- Email: [email protected]
Evidence Locator: Sources of Evidence-Based Dentistry Information
Evidence Locator: Sources of Evidence-Based Dentistry Information Julie Frantsve-Hawley, RDH, PhD The American Dental Association Center for Evidence-based Dentistry, Chicogo, IL, USA
Multiple 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. Key Words: Evidence-based dentistry, Web sites, evidence locator.
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.5-9 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 Corresponding Author: Center for Evidence-based Dentistry; American Dental Association; 211 E. Chicago Ave; Chicago, IL 60011; o-312-4402519; f-312-440-2536; E-mail: [email protected].
J Evid Base Dent Pract 2008;8:133-138 1532-3382/$34.00 Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2008.05.013
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
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
TABLE 1. Evidence Locator Summaries of Systematic Reviews Resource
Link
EBD at ADA.org
www.ada.org/goto/ebd
Journal of Evidence-Based Dental Practice
http://journals.elsevierhealth.com/ periodicals/ymed
Database of Abstracts of Reviews of Effectiveness (DARE) National Library for Health—Oral Health Specialist Library Evidence-Based Dentistry journal (UK)
http://www.crd.york.ac.uk/CRDWeb/
Evidentista (Pan American Centers for Evidence-Based Dentistry) Agency for Healthcare Research and Quality (AHRQ) Bandolier: Dental and Oral Health
http://www.library.nhs.uk/oralhealth/
Information Available Summaries of dental systematic reviews published elsewhere (new ADA-sponsored critical summaries are under development); additional Web resources Summaries of dental systematic reviews, plus commentary and analysis; critical evaluations of published articles on various topics Structured abstracts of systematic reviews; includes commentary on overall review quality Structured abstracts of systematic reviews
http://www.nature.com/ebd/archive/ index.html http://us.evidentista.org/?o¼1026
Systematic review summaries/analyses.
http://www.ahrq.gov/clinic/epcquick.htm
Summaries of AHRQ evidence reports on dental caries, dental patients who are HIV positive, scaling and root planning therapy, and others Critical appraisals of systematic reviews and supporting studies on dental topics Abstracts and plain-language summaries of dental systematic reviews Evidence summaries from the Oral Health Specialist library grouped by topic and/or specialty area
Cochrane Oral Health Group
http://www.jr2.ox.ac.uk/bandolier/booth/ booths/dental.html http://www.ohg.cochrane.org/reviews.html
Centre for Evidence-Based Dentistry
http://www.cebd.org/?o¼1069
Clinical questions and answers grouped by topic area
Clinical Recommendations/Guidelines Resource National Guideline Clearinghouse ADA Evidence-Based Clinical Recommendations PubMed Clinical Queries (National Library of Medicine) National Institute for Health and Clinical Excellence (NICE) Centers for Disease Control and Prevention (CDC) Division of Oral Health Scottish Intercollegiate Guidelines Network Royal College of Surgeons (RCS) of England Agency for Healthcare Research and Quality (AHRQ)
Link
Information Available
www.guidelines.gov http://www.ada.org/prof/resources/ebd/ clinical.asp http://www.ncbi.nlm.nih.gov/entrez/query/ static/clinical.shtml#reviews http://www.nice.org.uk/guidance/index. jsp?action¼byTopic&o¼7298&set¼true http://www.cdc.gov/oralhealth/guidelines. htm
Clinical practice guidelines Evidence-based clinical recommendations on oral health topics, including topical fluoride and sealants Clinical practice guidelines grouped by category
http://www.sign.ac.uk/guidelines/published/ index.html#Dentistry http://www.rcseng.ac.uk/fds/clinical_ guidelines http://www.ahrq.gov/clinic/cpgsix.htm
SUMSearch
http://sumsearch.uthscsa.edu/
Centre for Evidence-Based Dentistry
http://www.cebd.org/?o¼1069
Clinical guidelines from UK on dental recall Guidelines developed by CDC and the Task Force on Community Preventive Services Clinical guidelines on dental topics available as full guidelines and in quick reference guide format Clinical guidelines on common clinical situations Clinical practice guidelines from the National Guideline Clearinghouse, Department of Health and Human Services, and AHRQ Searches free online resources—PubMed (Medline), Database of Abstracts of Reviews of Effectiveness (DARE), National Institutes of Health (NIH) Guidelines Clearinghouse—to retrieve systematic reviews and/or clinical guidelines. Guidelines and consensus statements
Systematic Reviews Resource
Link
EBD at ADA.org
www.ada.org/goto/ebd
Cochrane Oral Health Group (affiliated with the Cochrane Collaboration)
http://www.ohg.cochrane.org/reviews. html#reviews
134
Information Available Abstracts of published systematic reviews on dental topics grouped by clinical topic areas, listed in A-Z format; full text available for systematic reviews published by the Journal of the American Dental Association Systematic reviews from the Cochrane Oral Health Group (Continued )
September 2008
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
TABLE 1. Evidence Locator (Continued ) Systematic Reviews Resource PubMed systematic review search page EviDents Search Engine for EBD TRIP Database, Oral Health page SUMSearch
International Centre for Evidence-Based Oral Health (Eastman Dental Institute, UK) Google Scholar Centre for Evidence-Based Dentistry AHRQ Evidence-based Practice Center (EPC) Reports Netting the Evidence
Link
Information Available
http://www.ncbi.nlm.nih.gov/entrez/ query/static/clinical.shtml#reviews http://medinformatics.uthscsa.edu/EviDents/ http://www.tripdatabase.com/oral/ specialismhomepage.html http://sumsearch.uthscsa.edu/
http://www.eastman.ucl.ac.uk/pdarkins/ iceph/ http://scholar.google.com/ http://www.cebd.org/?o¼1069 http://www.ahrq.gov/clinic/epcindex. htm#oral http://www.google.com/coop/cse?cx¼ 004326897958477606950%3Adjcbsrxkatm
Systematic review abstracts, plus links to full-text copies where available. Searchable resource for systematic review abstracts and other studies Systematic reviews related to oral health Searches free online resources—PubMed (Medline), Database of Abstracts of Reviews of Effectiveness (DARE), NIH Guidelines Clearinghouse—to retrieve systematic reviews and/or clinical guidelines ‘‘Publications’’ link includes full-text systematic reviews on clinical topics Search tool for systematic reviews and other research Resources on dental systematic reviews Evidence-based reports on oral health topics Customized Google search engine devoted to evidence-based practice
Copyright Ó [2008] American Dental Association. All rights reserved. Reproduced by permission.
format.6,10 There are numerous online resources available for evidence-based dentistry. These resources can be categorized into at least 8 broad subjects (Tables 1 and 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 evidencebased 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, evidencebased 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. Volume 8, Number 3
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 135
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TABLE 2. Additional Resources Evidence-Based Centers Centre for Evidence-Based Dentistry Centre for Evidence-Based Medicine (Oxford University) Cochrane Collaboration Agency for Healthcare Research and Quality DSM-Forsyth Center for Evidence-Based Dentistry Centre for Health Evidence International Centre for Evidence-Based Oral Health (Eastman Dental Institute—London, UK) Evidentista (Pan American Centers for Evidence-Based Dentistry) Centre for Evidence-Based Medicine (University of Toronto, Canada) Journals Journal of Evidence-Based Dental Practice Evidence-Based Dentistry Evidence-Based Medicine Online Databases Cochrane Library PubMed (National Library of Medicine) TRIP Database, Oral Health page Database of Abstracts of Reviews of Effectiveness (DARE) National Guideline Clearinghouse Other Resources Evidence-Based Dentistry Resource Guide (Virginia Commonwealth University) Evidence-Based Medicine Resource Center Evidence-Based On Call Health Evidence Bulletins-Wales (oral health) PrimeAnswers Tutorials ScHARR Introduction to Evidence-based Practice on the Internet Evidence-Based Clinical Practice Tutorial (Miner Library) A Student’s Guide to the Medical Literature (University of Colorado Health Sciences Center) Evidence-Based Medicine: Finding the Best Clinical Literature (University of Illinois Library of the Health Sciences) Introduction to Evidence-Based Medicine (Duke University Medical Center Library and Health Sciences Library, UNC-Chapel Hill) PubMed Tutorial Using Numerical Results from Systematic Reviews in Clinical Practice SUNY Downstate Medical Center Evidence-Based Medicine Tutorial
http://www.cebd.org/ www.cebm.net http://www.thecochranelibrary.com http://www.ahrq.gov/clinic/epcix.htm http://www.forsyth.org/forsyth.asp?pg¼100111 http://www.cche.net/ http://www.eastman.ucl.ac.uk/pdarkins/iceph/ http://us.evidentista.org/?o¼1026 http://www.cebm.utoronto.ca/
http://www.elsevier.com/wps/find/journaldescription. cws_home/623234/description#description http://www.nature.com/ebd/index.html http://ebm.bmjjournals.com/ http://www.thecochranelibrary.com http://www.pubmed.com http://www.tripdatabase.com/oral/specialismhomepage. html http://www.crd.york.ac.uk/crdweb/ www.guidelines.gov http://www.library.vcu.edu/tml/bibs/ebd.html http://www.ebmny.org/ http://www.eboncall.org/ http://hebw.cf.ac.uk/oralhealth/index.html http://www.primeanswers.org/primeanswers/index.cfm http://www.shef.ac.uk/scharr/ir/netting/ http://www.urmc.rochester.edu/hslt/miner/resources/ evidence_based/index.cfm http://grinch.uchsc.edu/sg/index.html http://www.uic.edu/depts/lib/lhsp/resources/ebm. shtml http://www.hsl.unc.edu/services/tutorials/ebm/index. htm http://www.nlm.nih.gov/bsd/disted/pubmed.html http://www.annals.org/cgi/content/full/126/9/712 http://library.downstate.edu/EBM2/contents.htm (Continued)
136
September 2008
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
TABLE 2. Additional Resources (Continued) Resources for Critical Appraisal and Evidence Analysis Appraisal Tools—Critical Appraisal Skills Programme (CASP) AMSTAR (tool for the ‘‘assessment of multiple systematic reviews’’) Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group publications QUOROM Statement (‘‘Quality of Reporting of Meta-Analyses’’) Center for Evidence-Based Medicine, Critical Appraisal Tools CONSORT Statement (consolidated standards of reporting trials) Meta-analysis of Observational Studies in Epidemiology (MOOSE): A Proposal for Reporting Glossaries of Terms American Dental Association EBD Glossary of Terms Bandolier EBM Glossary British Medical Journal—Clinical Evidence Glossary Centre for Evidence-Based Medicine: Key Terms in Evidence-Based Practice Evidence-Based On Call (Glossary) Definitions of Evidence-Based Practice (University of Sheffield, UK)
http://www.phru.nhs.uk/Pages/PHD/resources.htm http://www.biomedcentral.com/1471-2288/7/10 http://www.gradeworkinggroup.org/index.htm
http://www.consort-statement.org/index.aspx?o¼1346 http://www.cebm.net/index.aspx?o¼1023 http://www.consort-statement.org/ http://jama.ama-assn.org/cgi/content/full/283/15/2008
http://www.ada.org/prof/resources/ebd/glossary.asp http://www.jr2.ox.ac.uk/bandolier/glossary.html http://clinicalevidence.bmj.com/ceweb/resources/ glossary.jsp http://www.cebm.net/index.aspx?o¼1116 http://www.eboncall.org/CONTENT/glossary.htm http://www.shef.ac.uk/scharr/ir/def.html
Copyright Ó [2008] American Dental Association. All rights reserved. Reproduced by permission.
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 Volume 8, Number 3
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. 137
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REFERENCES: 1. Evidence-based Dentistry: Glossary of Terms. Available at: http://www. ada.org/prof/resources/ebd/resources.asp. Accessed March 28, 2008. 2. American 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. Feifer 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):235-45. 4. Helminen SE, Vehkalahti M, Murtomaa H. Dentists’ perception of their treatment practices versus documented evidence. Int Dent J 2002;52(2):71-4. 5. Ismail AI, Bader JD. Evidence-based dentistry in clinical practice. J Am Dent Assoc 2004;135(1):78-83. 6. Minton K. Perspective of a practicing dentist on the concept of evidence-based dentistry. Tex Dent J 2004;121(5):374-8.
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7. Iqbal A, Glenny AM. General dental practitioners’ knowledge of and attitudes towards evidence based practice. Br Dent J 2002; 193(10):587-91; discussion 83. 8. McKenna HP, Ashton S, Keeney S. Barriers to evidence-based practice in primary care. J Adv Nurs 2004;45(2):178-89. 9. Newman M, Papadopoulos I, Sigsworth J. Barriers to evidence-based practice. Intensive Crit Care Nurs 1998;14(5):231-8. 10. Hersh WR, Hickam DH. How well do physicians use electronic information retrieval systems? A framework for investigation and systematic review. JAMA 1998;280(15):1347-52. 11. Aurbach FE. Evidence-based dentistry: a practitioner’s perspective. J Am Coll Dent 1999;66(1):17-20. 12. Koch S. Designing clinically useful systems: examples from medicine and dentistry. Adv Dent Res 2003;17:65-8. 13. Forrest JL, Miller SA. Evidence-based decision making in dental hygiene education, practice, and research. J Dent Hyg 2001;75(1): 50-63.
September 2008
Multiple 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. Key Words: Evidence-based dentistry, Web sites, evidence locator.
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.5-9 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 Corresponding Author: Center for Evidence-based Dentistry; American Dental Association; 211 E. Chicago Ave; Chicago, IL 60011; o-312-4402519; f-312-440-2536; E-mail: [email protected].
J Evid Base Dent Pract 2008;8:133-138 1532-3382/$34.00 Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2008.05.013
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
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
TABLE 1. Evidence Locator Summaries of Systematic Reviews Resource
Link
EBD at ADA.org
www.ada.org/goto/ebd
Journal of Evidence-Based Dental Practice
http://journals.elsevierhealth.com/ periodicals/ymed
Database of Abstracts of Reviews of Effectiveness (DARE) National Library for Health—Oral Health Specialist Library Evidence-Based Dentistry journal (UK)
http://www.crd.york.ac.uk/CRDWeb/
Evidentista (Pan American Centers for Evidence-Based Dentistry) Agency for Healthcare Research and Quality (AHRQ) Bandolier: Dental and Oral Health
http://www.library.nhs.uk/oralhealth/
Information Available Summaries of dental systematic reviews published elsewhere (new ADA-sponsored critical summaries are under development); additional Web resources Summaries of dental systematic reviews, plus commentary and analysis; critical evaluations of published articles on various topics Structured abstracts of systematic reviews; includes commentary on overall review quality Structured abstracts of systematic reviews
http://www.nature.com/ebd/archive/ index.html http://us.evidentista.org/?o¼1026
Systematic review summaries/analyses.
http://www.ahrq.gov/clinic/epcquick.htm
Summaries of AHRQ evidence reports on dental caries, dental patients who are HIV positive, scaling and root planning therapy, and others Critical appraisals of systematic reviews and supporting studies on dental topics Abstracts and plain-language summaries of dental systematic reviews Evidence summaries from the Oral Health Specialist library grouped by topic and/or specialty area
Cochrane Oral Health Group
http://www.jr2.ox.ac.uk/bandolier/booth/ booths/dental.html http://www.ohg.cochrane.org/reviews.html
Centre for Evidence-Based Dentistry
http://www.cebd.org/?o¼1069
Clinical questions and answers grouped by topic area
Clinical Recommendations/Guidelines Resource National Guideline Clearinghouse ADA Evidence-Based Clinical Recommendations PubMed Clinical Queries (National Library of Medicine) National Institute for Health and Clinical Excellence (NICE) Centers for Disease Control and Prevention (CDC) Division of Oral Health Scottish Intercollegiate Guidelines Network Royal College of Surgeons (RCS) of England Agency for Healthcare Research and Quality (AHRQ)
Link
Information Available
www.guidelines.gov http://www.ada.org/prof/resources/ebd/ clinical.asp http://www.ncbi.nlm.nih.gov/entrez/query/ static/clinical.shtml#reviews http://www.nice.org.uk/guidance/index. jsp?action¼byTopic&o¼7298&set¼true http://www.cdc.gov/oralhealth/guidelines. htm
Clinical practice guidelines Evidence-based clinical recommendations on oral health topics, including topical fluoride and sealants Clinical practice guidelines grouped by category
http://www.sign.ac.uk/guidelines/published/ index.html#Dentistry http://www.rcseng.ac.uk/fds/clinical_ guidelines http://www.ahrq.gov/clinic/cpgsix.htm
SUMSearch
http://sumsearch.uthscsa.edu/
Centre for Evidence-Based Dentistry
http://www.cebd.org/?o¼1069
Clinical guidelines from UK on dental recall Guidelines developed by CDC and the Task Force on Community Preventive Services Clinical guidelines on dental topics available as full guidelines and in quick reference guide format Clinical guidelines on common clinical situations Clinical practice guidelines from the National Guideline Clearinghouse, Department of Health and Human Services, and AHRQ Searches free online resources—PubMed (Medline), Database of Abstracts of Reviews of Effectiveness (DARE), National Institutes of Health (NIH) Guidelines Clearinghouse—to retrieve systematic reviews and/or clinical guidelines. Guidelines and consensus statements
Systematic Reviews Resource
Link
EBD at ADA.org
www.ada.org/goto/ebd
Cochrane Oral Health Group (affiliated with the Cochrane Collaboration)
http://www.ohg.cochrane.org/reviews. html#reviews
134
Information Available Abstracts of published systematic reviews on dental topics grouped by clinical topic areas, listed in A-Z format; full text available for systematic reviews published by the Journal of the American Dental Association Systematic reviews from the Cochrane Oral Health Group (Continued )
September 2008
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
TABLE 1. Evidence Locator (Continued ) Systematic Reviews Resource PubMed systematic review search page EviDents Search Engine for EBD TRIP Database, Oral Health page SUMSearch
International Centre for Evidence-Based Oral Health (Eastman Dental Institute, UK) Google Scholar Centre for Evidence-Based Dentistry AHRQ Evidence-based Practice Center (EPC) Reports Netting the Evidence
Link
Information Available
http://www.ncbi.nlm.nih.gov/entrez/ query/static/clinical.shtml#reviews http://medinformatics.uthscsa.edu/EviDents/ http://www.tripdatabase.com/oral/ specialismhomepage.html http://sumsearch.uthscsa.edu/
http://www.eastman.ucl.ac.uk/pdarkins/ iceph/ http://scholar.google.com/ http://www.cebd.org/?o¼1069 http://www.ahrq.gov/clinic/epcindex. htm#oral http://www.google.com/coop/cse?cx¼ 004326897958477606950%3Adjcbsrxkatm
Systematic review abstracts, plus links to full-text copies where available. Searchable resource for systematic review abstracts and other studies Systematic reviews related to oral health Searches free online resources—PubMed (Medline), Database of Abstracts of Reviews of Effectiveness (DARE), NIH Guidelines Clearinghouse—to retrieve systematic reviews and/or clinical guidelines ‘‘Publications’’ link includes full-text systematic reviews on clinical topics Search tool for systematic reviews and other research Resources on dental systematic reviews Evidence-based reports on oral health topics Customized Google search engine devoted to evidence-based practice
Copyright Ó [2008] American Dental Association. All rights reserved. Reproduced by permission.
format.6,10 There are numerous online resources available for evidence-based dentistry. These resources can be categorized into at least 8 broad subjects (Tables 1 and 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 evidencebased 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, evidencebased 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. Volume 8, Number 3
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 135
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TABLE 2. Additional Resources Evidence-Based Centers Centre for Evidence-Based Dentistry Centre for Evidence-Based Medicine (Oxford University) Cochrane Collaboration Agency for Healthcare Research and Quality DSM-Forsyth Center for Evidence-Based Dentistry Centre for Health Evidence International Centre for Evidence-Based Oral Health (Eastman Dental Institute—London, UK) Evidentista (Pan American Centers for Evidence-Based Dentistry) Centre for Evidence-Based Medicine (University of Toronto, Canada) Journals Journal of Evidence-Based Dental Practice Evidence-Based Dentistry Evidence-Based Medicine Online Databases Cochrane Library PubMed (National Library of Medicine) TRIP Database, Oral Health page Database of Abstracts of Reviews of Effectiveness (DARE) National Guideline Clearinghouse Other Resources Evidence-Based Dentistry Resource Guide (Virginia Commonwealth University) Evidence-Based Medicine Resource Center Evidence-Based On Call Health Evidence Bulletins-Wales (oral health) PrimeAnswers Tutorials ScHARR Introduction to Evidence-based Practice on the Internet Evidence-Based Clinical Practice Tutorial (Miner Library) A Student’s Guide to the Medical Literature (University of Colorado Health Sciences Center) Evidence-Based Medicine: Finding the Best Clinical Literature (University of Illinois Library of the Health Sciences) Introduction to Evidence-Based Medicine (Duke University Medical Center Library and Health Sciences Library, UNC-Chapel Hill) PubMed Tutorial Using Numerical Results from Systematic Reviews in Clinical Practice SUNY Downstate Medical Center Evidence-Based Medicine Tutorial
http://www.cebd.org/ www.cebm.net http://www.thecochranelibrary.com http://www.ahrq.gov/clinic/epcix.htm http://www.forsyth.org/forsyth.asp?pg¼100111 http://www.cche.net/ http://www.eastman.ucl.ac.uk/pdarkins/iceph/ http://us.evidentista.org/?o¼1026 http://www.cebm.utoronto.ca/
http://www.elsevier.com/wps/find/journaldescription. cws_home/623234/description#description http://www.nature.com/ebd/index.html http://ebm.bmjjournals.com/ http://www.thecochranelibrary.com http://www.pubmed.com http://www.tripdatabase.com/oral/specialismhomepage. html http://www.crd.york.ac.uk/crdweb/ www.guidelines.gov http://www.library.vcu.edu/tml/bibs/ebd.html http://www.ebmny.org/ http://www.eboncall.org/ http://hebw.cf.ac.uk/oralhealth/index.html http://www.primeanswers.org/primeanswers/index.cfm http://www.shef.ac.uk/scharr/ir/netting/ http://www.urmc.rochester.edu/hslt/miner/resources/ evidence_based/index.cfm http://grinch.uchsc.edu/sg/index.html http://www.uic.edu/depts/lib/lhsp/resources/ebm. shtml http://www.hsl.unc.edu/services/tutorials/ebm/index. htm http://www.nlm.nih.gov/bsd/disted/pubmed.html http://www.annals.org/cgi/content/full/126/9/712 http://library.downstate.edu/EBM2/contents.htm (Continued)
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TABLE 2. Additional Resources (Continued) Resources for Critical Appraisal and Evidence Analysis Appraisal Tools—Critical Appraisal Skills Programme (CASP) AMSTAR (tool for the ‘‘assessment of multiple systematic reviews’’) Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group publications QUOROM Statement (‘‘Quality of Reporting of Meta-Analyses’’) Center for Evidence-Based Medicine, Critical Appraisal Tools CONSORT Statement (consolidated standards of reporting trials) Meta-analysis of Observational Studies in Epidemiology (MOOSE): A Proposal for Reporting Glossaries of Terms American Dental Association EBD Glossary of Terms Bandolier EBM Glossary British Medical Journal—Clinical Evidence Glossary Centre for Evidence-Based Medicine: Key Terms in Evidence-Based Practice Evidence-Based On Call (Glossary) Definitions of Evidence-Based Practice (University of Sheffield, UK)
http://www.phru.nhs.uk/Pages/PHD/resources.htm http://www.biomedcentral.com/1471-2288/7/10 http://www.gradeworkinggroup.org/index.htm
http://www.consort-statement.org/index.aspx?o¼1346 http://www.cebm.net/index.aspx?o¼1023 http://www.consort-statement.org/ http://jama.ama-assn.org/cgi/content/full/283/15/2008
http://www.ada.org/prof/resources/ebd/glossary.asp http://www.jr2.ox.ac.uk/bandolier/glossary.html http://clinicalevidence.bmj.com/ceweb/resources/ glossary.jsp http://www.cebm.net/index.aspx?o¼1116 http://www.eboncall.org/CONTENT/glossary.htm http://www.shef.ac.uk/scharr/ir/def.html
Copyright Ó [2008] American Dental Association. All rights reserved. Reproduced by permission.
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 Volume 8, Number 3
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. 137
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REFERENCES: 1. Evidence-based Dentistry: Glossary of Terms. Available at: http://www. ada.org/prof/resources/ebd/resources.asp. Accessed March 28, 2008. 2. American 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. Feifer 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):235-45. 4. Helminen SE, Vehkalahti M, Murtomaa H. Dentists’ perception of their treatment practices versus documented evidence. Int Dent J 2002;52(2):71-4. 5. Ismail AI, Bader JD. Evidence-based dentistry in clinical practice. J Am Dent Assoc 2004;135(1):78-83. 6. Minton K. Perspective of a practicing dentist on the concept of evidence-based dentistry. Tex Dent J 2004;121(5):374-8.
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7. Iqbal A, Glenny AM. General dental practitioners’ knowledge of and attitudes towards evidence based practice. Br Dent J 2002; 193(10):587-91; discussion 83. 8. McKenna HP, Ashton S, Keeney S. Barriers to evidence-based practice in primary care. J Adv Nurs 2004;45(2):178-89. 9. Newman M, Papadopoulos I, Sigsworth J. Barriers to evidence-based practice. Intensive Crit Care Nurs 1998;14(5):231-8. 10. Hersh WR, Hickam DH. How well do physicians use electronic information retrieval systems? A framework for investigation and systematic review. JAMA 1998;280(15):1347-52. 11. Aurbach FE. Evidence-based dentistry: a practitioner’s perspective. J Am Coll Dent 1999;66(1):17-20. 12. Koch S. Designing clinically useful systems: examples from medicine and dentistry. Adv Dent Res 2003;17:65-8. 13. Forrest JL, Miller SA. Evidence-based decision making in dental hygiene education, practice, and research. J Dent Hyg 2001;75(1): 50-63.
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