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what are clinical guidelines?

Systematically developed recommendations on how healthcare and other professionals should care for people with specific conditions


what are national institute for health and care excellence (NICE) clinical guidelines?

-Systematically developed recommendations on how healthcare and other professionals should care for people with specific conditions
-Based on the best available evidence


what are Scottish intercollegiate guidelines network (SIGN) guidelines?

-Derived from a systematic review of the scientific literature
-Aimed to accelerate the translation of new knowledge into action
-Aim to reduce variations in practice
-Improve patient-important outcomes


Name 3 organisations that produce guidelines.

-British Dental Journal
-European Commission
-General Dental Council (GDC)


How do we rate the quality of a guideline?

-the potential benefits of practice guidelines are only as good as the quality of the guidelines themselves
-it is important to assess the methods used to develop practice guidelines in order to be confident of the resulting recommendations


What should high quality guidelines be?

-based on the best available evidence
-have a clear scope and purpose
-demonstrate methodological rigour
-be free from bias


what is a systemic review?

A replicable, scientific, and transparent process


what do a systemic review do?

A systematic review summarises the results of available carefully designed healthcare studies (controlled trials) and provides a high level of evidence on the effectiveness of healthcare interventions. Judgments may be made about the evidence and inform recommendations for healthcare


What is a benefit of a systemic review?

It reduces researcher bias and demands the researcher is comprehensive in their approach


what are other benefits of a systematic review?

-Can end confusion
-Yield new insights by combining findings from different studies
-Highlights where there is not enough evidence
-When there is enough evidence can reduce the influence of flawed single studies


Name the features of a good systemic review.

-Based on scientifically rigorous methods
-Answers a defined research question
-Searches all relevant sources of peer reviewed published studies and checks for unpublished studies
-Includes and reports pre-established quality control guidelines for studies
-Transparency and replicability of methods


what is the transparency of a systemic review?

-What search terms were used?
-What data sources were searched?
-What studies were excluded and why?
-What period was covered?
-Any conflict of interests?


True or false -A meta -analysis combine the results of individual studies in a systemic review to produce an overall statistic?

True or false - check with someone


what is a meta-analysis?

A meta-analysis combines results of individual studies in a systematic review to produce an overall statistic i.e. the ‘average result’.


what is the aim of meta-analysis?

-Provide a more precise estimate of the effects of an intervention
-to reduce uncertainty


what diagram can results of a meta-analysis be put on?

Forest plot


what does the solid vertical line in the centre of a first plot represent?

the line of no effect


what are the limitations of systemic reviews and meta-analyses?

-In a ‘hot’ subject may soon become outdated
-May be poorly conducted or reported
-May only have weak or biased Randomised Control Trials (RCTs) included
-May be Anglo-centric
-May ignore/under-represent grey literature
-May be weakened by ‘heterogeneity’ of RCTs


How good is the review?

-The Grading of Recommendations Assessment, Development
and Evaluation (GRADE) is a system for rating quality of evidence and
strength of recommendations
- Critical Appraisal Skills Program (CASP)
a methodological checklist which provides key criteria
relevant to systematic reviews


True or false- clinical guidelines are an essential part of evidence based practice?



what are the components of evidence based dentistry?

-Dentists expertise
-Scientific evidence
-Patient needs and preferences


What if there are no (high quality) Systematic Reviews?

-Guideline recommendations can be based on expert opinion.....
-Are recommendations based on expert opinion as good as those based on evidence from one or more high quality systematic reviews?
-Do guidelines differentiate between recommendations based on ‘high quality’ evidence and those based on ‘low quality’ evidence?


What should high quality clinical guidelines include?

-Have clear scope and purpose
-Be evidence- based (best available evidence that has been quality appraised)
-Include end-users and patients in the development
-Developed by a group of qualified individuals
-Communicate the strength of recommendations (GRADE)
-Presented in clear, unambiguous language
-Be free from bias
-Subject to public consultation


What did a review by the NHS centre for reviews and dissemination conclude?

There appears to be little justification for the removal of pathology-free impacted third molars


What is SDCEP?

The Scottish Dental Clinical Effectiveness Programme (SDCEP) is part of the Dental Directorate within NHS Education for Scotland


what does SDCEP do?

-develops guidance on priority topics for oral health care that aims to be evidence-based, practical and user friendly to support quality care

-guidance informs under-graduate and post- graduate education and training as well as daily dental practice in Scotland and beyond

- involved in implementation research to understand how to bring about changes in practice Healthier


True or false - One of the most frequent dental procedures carried out in Scotland is the simple supra-gingival scale and polish?



True or false -<10% of patients receive the more intensive
categories of care designated for managing patients
with moderate to severe disease?



True or false -Medico-legal defense unions report that an increasing number of claims relate to alleged failure to diagnose and treat periodontitis?



What areas does guidance provide evidence - based recommendations?

-Changing Patient Behaviour
-Maintaining Dental Implants
-Providing Treatment
-Record Keeping
-Long Term Maintenance