Evidence based dentistry/certified fixed orthodontic courses by Indian dental academy

www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education

Evidence-Based Dentistry
A New Initiative In Health Care

Presentation brought to you by
College of Dental Sciences,
Davangere
Dr. Anmol S. Kalha, Prof & Head Dept Of Orthodontics
Director & Co-ordinator
Chief Convenor 1st
National Workshop On EBD
Centre for
Evidence-Based Dentistry & Informatics

Evidence-Based DentistryA New Initiative In Health Care
©Truths of today, myths of tomorrow…
Universally accepted scientific truth
that explains a natural phenomenon
Foundation for building a scientific structure
ideas and concepts are like bricks
Paradigms

©
Opinion-based
decisions
Charismatic
leadership
Vast array of
philosophies
Evidence-based
decisions
Empowerment
Accountability
Paradigms

©
+ Experience
• May be out of date
• Increasingly difficult to
keep up with
• New ideas and concepts
• Acquisition of new
knowledge is slow
& haphazard
KnowledgeExpertise =
Clinical Decision-making

©
• May be limited, subject
to personal bias
• May outweigh
knowledge
Clinical Decision-making
+ Experience
• May be out of date
• Increasingly difficult to
keep up with
• New ideas and concepts
• Acquisition of new
knowledge is slow
& haphazard
KnowledgeExpertise =

©
How does one arrive at a clinical
decision that is valid, current and
applicable to one’s patient?

©
CERTAINTY
CLINICAL
DECISION
Clinical Situation
Etiology, Diagnosis, Treatment, Prognosis
UNCERTAINTY
CLINICAL
INDECISION

©
CERTAINTY
CLINICAL
DECISION
Clinical Decision
1. Increased awareness
2. Increased access to information
3. Cost of procedure
4. Litigious society
Patients may challenge your decision:

©
HOW DO YOU DEFEND YOUR
CLINICAL DECISION?

©
UNCERTAINTY
CLINICAL
INDECISION
Clinical Indecision
1. What is the current evidence?
2. Where and how to look for it?
3. Is the evidence valid?
4. Is it applicable to my patient?
May challenge your mind:

©
HOW DO YOU REACH A CLINICAL
DECISION?

©
HOW DO YOU REACH A CLINICAL
DECISION?
HOW DO YOU DEFEND YOUR
CLINICAL DECISION?

©
If you are a:
Undergraduate
student
Teacher,
textbooks

©
If you are a:
Practicing
Dentist
Fellow dentists, product
literature, former teachers, old
textbooks, CDEs, journals

©
If you are a:
Postgraduate
Student
PG guide, product literature,
textbooks, journals

©

©
Evidence-Based Dentistry
(Health Care)

©
DEFINITION
“a conscientious, explicit, and judicious
use of current best evidence in
conjunction with clinical experience to
make decisions regarding patient care”

©
HISTORY
 Post-revolutionary Paris; around 1850s
 China B.C.
 Some tools of EBHC can be traced Biblical
times
 1970s : McMaster University, Canada
 1980s : University Harvard, US
 1995 : Oxford, UK

©
HISTORY
 1970s : McMaster University, Canada
 1980s : University Harvard, US
 1995 : Oxford, UK
• Centre for Evidence-based
Medicine
Dentistry
Medicine
Dentistry

©
HISTORY
31st
March 2000
Centre for
Evidence-Based Dentistry And Informatics
College of Dental Sciences
Davangere

©
STEPS

©
STEPS
Formulating a relevant, focused, clinically
important question that is likely to be answered.
Gaps in our knowledge about etiology, diagnosis,
prognosis or therapy.
Problem areas or controversial aspects of health
sciences.
Introduction of new diagnostic test, therapy (surgical
procedure, medicaments, materials) or preventive
measure.
Research in fundamental sciences suggests clinical
application.

©
STEPS
Finding the evidence.
Sources:
Primary research: articles in journals (& even
unpublished research work)
Secondary research: systematic reviews (with
or without meta-analysis), non-systematic
reviews, guidelines, decision analysis,
economic analysis

©
Search strategy:
Manual search:
library, correspondence
Electronic search: Medline, Dental Gate,
Dentist’s SilverPlatter, Embase, AIDSline,
Toxline
MeSH, Ovid
STEPS

©
STEPS
M
E
D
L
I
N
E
MeSH

©
STEPS
Limit
Thesaurus
S
I
L
V
E
R
P
L
A
T
T
E
R

©
Levels of evidence:
• Systematic reviews and meta-analysis
• Randomized controlled trials
• Cohort studies
• Case-control studies
• Cross-sectional surveys
• Case reports
STEPS

©
STEPS
Appraising the evidence for validity and its
applicability in your patient.
Systematic
Reviews
Meta-
analysis
Clinical Practice
Guidelines
NNTs, SpPins
& SpNouts
Critical Appraisal
of a Topic

©
STEPS
Appraising the evidence for validity and its
applicability in your patient.
‘CAT’
CRITICALLY
APPRAISED
TOPIC
Practical
Approach
to EBHC

©
STEPS
Applying the evidence in one’s own patients,
based upon one’s clinical judgement, experience
and patient’s expectations and values.
Assessing the outcome of applying the evidence
in your patients.
Summarizing and storing records for future
reference.

©
VALUE
Defines the current acceptable standard of
health care (medico-legal, health insurance &
health administration implications).
Immediately applicable clinically : regularly
incorporating new concepts and techniques
into practice.
Improves one’s skills in acquisition and critical
assessment of information: fun and exciting
part but based on scientific fact and validity.

©
Points out areas for further research.
VALUE
Educational value:
1. The need to provide the most current and
relevant scientific inputs to students
2. Developing and implementing a cadre of
clinical faculty capable of bridging the gap
between basic research and clinical skills
3. Provide a data base / electronic referral
point to analyze research and data and
provide ready reference

©
LIMITATIONS
Access to information is limited.
Suitable evidence (studies) may not be
available.
Some of the tools of EBHC are time
consuming and difficult to master.
Evidence-based practice may increase
rather than decrease the cost of health care.
Authoritarian clinicians & teachers perceive
it as a threat !!

©
WHY PRACTICE EBD?
“simply because we, as health care
professionals, owe it to our patients to
provide the currently best care available”
WHY TEACH EBD?
“to prepare our students with life-long
learning skills, so that they continue to
evaluate and use information for patients ”

WHY PRACTICE EBD?
“simply because we, as health care
professionals, owe it to our patients to
provide the currently best care available”
WHY TEACH EBD?
“to prepare our students with life-long
learning skills, so that they continue to
evaluate and use information for patients ”
©
“PROFESSIONAL RESPONSIBILITY”
“PROFESSIONAL RESPONSIBILITY”

©
IN A NUTSHELL
The practice of EBD is
the integration of…
Individual
Clinical
Expertise
Best Available
External Evidence
Patient’s Values
& Expectations

©
IN A NUTSHELL
The practice of EBD is
the integration of…
…so as to deliver the
most valid and current
health care.www.indiandentalacademy.com

©
• A Change in Mindset
• Faculty Development
• Policy Implementation
• Minimum Essential Infrastructure
• Sharing of Data and Information
• Creation of an Electronic Library
EBD – A GLOBAL EVENT
CEBD-i: a Progressive Step
Part of a Global Initiative
Support the Initiative

Evidence Based Health Care
will segmented
archtechnique
Patient or
Problem
Intervention
Comparison
Intervention
Outcomes result in better vertical control by
Causing no extrusion of posterior
Buccal teeth
as compared to continuous
leveling wires
In overbite correction with
fixed appliances…
Practice: Critical Appraisal of a Topic (CAT)

SEARCH
“”Evaluation of continuous and segmented
Arch leveling techniques in adult patients”
Frank J.Weiland et al
AJODO, Vol.110 no.6, dec1996, 647-52

Title:
Clinical bottom line: In overbite correction with fixed appliances,
segmented arch technique provides better vertical control in
comparison to continuous leveling wires as it does not cause
extrusion of posterior buccal teeth.
Citation:
Three-part clinical question:
The study:
The evidence: ARR, RRR, CI, NNT
Comments:
Appraised by: Dr. Anmol Kalha Date: 21/10/2000
Kill by or update by: 27 oct 2001
1-PAGE CAT

CLINICAL EXAMPLE
A 14-YEAR OLD BOY AFTER COMPLETION OF ORTHO
TREATMENT PRESENTS FOR EVALUATION OF CLINICALLY
AND RADIOGRAPHICALLY ASYMPTOMATIC UNERUPTED
THIRD MOLARS.
EXTRACTIONTRADITIONAL MODEL

NEW MODEL
SELF-ASSESSMENT
ON-LINE LITERATURE
DATABASE
LITTLE EVIDENCE EXISTS

THE MYTH OF ORAL FOCI
OF INFECTION
• BASED ON THE ASSUMPTION ORAL
INFECTION AFFLICTS OTHER
ORGANS
• CRITICALLY APPRAISED BY
EASLICK IN 1951
• NO CORRELLATION!!!
• RECOMMENDATIONS BY ADA

Center for Evidence-based Dentistry
College of Dental Sciences
invites you for
FIRST NATIONAL WORKSHOP ON
EVIDENCE-BASED DENTISTRY
10-11, March 2001
Dr Derek Richards
Director, CEBD, Oxford, UK.
Dr Asbjorn Jokstad
University of Oslo, Norway.
YOU CAN REGISTER ONLINE AT:
http://www.cods.net/cebd/workshop.htm

Evidence based dentistry/certified fixed orthodontic courses by Indian dental academy

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Semelhante a Evidence based dentistry/certified fixed orthodontic courses by Indian dental academy

Semelhante a Evidence based dentistry/certified fixed orthodontic courses by Indian dental academy (20)

Mais de Indian dental academy

Mais de Indian dental academy (20)

Último

Último (20)

Evidence based dentistry/certified fixed orthodontic courses by Indian dental academy