Strengths and Limitations of the Evidence-Based Movement Aimed to Improve Clinical Outcomes in Dentistry and Oral Surgery

2010 ◽  
pp. 149-171
Author(s):  
Pier Francesco Nocini ◽  
Giuseppe Verlato ◽  
Daniele De Santis ◽  
Andrea Frustaci ◽  
Giovanni De Manzoni ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Oral Surgery ◽  
Evidence Based

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

scholarly journals Evidence-Based Policy Making for Public Health Interventions in Cardiovascular Diseases: Formally Assessing the Feasibility of Clinical Trials

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Kathryn Foti ◽  
Randi E. Foraker ◽  
Pamela Martyn-Nemeth ◽  
Cheryl A.M. Anderson ◽  
Nancy R. Cook ◽  
...  
Keyword(s):  
Public Health ◽  
Clinical Outcomes ◽  
Sodium Intake ◽  
Cardiovascular Outcomes ◽  
Health Interventions ◽  
Evidence Based ◽  
Sodium Reduction ◽  
Public Health Interventions ◽  
Antihypertensive Medications ◽  
Evidence Based Policy

Implementation of prevention policies has often been impeded or delayed due to the lack of randomized controlled trials (RCTs) with hard clinical outcomes (eg, incident disease, mortality). Despite the prominent role of RCTs in health care, it may not always be feasible to conduct RCTs of public health interventions with hard outcomes due to logistical and ethical considerations. RCTs may also lack external validity and have limited generalizability. Currently, there is insufficient guidance for policymakers charged with establishing evidence-based policy to determine whether an RCT with hard outcomes is needed before policy recommendations. In this context, the purpose of this article is to assess, in a case study, the feasibility of conducting an RCT of the oft-cited issue of sodium reduction on cardiovascular outcomes and then propose a framework for decision-making, which includes an assessment of the feasibility of conducting an RCT with hard clinical outcomes when such trials are unavailable. We designed and assessed the feasibility of potential individual- and cluster-randomized trials of sodium reduction on cardiovascular outcomes. Based on our assumptions, a trial using any of the designs considered would require tens of thousands of participants and cost hundreds of millions of dollars, which is prohibitively expensive. Our estimates may be conservative given several key challenges, such as the unknown costs of sustaining a long-term difference in sodium intake, the effect of differential cotreatment with antihypertensive medications, and long lag time to clinical outcomes. Thus, it would be extraordinarily difficult to conduct such a trial, and despite the high costs, would still be at substantial risk for a spuriously null result. A robust framework, such as the one we developed, should be used to guide policymakers when establishing evidence-based public health interventions in the absence of trials with hard clinical outcomes.

17 Decannulation Following Tracheostomy in Children: A Systematic Review

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e11-e12
Author(s):  
Rahul Verma ◽  
Cora Mocanu ◽  
Jenny Shi ◽  
Michael Miller ◽  
Jackie Chiang ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Airway Obstruction ◽  
Clinical Outcomes ◽  
Tracheostomy Tube ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Evidence Based ◽  
Anatomic Site ◽  
Large Variability ◽  
Evidence Based Guidelines

Abstract Primary Subject area Respirology Background Despite the large morbidity and potential mortality associated with tracheostomy tube decannulation failure, there are currently no consensus guidelines on pediatric tracheostomy decannulation. This has led to wide practice variation that is largely based on expert option. This is the largest review of pediatric decannulation protocols. Objectives To systematically review the literature on existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes. Design/Methods Five online databases were searched for relevant studies from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Independent reviewers extracted data, including patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted, including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location and length of observation period, and clinical outcomes were also collected. Quality assessment of included studies was performed using the Newcastle-Ottawa Scale (NOS) tool. Descriptive statistical analyses were performed. Results Twenty-three studies with 1328 children were included (Figure 1). Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (37%), upper airway obstruction not at a well-defined site (13%), and need for long-term ventilation (50%). Bronchoscopy was routinely used in 96% of protocols. Tracheostomy tube modifications in the protocols included capping (83%), downsizing (57%), and fenestrations (9%). Measurements of gas exchange in the protocols included polysomnography (72%), oximetry (61%), blood gases (17%), and capnography with end-tidal CO2 (17%). After tracheostomy decannulation, children in 92% of protocols were transitioned to room air, and 38% of protocols used non-invasive ventilation. Most children (76%) were observed in hospital for 48 hours or less. Of all decannulation attempts, 79% were successful. Overall risk of bias in included studies was low. Conclusion The absence of clear evidence-based guidelines in pediatric tracheostomy decannulation has led to large variability in clinical practice. Most protocols include bronchoscopy, tube modifications, gas exchange measurements, and brief hospital admission. Polysomnography plays an integral role in assessing the majority of children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.

An Overview of Oral Surgery Journal’s Role in Evidence-Based Oral Care

2015 ◽  
Vol 8 (1) ◽  
pp. 45-46
Author(s):  
Nisha Rani Jamwal ◽  
Senthil P Kumar ◽  
Keyword(s):  
Oral Surgery ◽  
Oral Care ◽  
Evidence Based

scholarly journals 1089. Implementation of a Febrile Neutropenia Management Algorithm on Antibiotic Use and Outcomes: An Interrupted Time Series Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S386-S387
Author(s):  
Trang D Trinh ◽  
Luke Strnad ◽  
Lloyd E Damon ◽  
John H Dzundza ◽  
Larissa R Graff ◽  
...  
Keyword(s):  
Time Series ◽  
Febrile Neutropenia ◽  
Time Series Analysis ◽  
Clinical Outcomes ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Evidence Based ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Management Algorithm

Abstract Background Febrile neutropenia (FN) is a common complication of cancer therapy and often necessitates prolonged antibiotic treatment. Antibiotic de-escalation can be challenging given tenuous clinical status. Furthermore, a microbiological or clinical etiology is identified in a minority of FN patients. In 2016 we implemented several evidence-based strategies to guide antibiotic use in high-risk FN patients including specifying vancomycin use indications, minimizing carbapenem escalation in stable patients with ongoing fevers, and defining antibiotic durations regardless of neutrophil count. The study objective was to characterize and evaluate our experience implementing these strategies on antibiotic use and clinical outcomes. Methods Interrupted time series analysis of all admissions to the Malignant Hematology service at the University of California, San Francisco between June 2014 and December 2018. The primary outcome was monthly days of therapy (DOT) per 1,000 patient-days of broad-spectrum IV antibiotics (aztreonam, cefepime, piperacillin–tazobactam, meropenem, and vancomycin). Secondary outcomes included DOT/1,000 patient-days for each IV antibiotic, incidence rates of bloodstream infections (BSI) and C. difficile infections (CDI), and in-hospital all-cause mortality. A segmented regression analysis was conducted to evaluate the impact of the FN management algorithm implementation on antibiotic use and clinical outcomes. Summary statistics and time series scatter plots were used to visualize the trends and outliers. Results 2319 unique patients with 6,788 encounters were included. The median (IQR) age was 59 (46–68) years and 60% were male. Regression results and time series plots are shown in Table 1 and Figures 1–3. Conclusion Implementation of an evidence-based FN management algorithm led to decreased vancomycin and meropenem use without a statistically significant impact on overall antibiotic use, CDI rates, or mortality.While BSI rates fluctuated in the 2 months post-implementation, rates returned to baseline thereafter. A multidisciplinary effort facilitated successful implementation of this stewardship project. This collaboration remains essential to addressing future antimicrobial management strategies in this population. Disclosures All authors: No reported disclosures.

scholarly journals Information Retrieval and Awareness about Evidence-Based Dentistry among Dental Undergraduate Students—A Comparative Study between Students from Malaysia and Finland

2020 ◽  
Vol 8 (3) ◽  
pp. 103
Author(s):  
Pentti Nieminen ◽  
Eswara Uma ◽  
Sudipta Pal ◽  
Marja-Liisa Laitala ◽  
Olli-Pekka Lappalainen ◽  
...  
Keyword(s):  
Information Retrieval ◽  
Oral Surgery ◽  
Dental Education ◽  
Scientific Information ◽  
Data Retrieval ◽  
Dental Students ◽  
Evidence Based ◽  
Lecture Notes ◽  
Malaysian Students ◽  
Evidence Based Dentistry

Background: A fundamental skill in education includes the ability to search for, evaluate, and synthesize information, and this cannot be underestimated in dental education. The aim of this study was to assess how dental students from Malaysia and Finland acquire scientific information and to compare their information retrieval skills. Methods: Fourth and fifth-year dental students from Malaysia and Finland were invited to participate. A self-administered structured questionnaire including items about the use of information sources, subjective assessment of literature retrieval skills and knowledge was used. Results: A total of 226 dental students participated in the survey: 131 from Malaysia and 95 from Finland. In both countries, the highest interest for data retrieval among students was found in the oral surgery specialty. The three most used sources of information among Malaysian students were personal lecture notes, dental textbooks, and colleagues; while Finnish students used colleagues, lecture notes, and current clinical guidelines. Students’ knowledge of evidence-based practice was inadequate in both student groups. Though the majority of participants reported that they had good or passable skills in literature retrieval, more students from Finland judged themselves to have at least good skills compared to those from Malaysia. Conclusion: Dental education in both countries includes information retrieval studies and mandatory research projects. However, students did not often use those sources that are considered essential in evidence-based dentistry. Universities should further develop educational and training interventions that guide students to use knowledge resources more effectively for critically appraising scientific evidence.

scholarly journals Pathways, Outcomes, and Costs in Colon Cancer: Retrospective Evaluations in Two Distinct Databases

2011 ◽  
Vol 7 (3S) ◽  
pp. 52s-59s ◽  
Author(s):  
J. Russell Hoverman ◽  
Thomas H. Cartwright ◽  
Debra A. Patt ◽  
Janet L. Espirito ◽  
Matthew P. Clayton ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Electronic Health Records ◽  
Clinical Outcomes ◽  
Evidence Based ◽  
Health Records ◽  
Electronic Health

Retrospective evaluations of electronic health records and claims databases to assess clinical outcomes and costs associated with evidence-based pathways in colon cancer.

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