EBD for Dental Staff Seminar 1: Educational prescription,
structured questions and effective searching Dominic Hurst
[email protected] evidenced.qm
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Learning outcomes By the end of this seminar participants
should be able to: 1.Explain the concept of EBD comprising patient
values, clinicians expertise and research evidence 2.Demonstrate
how the educational prescription can form part of treatment
planning 3.Create a structured question using the PICO format
4.Identify key sources for identifying research evidence including
medical databases and search engines 5.Demonstrate some of the
common strategies for making a search efficient
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Structure of the seminars Seminar 1 Recap of EBD Using an
educational prescription Structured questions and search Seminar 2
Critical appraisal Seminar 3 Communicating evidence to patients
Getting evidence into practice Workshop Focused work on one or more
of these
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EBD Patients, clinicians and the role of research
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Context / Environment Shared decision- making
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Systematic reviews of RCTs Randomised controlled trials Cohort
studies Case-control studies Surveys, Case series Expert opinion /
lab or animal studies Evidence hierarchy Prevalence? Risk factors?
Prognosis? Qualitative?
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The ideal approach Ask a structured question Search for the
best evidence Appraise its validity and results Apply to patient
care (make an evidence-based decision with the patient) Evaluate
how it worked
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Realitylearning is haphazard GABBAY, J. & LE MAY, A. 2004.
Evidence based guidelines or collectively constructed "mindlines?"
Ethnographic study of knowledge management in primary care. BMJ,
329, 1013.
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Educational prescription Bringing research into clinical
decision-making
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What is it? Structured approach to help students: 1.Ask a
question that helps them 2.Search effectively for relevant research
that they 3.Critically appraise to determine whether they should
4.Use it with their patients in agreeing a way forward
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Brief description of the problem e.g. the patient I am treating
has tooth surface loss and seems to have GORD. I would like to know
how effective proton pump inhibitors are at controlling this and
what the side-effects might be Adult with GORD Proton pump
inhibitors Nothing 1) Tooth surface loss 2) harms?
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I think patients are likely to have less TSL because it seems
logical that if there is less acid reflux there should be less TSL.
Usually Cochrane +/- PubMed Can use medical or academic search
engines too e.g. Google Scholar or TRIP Database Intervention
Randomised controlled trial
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Harvard: HURST, D. 2014. Research and other evidence in
practice: the importance of our professional discourse and social
relationships. Evid Based Dent, 15, 34. High / medium / low risk of
bias? Why? External validity: is there something so different about
the participants in this study that means these results may not be
applicable to the patient(s) being treated in the setting where we
work? E.g. Number Needed to Treat (NNT), Absolute risk reduction
(ARR)
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Shared decision-making: Patient at centre: what are their
values and aims? How persuasive is the evidence? How has the
students / tutors experience and expertise influenced this?
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Assessment Case presentations 8-9/year 5 th year Course Unit
Assessment Finals cases Case Presentation Formative assessment
StudentTermDate Patient MRN GradeSatisfactoryUnsatisfactory
Feedback Content Reflection Evidence
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Case based discussions As part of case presentations and
discussions Helping students put the research into context Strength
of evidence Our experience and expertise Reflecting on patient
wishes
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Educational prescription and you 1.How might you use this?
2.What are the barriers to using it?
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evidenced.qm
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Structured questions Turning clinical problems into answerable
questions
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Why structure questions? Helps clarify the question Helps
create more effective search strategies
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PICO Think of a clinical situation where you have some
uncertainty over what is best to do P What is the core issue or
problem? Or which group of patients does it concern? Or which
population of people is it about? I/E What intervention are you
interested in knowing about, if at all? Or what has the patient or
population been exposed to? C Is there a comparison or control youd
like to compare the intervention or exposure to? O What outcome(s)
interests you?
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Effective searching Lifes too short: learning to find research
with minimal effort
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Where to search: Databases
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Where to search: medical search engines
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Where to search: Google.
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Strategy: Boolean logic PI / ECO GORDProton Pump
InhibitorNilTooth surface loss OR GERDOmeprazoleErosion OR
Gastro-oesophageal refluxLansoprazoleTooth wear OR
Gastro-esophageal reflux (GORD OR GERD OR Gastro-oesophageal reflux
OR Gastro-esophageal reflux) AND (Proton Pump Inhibitor OR
omeprazole OR Lansoprazole) AND [maybe] (Tooth surface loss OR
erosion OR tooth wear)
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Strategy: Filters
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Mobile TRIP
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More help?
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Key messages Research is just one part of decision-making, but
an important one The educational prescription provides a structure
to help students bring research into treatment planning Structured
questions help communication and searching Various databases and
search engines can be used to find research but use a strategy for
improved efficiency wherever searching