answer 26

CASP- clinical appraisal skills programme