Jane L. Forrest

Methods for the design and administration of web-based surveys.

This paper describes the design, development, and administration of a Web-based survey to determine the use of the Internet in clinical practice by 450 dental professionals. The survey blended principles of a controlled mail survey with data collection through a Web-based database application. The survey was implemented as a series of simple HTML pages and tested with a wide variety of operating environments. The response rate was 74.2 percent. Eighty-four percent of the participants completed the Web-based survey, and 16 percent used e-mail or fax. Problems identified during survey administration included incompatibilities/technical problems, usability problems, and a programming error. The cost of the Web-based survey was 38 percent less than that of an equivalent mail survey. A general formula for calculating breakeven points between electronic and hardcopy surveys is presented. Web-based surveys can significantly reduce turnaround time and cost compared with mail surveys and may enhance survey item completion rates.

Enhancing your practice through evidence-based decision making: PICO, learning how to ask good questions

This article is the second of a feature series that focuses on strategies that can be used to integrate an evidence-based decision-making (EBDM) approach into your practice or curriculum. The first article provided an overview of EBDM methodology and skills, introduced readers to evidence-based concepts, and identified related online resources. The purpose of this article is to discuss PICO, a systematic process for converting information needs/problems into clinical questions so that they can be answered. Two case scenarios outline the sequential steps in this process and demonstrate the application of the skills involved. Educational tips and learning activities are provided, along with online resources that supplement the information on learning how to ask a good question.

Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.

BACKGROUND Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. METHODS A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence. RESULTS The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers). CONCLUSIONS AND PRACTICAL IMPLICATIONS With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline.

Enhancing your practice through evidence-based decision making: Finding the best clinical evidence

This article is the third of a feature series that focuses on strategies to integrate an evidence-based decision-making (EBDM) approach into your practice or curriculum. The first article provided an overview of EBDM methodology and skills, and the second article introduced PICO, a systematic process for asking clinical questions. The purpose of this article is to demonstrate how to find valid evidence to answer these questions. Knowing which segment of the literature is appropriate for clinical decision making and how to quickly retrieve this information is important to evidence-based practice. Steps involved in structuring and conducting the search will be outlined, along with a discussion of the type of question and type of evidence for which you will be searching. A case scenario will demonstrate the application of the skills involved. Educational tips and learning activities are provided, as are online resources related to searching the literature and levels of evidence.

Translating Evidence-Based Decision Making into Practice: Appraising and Applying the Evidence

This is the second of 2 articles that focus on strategies to integrate an evidence-based decision-making (EBDM) approach into your practice. The previous article provided an overview of EBDM concepts and identified strategies for finding evidence to answer clinical questions, the first 2 steps in the evidence-based process. The next steps are to determine the credibility and usefulness of the evidence and to apply the evidence to patient care. The purpose of this article is to discuss those steps by reviewing the critical appraisal criteria used to assess the methodological quality of a study. A case scenario will be used to demonstrate how appraising the evidence helps to answer questions and how to translate the evidence into everyday practice. Characteristics of an evidence-based practice and educational tips are provided along with a glossary of terms related to appraising the literature. Together, the two articles can serve as a primer for integrating EDBM into your practice. Generally, the most frequently asked clinical questions are related to the effectiveness of a certain technique, medication, diagnostic test, treatment, material, or product. The type of scientific evidence may include systematic reviews and critically appraised topics; clinical practice guidelines and protocols; article reviews; pharmaceutical and drug interaction information; and individual studies addressing questions about therapy, prevention, diagnosis, prognosis, and harm/etiology. Once the most current evidence has been found, the next step in the EBDM process is to understand what you have and its relevance to your patient.

Translating evidence-based decision making into practice: EBDM concepts and finding the evidence.

This is the first of 2 articles that focuses on strategies that can be used to integrate an evidence-based decision making [EBDM] approach into practice. The articles will focus on EBDM methodology and enhancing skills, including how to find valid evidence to answer clinical questions, critically appraise the evidence found and determine if it applies. In addition, online resources will be identified to supplement information presented in each article. The purpose of this article is to define evidence-based decision making and discuss skills necessary for practitioners to efficiently adopt EBDM. It will provide a guide for finding evidence to answer a clinical question using PubMeds specialized searching tools under Clinical Queries.

Introduction to the Basics of Evidence-Based Dentistry: Concepts and Skills

The purpose of this section of the ADA Champions Pre-Conference is to review the basics of Evidence-based dentistry (EBD), research designs and levels of evidence, and identify the skills necessary for clinicians to efficiently use an evidence-based approach in practice. This session of the pre-conference preceded the session on the skills needed to define a clinical question and search for the evidence to answer that question.

Dental practice websites: creating a Web presence

Web technology provides an opportunity for dentists to showcase their practice philosophy, quality of care, office setting, and staff in a creative manner. Having a Website provides a practice with innovative and cost-effective communications and marketing tools for current and potential patients who use the Internet. The main benefits of using a Website to promote ones practice are: Making office time more productive, tasks more timely, follow-up less necessary Engaging patients in an interactive and visual learning process Providing online forms and procedure examples for patients Projecting a competent and current image Tracking the usage of Web pages. Several options are available when considering the development of a Website. These options range in cost based on customization of the site and ongoing support services, such as site updates, technical assistance, and Web usage statistics. In most cases, Websites are less expensive than advertising in the phone book. Options in creating a Website include building ones own, employing a company that offers Website templates, and employing a company that offers customized sites. These development options and benefits will continue to grow as individuals access the Web and more information and sites become available.

Critical Thinking in Patient Centered Care

UNLABELLED Health care providers can enhance their critical thinking skills, essential to providing patient centered care, by use of motivational interviewing and evidence-based decision making techniques. BACKGROUND AND PURPOSE The need for critical thinking skills to foster optimal patient centered care is being emphasized in educational curricula for health care professions. The theme of this paper is that evidence-based decision making (EBDM) and motivational interviewing (MI) are tools that when taught in health professions educational programs can aid in the development of critical thinking skills. This paper reviews the MI and EBDM literature for evidence regarding these patient-centered care techniques as they relate to improved oral health outcomes. METHODS Comparisons between critical thinking and EBDM skills are presented and the EBDM model and the MI technique are briefly described followed by a discussion of the research to date. CONCLUSIONS The evidence suggests that EBDM and MI are valuable tools; however, further studies are needed regarding the effectiveness of EBDM and MI and the ways that health care providers can best develop critical thinking skills to facilitate improved patient care outcomes.

Online resources, courses, and training programs

There are several online resources for those who would like to learn more about evidence-based practice/health care, improve their knowledge of research methodology and statistics, and develop skills in each of the steps of evidence-based decision making. In addition, a range of course offerings and centers that have links to additional sites, including calendars or training agendas of workshop offerings are provided. You may want to bookmark the Web sites you find particularly interesting since they are periodically updated with new course listings and dates.