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EBP FOR D3s

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“

By all means let's be open-minded, but not soopen-minded that our brains drop out.” 

~Richard Dawkins

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Learning Objectives

!  Why write?

!  The ABCs of EBP

!  The D3 risk assessment portfolio evidence-based

PICO project

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Goals of D3 Patient Report

!  Identify a patient who presents with a topic uniqueto practice of general dentistry

!  Assess patient and record findings

!  Assess proper course of care based on literature

review

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Why Write?

!  Communication skills

!  How much do you know?

!  EBP

!  Critical thinking

!  Knowledge synthesis

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Are you sure?

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TMI

!  MEDLINE:

!  4,000 journals

!  6 million references

!  400,000 new entries yearly

American Dental Association (2009). Final_EBD_-_Intro_for_Champions_120909. The Evidence-

Based Dentistry Champion Conference. ADA Headquarters, Chicago, IL.

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What is EBP? (NOT!)

!  Evidence based practice is not. . .

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EBP According to the ADA

!  “An approach to oral health care that requires

the judicious integration of systematic

assessments of clinically relevant scientific

evidence, relating to the patient's oral andmedical condition and history, with the dentist's

clinical expertise and the patient's treatment

needs and preferences.” 

American Dental Association (n.d.) Evidence-Based Dentistry: Glossary of Terms. Retrieved March

5, 2009 from the World Wide Web: http://ada.org/prof/resources/ebd/glossary.asp#ebd

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What Does That Mean?

Decision

Patient’sneeds

Best

availableevidence

Practitioner’sclinical expertise

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What’s the Difference?

EBP!  Best evidence

!  Systematic search andappraisal

!  Objective & unbiased

! Acceptable level ofuncertainty

BAU!  Who needs evidence?

!  Random search, limitedappraisal

!  Subjective & potentially

biased

!  Inappropriate level of

certainty

American Dental Association (2009). Final_EBD_-_Intro_for_Champions_120909. The Evidence-

Based Dentistry Champion Conference. ADA Headquarters, Chicago, IL.

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The Five “A”s of EBP

!  Ask – Determine the clinical question

!  Acquire – Systematically search the literature

!  Appraise – Critically appraise the literature

!  Apply – Make a decision

!  Assess – Evaluate the results

Centre for Evidence-Based Dentistry (2007). Introduction to practising Evidence-based dentistry.

Retrieved March 5, 2009 from the World Wide Web: http://www.cebd.org/index.aspx?o=1007

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Evidence Based Written Project

!  D3 – First 3 A’s

!  Ask

!  Acquire

!  Appraise

!  D4 – All 5 A’s

!  Ask

!  Acquire!  Appraise

!  Apply

!  Assess

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Hierarchy of evidence

Retrieved January 12, 2010 from the World Wide Web: http://libguides.uttyler.edu/

content.php?pid=4904&sid=30812

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D3 Patient Report

!  Ask – PICO format, identify clinical question

!  Acquire – Identify search strategy

! Appraise – Literature analysis

!  Synthesize

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A #1 – Asking Focused Questions

! Patient or Problem 

! Intervention 

! Comparison 

! Outcomes 

Centre for Evidence-Based Medicine (2009). Asking Focused Questions. Retrieved March 5, 2009

from the World Wide Web: http://www.cebm.net/index.aspx?o=1036

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PICO Example

! P – Adult human patients 

! I  – Chairside tooth whitening 

! C – At-home tooth whitening 

! O – Lighter teeth 

h // di f i h d /

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http://medinformatics.uthscsa.edu/

EviDents

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Clinical Question

!  In adult human patients, is chairside tooth

whitening more effective than at-home tooth

whitening in producing lighter teeth?

50 ld i ll d l

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"#$%&'(#)

*)+,-.,)(#) /#0$'-12#)

50 yr old partially edentulous

woman who smokes tobacco

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No!"#$%&'(#) 3 "'-('&&4

,5,)+%&#%2 '5%&+2 67#

20#8,

*)+,-.,)(#) 3

9,)+'& 10$&')+

/#0$'-12#) 3

:#);20#8,-2

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Yes"#$%&'(#) 3 "'-('&&4

,5,)+%&#%2 '5%&+2 61+7

5,)+'& 10$&')+2*)+,-.,)(#) 3

<0#81)=

/#0$'-12#) 3

:#+ 20#81)=

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Yes"#$%&'(#) 3 "'-('&&4

,5,)+%&#%2 '5%&+

20#8,-2

*)+,-.,)(#) 3

*0$&')+

/#0$'-12#) 3

:# 10$&')+

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A #2 – Acquire

!  Systematically search the literature

!  PubMed

!  Describe your search strategy

!  Flowchart

!  Appendix – screen capture search strategy

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Flowchart of Search Strategy

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A #3 - Appraise

!  Critically appraise the literature

!  LAFs – appendix

!  At least one page per article – use effective prose

to convey empirical evidence

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Sections of the paper

!  Introduction of clinical question

!  Literature review

!  Description of patient

!  Discussion of positive findings

!  Conclusion and recommendations for treatment,

based on literature

!  References

!  Appendices

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!  Crop

!  Remove extraneous

info

!  HIPAA

Photography

!  Retract

!  Focus

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Photography

!  http://iti.articulate-online.com/p/5051944432/DocumentViewRouter.ashx?

Cust=50519&DocumentID=b879d225-602e-4e3a-

a92c-3fe83a6e2654&Popped=True&&InitialPage=player.html 

!  Dr. Rebecca Poling

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Be thorough!

!  Look for Preparation and Presentation of the D3Patient Report in Comprehensive Patient Care

syllabus

!  Refer to grading sheet for format!  Table of contents

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NYU Writing Center

!  http://www.nyu.edu/cas/ewp/html/

writing_center.html

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PLAGIARISM!

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Turnitin.com

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Turnitin.com

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Turnitin.com

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Plagiarism Tutorial

!  http://www.umuc.edu/writingcenter/plagiarism/

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Coherence

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Deadlines

!  November 18, 2013 – PICO and Clinical question

!  December 16, 2013 – Search strategy and articles

!  January 21, 2014 – Risk Assessment Portfolio

Evidence-Based PICO Project due

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“If you always do what you’ve always done,then you always get what you always got.” 

~Special Agent Anthony DiNozzo, (2006)

“Twisted Sister.

” NCIS, USA Network.

Brain Surgeon

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Brain SurgeonThat Mitchell & Webb Look , Series 3(2) - BBC Two 

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Questions?