Evidence-Based Practice: Toward Optimizing Clinical Outcomes (eBook)

Evidence-Based Practice: toward Optimizing Clinical Outcomes 2
Copyright 4
Foreword 5
References 7
Preface 8
References 9
Acknowledgements 10
Contents 11
PART 1: The Science of Research Synthesis in Clinical Decision-Making 13
1: Introduction: Research Synthesis in Evidence-Based Clinical Decision-Making 14
1.1 .Introduction: Evidence-Based Health Care 14
1.1.1 .The Example of Dentistry 14
1.2 .Probabilistic Models for Clinical Decision Making 17
1.3 .Logic Evidence-Based Decisions in Clinical Practice 20
1.4 .Conclusions 24
References 26
2: Overview, Strengths, and Limitations of Systematic Reviews and Meta-Analyses 28
2.1 .Introduction 28
2.1.1 .Background 29
2.1.2 .Overview of Statistical Terms and Approaches 31
2.1.2.1 .Continuous Data 31
2.1.2.1.1 .Heterogeneity 32
2.1.2.1.2 .Meta-Regression 33
2.1.2.1.3 .Funnel Plots to Measure Bias 34
2.1.2.2 .Categorical Data 35
2.1.2.3 .Time to Event Data 37
2.1.3 .Other Tests in Meta-Analysis 37
2.1.3.1 .Test for Interaction 37
2.1.3.2 .Test for Trend 38
2.1.3.3 .Sensitivity Analysis and “File-Drawer Effect” 38
2.1.4 .Statistical Techniques to Account for Study Size and Quality 39
2.1.4.1 .Weighing of Evidence 39
2.1.4.2 .Random Effects 40
2.1.4.3 .Random Effects vs. Fixed Effects 41
2.1.5 .Bayesian Meta-Analysis 41
2.2 .Discussion 43
2.2.1 .Conclusion and Resources 43
References 44
3: Understanding and Interpreting Systematic Review and Meta-Analysis Results 45
3.1 .Introduction 45
3.1.1 .Example: Studies Characteristics and Descriptive Results 46
3.2 .Main Results: Overall Estimates of Effect 46
3.3 .Forest Plots 48
3.4 .Exploring Heterogeneity 49
3.5 .Fixed-Effects vs. Random-Effects 50
3.6 .Meta-Regression 51
3.7 .Funnel Plots and Publication Bias 53
3.8 .Exploring Influential Studies 57
3.9 .The Cochrane Collaboration Forest Plot 58
3.10 .Standardized Mean Differences 58
3.11 .Dichotomous Outcomes 58
3.12 .Concluding Remarks 59
References 60
PART 2: Making Evidence-Based Decisions 61
4: Making Evidence-Based Decisions in Nursing 62
4.1 .Introduction 62
4.1.1 .How Do Nurses Make Clinical Decisions? 63
4.2 .Why Is It Important to Nursing? 64
4.3 .Translating Knowledge Development into Knowledge Use 66
4.3.1 .Identifying the Issue 66
4.3.2 .Finding and Evaluating the Evidence 67
4.3.3 .Making the Change 69
4.3.4 .Evaluation and Maintenance 70
4.4 .Summary 71
4.5 .Addendum 72
References 73
5: A Model for Implementing Evidence-Based Decisions in Dental Practice 76
5.1 .Introduction 76
5.2 .Development of the Evidence-Based Model 76
5.2.1 .PICO Question 77
5.2.2 .Search Process and Selection of the Studies 77
5.2.3 .Appraisal of the Studies Selected 77
5.2.4 .Statistical Analysis 79
5.3 .Results from Assessment of the Effectiveness and Methodological Quality of SRs 79
5.3.1 .Main Results of the Studies Selected 80
5.3.2 .Agreement Between Referees 80
5.3.3 .Methodological Quality of SRs 80
5.4 .Applying Evidence in a Clinical Setting 80
5.4.1 .Decision Tree Approach 81
5.4.2 .Advantages of Decision Trees 81
5.5 .Discussion 81
5.6 .Grading the Quality of Evidence and the Strength of Recommendations 83
5.6.1 .SORT 83
5.6.2 .GRADE 83
5.6.3 .The Usefulness of Both Systems in Dentistry 84
5.7 .Economic Evaluation of Dental Health Services 84
5.7.1 .The Rationale for Incorporating Costs in the Decision-Making Process 84
5.7.2 .Cost-Effectiveness Analysis vs. Cost–Utility Analysis 84
5.7.3 .Decision Analytical Modeling 85
5.7.4 .Incremental Cost-Effectiveness Ratios (ICERs) 86
5.8 .Conclusions 86
References 86
6: Evidence-Based Decisions in Human Immunodeficiency Virus Infection and Cardiac Disease 88
6.1 .Epidemiology 88
6.2 .Pericarditis 89
6.3 .Coronary Artery Disease 89
6.3.1 .Clinical Features of CAD in HIV Patients 89
6.3.2 .Cardiovascular Risk Factors in HIV Patients 90
6.3.3 .Pathogenesis of Atherosclerosis in HIV Patients 91
6.3.4 .Endothelial Dysfunction and HIV Infection 91
6.3.5 .Endothelial Dysfunction and HIV Medications 91
6.3.6 .Surrogate Measurement of Atherosclerosis in HIV Patients 92
6.3.6.1 .Carotid Intima-Media Thickness (IMT) 92
6.4 .Metabolic Abnormalities Associated with Antiretroviral Therapy 92
6.5 .Treatment of Coronary Risk Factors in HIV Patients 93
6.6 .Myocardial Disease 94
6.7 .Pulmonary Hypertension 94
6.8 .Valvular Disease 95
6.9 .Cardiac Tumors 95
6.10 .Long QT Syndrome 95
6.11 .Autonomic Dysfunction 95
6.12 .Peripheral Arterial Disease 96
References 96
7: Bringing Evidence Basis to Decision Making in Complementary and Alternative Medicine (CAM): Prakriti (Constitution) Analysis 100
7.1 .Introduction 100
7.2 .Ayurveda: The Science of Life: Background 101
7.2.1 .Concept of ...Prakriti... in Ayurveda: The Empirical Basis 102
7.2.1.1 .Conceptual Evolution of Fundamentals in Ayurveda 103
7.2.1.2 ..Prakriti.: The Proto Typical Composition 104
7.2.1.3 .Linking .Prakriti. with .Tridosha.: Understanding Ayurvedic Physiology 105
7.3 .Evidence Basis to .Prakriti.: The Scientific Correlates 106
7.3.1 .Mechanism of .Prakriti. Determination Through Cellular Differentiation 106
7.3.2 .Mechanism of Cell Differentiation: Ayurvedic View 107
7.3.3 .Evidences from the Genomic Studies 107
7.4 .Clinical Application of .Prakriti. Identification: Translating Theory into Practice 108
7.4.1 .Approaching .Prakriti. Identification in Clinic: Where is the Tool of Practice? 109
7.4.2 .Diagnosing .Prakriti.: The Retrospective Approach 110
7.5 .Conclusion: Steps Ahead Toward an Evidence-Based Ayurveda 114
References 115
8: Evidence-Based Clinical Decisions in Oral Surgery 116
8.1 .Introduction 116
8.2 .Evidence-Based Decisions in Third Molar Surgery 116
8.2.1 .Removal of Impacted Mandibular Third Molar 117
8.2.2 .Imaging Techniques in Third Molar Management 118
8.2.3 .Evaluation of Surgical Difficulty 119
8.2.4 .Prophylactic Use of Antibiotics 120
8.2.5 .Control of Postoperative Pain, Swelling, and Trismus 122
8.2.6 .Prevention of Lingual Nerve Injury 126
8.3 .Conclusion 126
8.4 .Evidence-Based Decisions in Jaw Augmentation 127
8.4.1 .Introduction 127
8.4.2 .Osteogenesis, Osteoinduction, and Osteconduction 128
8.4.3 .Healing of Autogenous Bone Graft 128
8.4.4 .Membranous vs. Endochondral Bone Grafts 129
8.4.5 .Donor Site for Autogenous Bone Graft 129
8.4.6 .Guided Tissue Regeneration 129
8.4.7 .Bone Substitute Materials in Jaw Augmentation 130
8.4.8 .Sinus Lift Procedure 130
8.4.9 .The Role of Distraction Osteogenesis in Jaw Augmentation 131
8.4.10 .Ridge Splitting and Inlay Technique in Jaw Augmentation 131
8.4.11 .The Role of Platelet-Rich Plasma in Jaw Augmentation 131
8.4.12 .Le Fort I Osteotomy in Severely Resorbed Maxilla 132
8.4.13 .Conclusions 132
References 132
PART 3: Evidence-Based Practice: Toward Clinical Outcomes 140
9: Evidence-Based Issues in Maxillofacial Trauma 141
9.1 .Epidemiological... Evidences in Maxillofacial Trauma 141
9.1.1 .Introduction 141
9.1.2 .Socio-Demographics Characteristics in Relation to Etiology 141
9.1.3 .Pattern of Injuries in Relation to Etiology 142
9.1.4 .Regional Differences in Maxillofacial Trauma Epidemiology 143
9.1.5 .Controversial Cases in Maxillofacial Trauma 143
9.1.6 .Conclusion 144
9.2 .Current Evidences in the Management of Mandibular Condyle Fractures 144
9.2.1 .Introduction 144
9.2.2 .Classification of Condylar Fractures 145
9.2.3 .Factors that DetermineTreatment Method 145
9.2.4 .Goal of Treatment 145
9.2.5 .The Areas of Controversy 145
9.2.6 .The Method of Treatment: Open or Closed 145
9.2.7 .The Approach to Open Treatment: Extraoral, Intraoral, or Endoscopy 150
9.2.8 .Debates on Fixation vs. No Fixation and the Types of Fixation 151
9.2.9 .Physical Therapy Regimen 151
9.2.10 .Conclusion 152
References 152
10: Strengths and Limitations of the Evidence-Based Movement Aimed to Improve Clinical Outcomes in Dentistry and Oral Surgery 156
10.1 ....Introduction 156
10.1.1 .History and Evolution of Research: The Development of Evidence-Based Medicine (EBM) 157
10.2 .Evaluating the Quality of Research 158
10.3 .Meta-Analysis as a New Approach in Clinical Research 160
10.3.1 .Thrombolytic Therapy and Lidocaine in Myocardial Infarction 160
10.3.2 .The Impact of Polyol-Containing Chewing-Gums on Dental Caries 161
10.4 .Randomized Clinical Trials (RCT) and Their Role in Medicine Progress 162
10.4.1 .Hormone Replacement Therapy (HRT) 163
10.4.2 .RCT: What they Can Say and What they Cannot Say. Are Observational Studies Still Needed? 164
10.4.2.1 .Smoking 164
10.4.2.2 .Caries Lesions and .Mutans streptococci. Infection 165
10.5 .“Best Available Research Evidence” in the Field of Dentistry 165
10.5.1 .How Evidence-Based Dentistry (EBD) Has Changed Clinical Practice 166
10.6 .Problems in Applying EBM to Surgery: Performing Surgical Procedure is Different from Administering Drugs 168
10.6.1 .An Example of Discrepancy Between Surgical Experience and Evidence-Based Review: Extension of Lymphadenectomy in Gas 169
10.6.2 .Limitation of EBM in Dentistry and Oral Surgery 170
10.7 .Combining EBM with Clinical Expertise: The GRADE System 171
10.8 .Conclusions 174
References 176
11: Evidence-Based Decision for Pharmacological Management of Alcoholic Liver Disease and Alcohol Dependence 179
11.1 .Introduction 179
11.2 .Pharmacological Management of Alcoholic Liver Disease 180
11.2.1 .General Treatment 180
11.2.1.1 .Abstinence 180
11.2.1.2 .Nutritional Support 180
11.2.2 .Pharmacological Treatment 181
11.2.2.1 .Corticosteroids 181
11.2.2.2 .Pentoxifylline (PTX) 182
11.2.2.3 .Anti-TNF-.a 182
11.2.2.4 .Propylthiuracil (PTU) 182
11.2.2.5 .Antioxidant Treatment (....N..-Acetylcysteine, Coenzime Q,...S...-Adenosylmethioninine (SAMe), Silymarin, etc) 183
11.2.2.6 .Anabolic Steroids 183
11.2.2.7 .Colchicine 183
11.2.2.8 .Miscellaneous 183
11.2.3 .Liver Transplantation 183
11.3 .Pharmacological Management of Alcohol Dependence 184
11.3.1 .Treatment of AWS 185
11.3.1.1 .BDZs 185
11.3.1.2 .Anticonvulsant 185
11.3.2 .Treatment for the Maintenance of Alcohol Abstinence 185
11.3.2.1 .Opioid Antagonists 185
11.3.3 .Nonevidence-Based Drugs: Currently Approved for the Treatment of Alcohol Dependence 186
11.3.3.1 .Disulfiram 186
11.3.3.2 .Gamma-Hydroxybutyric Acid (GHB) 186
11.3.3.3 .ACP 186
11.3.4 .Nonevidence-Based Drugs: Not Approved for the Treatment of Alcohol Dependence: The Near Future 187
11.3.4.1 .Topiramate 187
11.3.4.2 .Baclofen 187
References 187
12: Temporomandibular Joint Disorders, a Bibliometric Evidence-Based Approach to Analysis 190
12.1 .Background 190
12.2 .Methods: Search Strategy and OmniViz™ Galaxy View Creation 191
12.3 .Results: TMJD Literature 192
12.4 .Results: Using OmniViz™ Galaxy Views 193
12.5 .Discussion: Understanding Our TMJD Literature Analysis 195
12.6 .Clinical Implications 196
12.7 .Conclusions 197
References 197
13: The Efficacy of Horizontal and Vertical Bone Augmentation Procedures for Dental Implants: A Cochrane Systematic... Review.. 199
13.1 .Background 200
13.2 .Objectives 201
13.3 .Materials and Methods 201
13.3.1 .Criteria for Considering Studies for this Review 201
13.3.2 .Search Strategy for Identification of Studies 202
13.3.3 .Quality Assessment 202
13.3.4 .Data Synthesis 203
13.4 .Results 203
13.4.1 .Characteristics of the Interventions 204
13.4.1.1 .Is Horizontal Augmentation Necessary? (No Trial) 204
13.4.2 .Different Techniques for Vertical Bone Augmentation 204
13.4.2.1 .Is Vertical Augmentation Necessary? (Two Trials) 204
13.4.2.2 .Which is the Most Effective Vertical Augmentation Technique? (Eight Trials) 205
13.4.3 .Characteristicsof Outcome Measures 208
13.4.4 .Duration of Follow-Up 208
13.4.6 .Allocation Concealment 209
13.4.7 .Blinding 209
13.4.8 .Completeness of Follow-Up 209
13.4.8.1 .Main Inclusion Criteria 209
13.4.8.2 .Main Exclusion Criteria 209
13.4.9 .Sample Size 209
13.4.10 .Effects of Interventions 210
13.4.10.1 .Is the Augmentation Procedure Necessary? (No Trial) 210
13.4.11 .Different Techniques for Vertical Bone Augmentation 211
13.4.11.1 .Augmentation Necessary? (Two Trials with 100 Patients) 211
13.5 .Discussion 217
13.6 .Conclusions 220
References 220
PART 4: Conclusion: Toward Optimization of the Evidence-Based Paradigm in Medicine and Dentistry 223
14: Evidence-Based Medicine: What does it Mean and Where Are We Going? 224
14.1 .Introduction 224
14.2 .EBM and the Development of Clinical Practice Guidelines (CPGs) 225
14.3 .Levels of Evidence from Healthcare Research 225
14.4 .EBM and Quality of Evidence 226
14.4.1 .Study Design 226
14.4.2 .Study Quality 227
14.4.3 .Consistency 227
14.4.4 .Directness 227
14.5 .Grades of Recommendations 228
14.6 .The GRADE Approach 228
14.7 .Implications of Recommendations 229
14.7.1 .The Implications of a Strong Recommendation 229
14.7.2 .The Implications of a Weak Recommendation 229
14.8 .Colon Cancer 229
14.8.1 .Colon Cancer Adjuvant Setting 230
14.8.1.1 .Colon Cancer Adjuvant Setting Recommendations 232
14.8.2 .Colorectal Metastatic Setting. First-Line Chemotherapy 232
14.8.2.1 .Metastatic Colon Cancer Setting Recommendations 235
14.9 .Breast Cancer 235
14.9.1 .Adjuvant Endocrine Therapy 236
14.9.2 .Adjuvant Chemotherapy 237
14.9.3 .Monoclonal Antibodies 238
14.9.4 .Neoadjuvant Therapy 239
14.10 .Closing Remarks 240
References 241
15: Future Avenues of Research Synthesis for Evidence-Based Clinical Decision Making 245
15.1 .Comparative Effectiveness 245
15.2 .Research Synthesis: Where Do We Need To Go in the Next Decade? 246
15.2.1 .Level of the Evidence vs. Quality of the Evidence 246
15.2.2 .Quality of Systematic Reviews 248
15.2.3 .Quantifying Clinical Relevance 248
15.2.4 .Toward Complex Systematic Reviews and .Meta.-Meta-Analyses for Evidence-Based Policies 248
15.3 .Conclusion 249
References 249
Index 250