Evidence-Based Clinical Decisions in Oral Surgery

2010 ◽  
pp. 107-130 ◽  
Author(s):  
Oladimeji Adeniyi Akadiri ◽  
Wasiu Lanre Adeyemo
Keyword(s):  
Oral Surgery ◽  
Evidence Based ◽  
Clinical Decisions

scholarly journals EBP e-Toolkit: Providing a Teaching and Learning Open and Innovative Toolkit for Evidence-Based Practice to Nursing European Curriculum – the second transnational project meeting in Warsaw

2019 ◽  
Vol 18 (3) ◽  
pp. 197-199
Author(s):  
Mariusz Panczyk ◽  
Joanna Gotlib
Keyword(s):  
Clinical Practice ◽  
Nursing Students ◽  
Teaching And Learning ◽  
Research Evidence ◽  
European Federation ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Clinical Decisions ◽  
Learning Tools ◽  
Efficient Option

AbstractIntroduction. Although European healthcare systems differ from country to country, almost all are currently going through profound changes and are becoming increasingly complex. New tasks and growing social expectations towards healthcare build high expectations of medical professionals regarding their competences. Knowledge and skills allowing for choosing the safest and most efficient option for patient care are particularly welcome. The idea of Evidence-based Nursing Practice (EBP) combines the best available research evidence on the one hand and clinical expertise and patients’ expectations on the other, allowing for solving problems in making clinical decisions. EBP is a tool used for making clinical decisions in nursing care that helps to reduce the cost of healthcare by increasing efficiency and safety. Under the Directive 2013/55/EU European Federation of Nurses Associations developed qualifications framework that provides requirements for nursing training, with the ability to apply research evidence in clinical practice being one of its key elements. Despite the aforementioned recommendations, the actual implementation of EBP into clinical practice is hindered by various obstacles. In addition, the existing European resources enhancing EBP teaching for nursing students are very limited.Summary. The EBP e-Toolkit Project is a response to high needs of the academic world and nursing practitioners, involving six institutions whose cooperation and expertise aim to ensure the development and implementation of high-quality learning tools tailored to the educational needs of modern nursing personnel. The six higher education institutions that jointly implement the aforementioned project involve: the University of Murcia (coordinating institution, Spain), Technological Educational Institute of Crete (Greece), University of Modena e Reggio Emilia (Italy), University of Ostrava (Czech Republic), Medical University of Warsaw (Poland), and Angela Boskin Faculty of Health Care (Slovenia).

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

Medical ethics

2020 ◽  
pp. 20-25
Author(s):  
Mike Parker ◽  
Mehrunisha Suleman ◽  
Tony Hope
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Critical Assessment ◽  
Best Interests ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Ethical Aspects ◽  
Scientific Medicine ◽  
Critical Skills ◽  
Based Medicine

Medicine is both a scientific and a moral enterprise. It is as important to give reasons for the ethical aspects of clinical decisions as it is for the scientific aspects. The corollary of evidence-based medicine is reason-based ethics. Two concepts central to many ethical aspects of clinical practice are autonomy and best interests. Evidence-based medicine emphasizes the importance of critical assessment: interventions should be evaluated on the basis of evidence, not tradition. Critical skills are therefore crucial to modern scientific medicine. Importantly, medicine is a moral enterprise as well as a scientific one. Many clinical decisions involve a combination of factual and ethical aspects. It is as important to be able to give good reasons for the ethical aspects of clinical decisions as it is for the science. Society increasingly expects this from doctors as part of transparent decision-making.

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.

Advancing evidence-based decisions in the management of EGFR-mutated metastatic NSCLC.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20663-e20663
Author(s):  
Tara Herrmann ◽  
Martin Warters ◽  
Douglas Blevins ◽  
Panos Fidias
Keyword(s):  
Learning Experience ◽  
Patient Simulation ◽  
Treatment Resistance ◽  
Educational Interventions ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Decisions ◽  
First Line ◽  
Metastatic Nsclc ◽  
Egfr Mutated

e20663 Background: In patients diagnosed with metastatic NSCLC it is now essential to identify targetable mutations and markers of treatment resistance in order to determine the appropriate therapy. A study was conducted to determine if simulation-based educational interventions to address clinical practice gaps could improve decisions of oncologists in the management of EGFR-mutated metastatic NSCLC. Methods: A cohort of US-oncologists who participated in a virtual patient simulation (VPS)-based education was evaluated. The VPS consisted of 2 cases that allowed oncologists to assess the patient and choose from a database of diagnostic possibilities matching the scope and depth of practice. Clinical decisions were analyzed using a decision engine, and instantaneous clinical guidance (CG) employing current evidence-based and expert faculty recommendations was provided after each decision. Oncologists were allowed a second chance at each decision point and decisions before and after CG were compared using a 2-tailed paired T-test to determine differences from pre- to post CG. P values are shown as a measure of significance; with P < .05 statistically significant. Results: 197 oncologists made clinical decisions within the simulation. As a result of CG, significant improvements were observed in: Ordering EGFR mutational testing (16%, P= 0.008) and making an accurate diagnosis (36%) Selecting an EGFR TKI in the first-line setting (24%, P< 0.001) Ordering a PET scan to assess disease progression (10%) and in diagnosing patients with EGFR T790M disease that is resistant (29% , P< 0.001) Evidence-based treatment selection for individuals whose disease progressed on first-line therapy (19%, P= .003) Number of oncologists who ordered adverse event education and counseling (23%, P< .001) Conclusions: This study showed improvements in evidence-based practices of oncologists in the diagnosis and management of EGFR-mutated NSCLC; demonstrating that VPS-based instruction that immerses and engages oncologists for an authentic, practical and16. consequence-free learning experience can result in an increase in appropriate clinical decisions. Therefore, VPS may have a role in improving the quality of patient care.

scholarly journals Medical Simulation in Relapsed Follicular Lymphoma Improves Clinical Decision Making of Hematologists/Oncologists

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-34
Author(s):  
Lauren Willis ◽  
Donna Topping ◽  
Sarah Atwood ◽  
Jonathon B. Cohen
Keyword(s):  
Decision Making ◽  
Follicular Lymphoma ◽  
Treatment Option ◽  
Clinical Decision Making ◽  
Response Rates ◽  
Clinical Decision ◽  
Evidence Based ◽  
Cell Transplant ◽  
Clinical Decisions ◽  
Appropriate Treatment

Background: Frontline treatment of follicular lymphoma (FL) yields high response rates, but most patients relapse. In addition, response rates and duration of response have historically declined with subsequent treatments. These factors make management of this disease challenging. Therefore, this study was conducted to determine if an online, simulation-based continuing medical education (CME) intervention could improve clinical decision making of hematologists/oncologists (hem/oncs) regarding treatment selection for relapsed/refractory (R/R) FL. Description of Intervention: A CME certified virtual patient simulation (VPS) was made available via a website dedicated to continuous professional development. The VPS consisted of 2 cases of R/R FL presented in a platform that allows hem/oncs to assess the patients and make diagnostic and therapeutic decisions supported by an extensive database of diagnostic and treatment possibilities, matching the scope and depth of actual practice. Case 1: Patient with FL who failed 2 prior lines of therapy (R-CHOP, bendamustine/obinutuzumab), past medical history (PMH) well controlled hypertension and poorly controlled type 2 diabetes, presenting with constitutional symptoms and needs 3rd line treatment. Case 2: Patient with FL who failed 2 prior lines of therapy (bendamustine/rituximab, lenalidomide/rituximab), PMH well controlled atrial fibrillation and ulcerative colitis, patient requests intravenous therapy because he has trouble remembering to take oral medications. Methods: Clinical decisions were analyzed using a sophisticated decision engine, and tailored clinical guidance (CG) employing up-to-date evidence-base and faculty recommendations was provided after each decision. Decisions were collected post-CG and compared with each user's baseline (pre-CG) decisions using McNemar's test to determine p-values (P &lt; .05 indicates significance). Data were collected between 11/20/19 and 2/19/20. Results: At the time of assessment, 154 hem/oncs who made clinical decisions were included in the analysis. From pre- to post-CG in the VPS, hem/oncs were more likely to make evidence-based practice decisions in: -Diagnosing patients with relapsed FL: 55% pre-CG and 73% post-CG (P &lt; 0.001) -Starting an appropriate treatment for a patient with R/R FL ----Case 1: Ordering idelalisib: 7% pre-CG and 33% post-CG (P &lt; 0.001) ----Case 1: Ordering lenalidomide + rituximab: 6% pre-CG and 28% post-CG (P &lt; 0.001) ----Case 1: Ordering duvelisib: 2% pre-CG and 9% post-CG (P &lt; 0.001) ----Case 2: Ordering copanlisib: 32% pre-CG and 73% post-CG (P &lt; 0.001) The top rationales for selecting an appropriate treatment option were: recommended by guidelines, convenience of administration route, better efficacy compared to other agents, and best option based on patient comorbidities. Other relevant concomitant therapies ordered were consult for chimeric antigen receptor (CAR) T-cell therapy, consult for stem cell transplant, radiation therapy, refer to a clinical trial, and Pneumocystis jirovecii pneumonia (PJP) prophylaxis (Figure 1). Conclusion: This study demonstrates that VPS that immerses and engages hem/oncs in an authentic and practical learning experience improved evidence-based clinical decisions related to the management of R/R FL. This VPS increased the percentage of heme/oncs who correctly diagnosed R/R FL and selected an appropriate treatment option. This study indicates that unique educational methodologies and platforms, which are available on-demand, can be effective tools for promoting guideline-based therapy selection and clinical decision making. Acknowledgement: This CME activity was supported by an independent educational grant from Bayer, Celgene Corporation, and Verastem Oncology. Jake Cohen contributed to data analysis for this research. Reference: https://www.medscape.org/viewarticle/915986 Figure Disclosures Cohen: Janssen, Adicet, Astra Zeneca, Genentech, Aptitude Health, Cellectar, Kite/Gilead, Loxo: Consultancy; Genentech, BMS, Novartis, LAM, BioInvent, LRF, ASH, Astra Zeneca, Seattle Genetics: Research Funding.

scholarly journals “Evidence-Based Dentistry in Oral Surgery: Could We Do Better?”

2010 ◽  
Vol 4 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Pier Francesco Nocini ◽  
Giuseppe Verlato ◽  
Andrea Frustaci ◽  
Antonio de Gemmis ◽  
Giovanni Rigoni ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Evidence Based Medicine ◽  
Oral Surgery ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Research Problems ◽  
Cad Cam ◽  
The Moment ◽  
Based Medicine ◽  
Evidence Based Dentistry

Evidence-based Dentistry (EBD), like Evidence-based Medicine (EBM), was born in order to seek the “best available research evidence” in the field of dentistry both in research and clinical routine.But evidence is not clearly measurable in all fields of healthcare: in particular, while drug effect is rather independent from clinician’s characteristics, the effectiveness of surgical procedures is strictly related to surgeon’s expertise, which is difficult to quantify. The research problems of dentistry have a lot in common with other surgical fields, where at the moment the best therapeutic recommendations and guidelines originates from an integration of evidence-based medicine and data from consensus conferences.To cope with these problems, new instruments have been developed, aimed at standardizing clinical procedures (CAD-CAM technology) and at integrating EBM achievements with the opinions of expert clinicians (GRADE System).One thing we have to remember however: it is necessary to use the instruments developed by evidence-based medicine but is impossible to produce sound knowledge without considering clinical expertise and quality of surgical procedures simultaneously. Only in this way we will obtain an evidence-based dentistry both in dental research and clinical practice, which is up to third millennium standards.

scholarly journals Harnessing Expert Judgment to Support Clinical Decisions When the Evidence Base Is Weak

2018 ◽  
Vol 39 (1) ◽  
pp. 74-79 ◽  
Author(s):  
James G. Dolan ◽  
Peter J. Veazie
Keyword(s):  
Formal Method ◽  
Probability Distributions ◽  
Evidence Base ◽  
Outcome Data ◽  
Professional Judgment ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Mean Values ◽  
Evidence Summary ◽  
Important Health

Purpose. In the process of developing an evidence-based decision dashboard to support treatment decisions for patients with newly diagnosed prostate cancer, we found that the clinical evidence base is insufficient to provide high-quality comparative outcome data. We therefore sought to determine if clinically acceptable outcome estimates could be created using a modified version of the Sheffield Elicitation Framework (SHELF), a formal method for eliciting judgments regarding probability distributions of expected decision outcomes. Methods. We asked a panel of 3 urologists, 4 radiation oncologists, and 2 medical oncologists to estimate the probabilities of 11 treatment outcomes based on their clinical experience and an annotated evidence summary. The estimates were elicited using a Microsoft Excel spreadsheet containing a self-guided, adapted version of the SHELF Roulette method distributed via email. We created combined outcome estimates by taking the mean values of the panel members’ upper and lower 95% bounds for each outcome. The combined estimates were then distributed via email to the panel for final approval. Results. Eight of the 9 responses were judged to be correct applications of the SHELF method and included in the combined outcome estimates. The final set of outcome estimates was unanimously accepted by the clinician panel members and used to create a decision dashboard suitable for clinical use and evaluation. Conclusions. Many important health care decisions need to be made in situations where the evidence base is inadequate. Use of a formal protocol for eliciting expert judgments is feasible and can be used to promote evidence-based practice by providing a powerful tool to facilitate the combination of professional judgment with research evidence and patient preferences to guide clinical decisions.

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