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What is Evidence-based Decision Making?
Mosby's Dental Dictionary defines evidence-based decision making as: a type of informal decision-making that combines clinical expertise, patient concerns, and evidence gathered from scientific literature to arrive at a diagnosis and treatment recommendation.
Or more graphically:
There are five elements to the approach:
1) Question Develop a clear question based on the patient's clinical problem. (PICO)
2) Find Find the latest evidence through efficient searching for information (articles, guidelines,
systematic reviews, etc.)
3) Appraise Critically appraise the evidence to assess its value (critical thinking)
4) Act Act on the evidence you find, if appropriate and relevant to the clinical situation to provide
treatment for the patients (i.e. add your expertise and the patient's concerns to the
evidence)
5) Evaluation Evaluate each aspect of your perfomance in this process (double-check that you did
each process thoroughly and properly)
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Find The Evidence
Choose the highest level of evidence. Start at the top of the pyramid and work your way down. Does Cochrane's have a systematice review? If not, is there another systematic review out there? If not, are there randomized controlled trial articles? If not, is there a case study? The top four tiers are secondary evidence -- information has been appraised and filtered. The fifth tier (Control Studies) indicates primary evidence. These are not filtered so try for peer reviewed articles.
Hierarchy of Evidence
If you can't find a systematic review then which of the controlled studies should you look at? Randomized controlled trials or Cohort controlled trials? Use the list below to choose.
If your question type is: Then find:
Therapy Randomized controlled trial (double-blind preferable)
Selected Websites
Evidence-based Dentistry
ADA Center for Evidence-Based Dentistry
Centre for Evidence-based Dentistry
EBD Tutorial
Introduction to Evidence-Based Dentistry
Help/Tutorials
How to Read a Scientific Journal
A short and fun guide to making sense of scholarly articles.
The Little Handbook of Statistical Practice
Explanations of what statistical information is really telling you
Dental Anatomy
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Looking for Research Articles?
Start with these Electronic Resources/Databases
- CINAHL with Full Text
Many full-text articles. Focus is on patients so use CINAHL when you need to find information on how people and dentistry interact. For example, dental hygienist occupational stress or nutrition and dental caries. CINAHL will give you fewer dental hygiene related articles than Medline, but more full-text. - Medline (EBSCOhost)
No full-text on its own – but there are lots of links to other database articles. Medline focuses on biomedical research. Use when you need to find research information on interactions, effects, diagnoses, behaviors, etc. For example, the effect of fluoride or prevalence of caries in a certain group.
- PubMed uses the same data that Medline does but is free to anyone. The searching interface may not be as easy as EBSCOhost’s but if you learn how to use PubMed, you can get the same results. The link above will allow you to be told if Oregon Tech Library has the article in one of its databases. PubMed links to open access articles so there is some full-text.
- Cochrane Library
Cochrane Library is primarily used for its database of systematic reviews. Use this when looking for evidence-based information. It also has many clinical trial articles, technology assessments, and economic evaluations. - SMART (Imagebase)
When you need an illustration for your report, try here. Academic Search Premier also has an image search.
For other medical and allied health databases, go to: http://www.oit.edu/libraries/find/articles/subject/healthmed
Specific Journal Articles on Evidence-based Decision Making
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Develop The Question
PICO
P – Patient or Problem How would you describe the patient or problem to a colleague?
What are the most important characteristics?
I – Intervention or Exposure What do you want to do for the patient?
C – Comparison or Control What is the main alternative to compare to?
(Another treatment, placebo, surgery? -- this can be
optional)
O – Outcome What do you want to accomplish, improve, or affect? Needs to be
measurable.
Types of clinical questions
Therapy (RCT) Determining the effect of different treatments on improving patient
function or avoiding adverse events
Harm (RCT/Cohort) Ascertaining the effects of potentially harmful agents
(including therapies) on patient function, morbidity, and mortality
Diagnosis (Compare to Gold Standard) Establishing the power of an intervention to differentiate between
those with and without a target condition or disease
Prognosis (Cohort) Estimating the future course of a patient’s disease
PICO Worksheet and Search Strategy
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