| | Evidence Locator: Sources of Evidence-Based Dentistry InformationMultiple resources are available to help practitioners access the latest scientific evidence. Evidence-based dentistry (EBD) is an approach to clinical decision making that incorporates the most current and comprehensive scientific evidence with the practitioner's judgment and the patient's needs and preferences. One challenge in implementing this approach is access to evidence, and there are multiple online resources that can be used in this endeavor. This article presents the Evidence Locator, a list of Web sites that provide access to “secondary sources” of evidence. Such “secondary sources” are typically summaries of systematic reviews and evidence-based clinical recommendations or guidelines. Also presented is a list of other Web sites that may be useful to the practitioner in implementing EBD. Background  The process of incorporating evidence-based dentistry (EBD) into clinical practice involves developing a clinical question on a particular topic, finding the best objective research evidence on that topic, and developing a conclusion from the evidence. The scientific evidence is incorporated with clinical considerations, the practitioner's expertise, and the patient's needs and preferences to make sound treatment decisions for individual patients on a case-by-case basis. A systematic review is a scientific publication that addresses a specific clinical question by systematically locating, appraising, and synthesizing evidence from scientific studies relevant to that question in order to provide a reliable overview of the current evidence.1 The aim is to ensure a review process that is comprehensive and unbiased. When available, systematic reviews assist the practitioner in gathering and assessing the scientific information and applying that information when making treatment decisions. There are more than 400 systematic reviews on oral health topics.2 The task of translating research findings into clinical practice is a barrier to improving patient care in multiple health care fields.3 In dentistry, as with medicine, the translation of science into dental practice has not been swift.4, 5 A number of significant barriers to implementing evidence-based principles in clinical practice have been identified, including lack of dissemination of scientific information, limited access to evidence, and time constraints.5, 6, 7, 8, 9 The time required to search for research articles and systematic reviews, obtain the articles, and appraise their content is impractical for most clinicians, especially at the point of care.10 Furthermore, the scientific literature is frequently written in a research-oriented format that can be difficult to comprehend. Thus, there has been a call for the presentation of evidence in a clear and concise format and for user-centered resources that are intuitive.11, 12 Rationale The use of computer-based systems for information retrieval has had an important impact on health care.10 Effective dissemination and application tools are necessary for the implementation of an evidence-based approach in dentistry.13 These tools should make clinically pertinent information quickly accessible in a user-friendly format.6, 10 There are numerous online resources available for evidence-based dentistry. These resources can be categorized into at least 8 broad subjects (Table 1, Table 2): systematic reviews, summaries of systematic reviews, clinical recommendations/guidelines, journals, databases, resources tutorials, resources for critical appraisal and evidence analysis, and glossaries of terms. Description of Tool The organizing committee for the EBD Champion Conference gave special consideration to the time constraints clinicians often face when accessing evidence, especially at the point of care. In this regard, the committee acknowledged that “secondary sources” of evidence-based information can be most helpful. Secondary sources, which are brief overviews of a large body of evidence, include summaries of systematic reviews and evidence-based clinical recommendations or guidelines. Summaries of systematic reviews typically are short, one or a few pages, and provide the most essential information, such as the primary conclusion, to inform the clinical decision-making process. In comparison, evidence-based recommendations or guidelines are developed through critical evaluation of the collective body of evidence on a particular topic to provide practical applications of scientific information that can assist dentists in clinical decision making. They are frequently based on the results of multiple systematic reviews, and provide specific recommendations on how the current body of evidence on a particular topic can be considered in the decision-making process. The Evidence Locator, which was introduced to attendees at the EBD Champion Conference, is a tool that lists secondary sources of EBD information (Table 1). The Evidence Locator has 3 primary categories. The first category consists of online resources that provide summaries of systematic reviews. The second category consists of online resources that provide access to evidence-based recommendations or guidelines. These secondary sources provide the practitioner with the most concise information that can be applied in patient treatment. However, because these resources may be insufficient for all circumstances, access to the full systematic review may be necessary. For this reason, the tool has a third category, a list of online resources for systematic reviews. The Evidence Locator does not list all of the known online resources available for each of the categories. Inclusion criteria were (1) the resource provides a wealth of evidence-based information on dental and oral health topics; (2) the resource contains subscription-free information. Some resources in the list, including journals, require a subscription for full access; however, in such cases abstracts are freely available. The practitioner may find useful other online resources in addition to the secondary sources of the Evidence Locator. These resources, which may include journals, databases, tutorials, critical appraisal and evidence analysis, and glossaries of terms, are listed in Table 2. Discussion Secondary sources of evidence-based information provide concise assessments of available evidence. Examples of secondary sources include summaries of systematic reviews and evidence-based clinical recommendations or guidelines. Because these sources provide “bottom line” information needed for clinical decision making, busy oral health care workers battling time constraints may find these sources helpful. The practitioner can assess whether or not the information is sufficient. The practitioner also can access the primary sources, typically full systematic reviews or published clinical studies, for more detailed information. The utility of the Evidence Locator will depend on the personal preferences of its individual users, who will determine which of the online resources will most effectively meet his or her needs. For example, each evidence summary resource offers different volumes of information, presents the information in different ways, and features different mechanisms for categorization and searching. Likewise, the same individual assessment needs to be done for the list of online resources for evidence-based recommendations/guidelines. For example, the National Guideline Clearinghouse features comprehensive databases on evidence-based guidelines. Although it encompasses all health care fields and is not specific to dentistry, several guidelines on oral health topics are available through this resource. The Evidence Locator assists the practitioner in identifying secondary sources of EBD information. The identified evidence should be considered in the decision-making process. This process also incorporates the practitioner's clinical judgment and the patient's needs and preferences. Conclusions 1.Multiple online resources are available to help oral health care workers access the most current scientific evidence for use in the clinical decision-making process. 2.The Evidence Locator is a tool that was developed to help the practitioner access secondary sources of EBD information, including summaries of systematic reviews and evidence-based recommendations/guidelines. 3.The Evidence Locator is not comprehensive, but includes resources that offer expansive information on dental and oral health topics that are freely accessible. References 1. 1Evidence-based Dentistry: Glossary of Terms. Available at: http://www.ada.org/prof/resources/ebd/resources.asp. Accessed March 28, 2008. 2. 2American Dental Association. Evidence-Based Dentistry: A-Z Systematic Reviews. Available at: http://www.ada.org/prof/resources/ebd/reviews/index.asp. Accessed March 28, 2008. 3. 3Feifer C, Fifield J, Ornstein S, Karson AS, Bates DW, Jones KR, et al. From research to daily clinical practice: what are the challenges in “translation”?. Jt Comm J Qual Saf. 2004;30(5):235–245. MEDLINE 4. 4Helminen SE, Vehkalahti M, Murtomaa H. Dentists' perception of their treatment practices versus documented evidence. Int Dent J. 2002;52(2):71–74. MEDLINE 5. 5Ismail AI, Bader JD. Evidence-based dentistry in clinical practice. J Am Dent Assoc. 2004;135(1):78–83. MEDLINE 6. 6Minton K. Perspective of a practicing dentist on the concept of evidence-based dentistry. Tex Dent J. 2004;121(5):374–378. MEDLINE 7. 7Iqbal A, Glenny AM. General dental practitioners' knowledge of and attitudes towards evidence based practice. Br Dent J. 2002;193(10):587–591. MEDLINE |
CrossRef
8. 8McKenna HP, Ashton S, Keeney S. Barriers to evidence-based practice in primary care. J Adv Nurs. 2004;45(2):178–189. MEDLINE |
CrossRef
9. 9Newman M, Papadopoulos I, Sigsworth J. Barriers to evidence-based practice. Intensive Crit Care Nurs. 1998;14(5):231–238. Abstract |
Full-Text PDF (898 KB)
|
CrossRef
10. 10Hersh WR, Hickam DH. How well do physicians use electronic information retrieval systems? A framework for investigation and systematic review. JAMA. 1998;280(15):1347–1352. MEDLINE |
CrossRef
11. 11Aurbach FE. Evidence-based dentistry: a practitioner's perspective. J Am Coll Dent. 1999;66(1):17–20. MEDLINE 12. 12Koch S. Designing clinically useful systems: examples from medicine and dentistry. Adv Dent Res. 2003;17:65–68.
CrossRef
13. 13Forrest JL, Miller SA. Evidence-based decision making in dental hygiene education, practice, and research. J Dent Hyg. 2001;75(1):50–63. The American Dental Association Center for Evidence-based Dentistry, Chicogo, IL, USA  Corresponding Author: Center for Evidence-based Dentistry; American Dental Association; 211 E. Chicago Ave; Chicago, IL 60011; o-312-440-2519; f-312-440-2536
PII: S1532-3382(08)00117-6 doi:10.1016/j.jebdp.2008.05.013 © 2008 Elsevier Inc. All rights reserved. | |
|
FULL TEXT