systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, together with the
dentist’s clinical expertise and
the patient’s treatment needs and preferences.
the effects of therapy
the utility of diagnostic tests
the prognosis of diseases
the etiology of disorders
Using PICO format, P ( Patient / Problem / Population ), I ( Intervention ), C ( Comparison ), O ( Outcome )
Ideally, you would like to find a systematic review to answer your question. Systematic reviews are often referred to as “Level I Evidence”.
Unfortunately, there aren’t systematic reviews to answer every clinical question
Databases to locate evidence, PubMed, Cochrane Library, TRIP Database, DARE (Database of Abstracts of Reviews of Effectiveness), National Guideline Clearinghouse
Different types of clinical questions are best answered by different types of research studies., All Clinical Questions = Systematic review, meta-analysis, Therapy = Randomized controlled trial (RCT)Also: cohort study, case-control study, case series, Etiology or harm = Cohort studyAlso: case-control study, case series, Diagnosis = Validating cohort study with goldstandards / Prospective studies, Prevention = Randomized controlled trial (RCT), Also: prospective study, cohort study, case-control study, case series, Prognosis = Cohort study / Also: case-control study, case series
Questions generated about: •the effects of therapy •the utility of diagnostic tests •the prognosis of diseases •the etiology of disorders
Summarise the results of all the articles (like Evidence based tables in systematic reviews)
Evaluate your performance with this patient.
Evaluate the decision with similar patients
Update the evidence –if needed.