EBD CEEBM-Searching For The Evidence PDF

Competence and Credible, Excel in Organization, Excel in Operation, Beyond Expectations, Management by Objective
Searching for the Evidence

~overview~
Drg. Melissa Adiatman, PhD

Department of Dental Public Health and Preventive Dentistry
– Fakultas Kedokteran Gigi Universitas Indonesia
Collaboration with: Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit
RSUPN Dr. Cipto Mangunkusumo – Fakultas Kedokteran Universitas Indonesia
Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit


The 4 eras of the evolution of
The dental knowledge base
BASED DENTISTRY

Level of evidence
SR-MA
Study Design
 Risk of Bias
RCTs
Cohort studies
Case-controlled studies
Case series/reports
Background information/
expert opinion

EVIDENCE BASED DENTISTRY

 “ An approach to oral health care that requires the
judicious integration of
- systematic assessments of clinically relevant
scientific evidence, relating to patient’s oral and
medical condition and history,
- with the dentist’s clinical expertise
- and the patient’s treatment needs
and preferences”
(American Dental Association)
IMPLIKASI EBD DALAM PRAKTIK
to help patients
make individual
decisions
regarding the
treatment that is
right for them

P I C O
Patient/ Problem/ Intervention/ Comparative Outcome
Population Index Test/ Indicators intervention
How would I Which main What is the What can I

describe a intervention main hope to
group of (or index test alternative to accomplish?
patients or indicators) compare with
similar to am I the or
mine? considering? intervention?
What could
this exposure
really affect?

Define keywords
Problem/
Intervention Comparison Outcome(s)
Population
• Bacterial • Dexametha- •- • Hearing loss
meningitis sone
• Haemophilus • Glucocorti-
meningitis coid
List the synonyms for each components of PICO

Resources for EBP: 6S Pyramid
Not yet very common
DynaMed; UpToDate; National Guideline

Clearinghouse, NICE Clinical Guidelines
Cochrane Summaries, Database of Abstracts of
Reviews of Effects (DARE)
Cochrane Systematic Reviews
ACP Journal Club; Evidence Updates
Pubmed/MEDLINE; EMBASE
Source: http://hsl.mcmaster.libguides.com/ebm
1
Pedoman Nasional Pelayanan
Kedokteran (PNPK)
Standar Pelayanan Kedokteran yang bersifat

nasional, dan dibuat oleh organisasi profesi serta
disahkan oleh Menteri
Permenkes No 1438 tahun 2010

2 Summaries and Guidelines

Regularly updated clinical guidelines that integrate evidence-
based information about specific clinical problems.
 Dynamed: http://search.ebscohost.com/
 Clinical Practice Guidelines
 National Guideline Clearinghouse:
http://www.guideline.gov/
 NICE Clinical Guidelines:
https://www.nice.org.uk/guidance
 Guideline International Network: http://www.g-i-n.net/

Summaries Clinical Practice Guidelines
 Regularly updated online  Usually focused on a specific
resources topic or disease

 Scattered across specialties
 Integrate the body of
journals or organizations
evidence at a topic-level website
 Actionable
recommendations for
practice.
Guidelines Recommendations at the Center of an
Effective Evidence-Based Practice
Thomas Agoritsas (McMaster University, Canada)
Presented in 3rd International Society for Evidence-
Based Health Care Conference 2014, Taiwan

DynaMed
 Guidance for clinicians on how to evaluate and treat
patients
 Recommendations that are based on most recent
evidence and clinical practice guidelines
 Systematic curation and critical appraisal of the
medical literature at the point of care
 Easy to find information with ease of access to primary
sources
 Growing network of experts and specialists
 Editorial Process and Team that exemplifies EBM
Sheila Bond, MD, 2016, Using Current Evidence Based Resources to Reach Well-Informed Shared Decision-Making
DynaMed’s content
▪ > 4500 Clinical topic and > 2000 topics on diseases commonly
encountered at the point of care
▪ > 17,000 clinical practice guideline listings organized by clinical

topic and geographic region, with key recommendations
incorporated directly into DynaMed content
▪ Streamlined access to additional relevant information sources

such as full text and PDF links directly to original literature and
quality improvement information
Sheila Bond, MD, 2016, Using Current Evidence Based Resources to Reach Well-Informed Shared Decision-Making
search.ebscohost.com

Dynamed






Source: http://www.dynamed.com/home/files/channel-assets/step-documents/levelsofevidencedynamedpluss.pdf


Regularly updated clinical guidelines that integrate evidence-
based information about specific clinical problems.
 Dynamed: http://search.ebscohost.com/
 Clinical Practice Guidelines
 National Guideline Clearinghouse:
http://www.guideline.gov/
 NICE Clinical Guidelines:
 Guideline International Network: http://www.g-i-n.net/

http://www.g-i-n.net/library/international-guidelines-library/

3
Syntheses:
Systematic Review/Meta-Analysis
Syntheses is commonly referred to as a systematic review, a

synthesis is a comprehensive summary of all the evidence
surrounding a specific research question.
 Cochrane Library: http://www.thecochranelibrary.com
 Medline/PubMed: http://www.ncbi.nlm.nih.gov/pubmed



http://www.cochranelibrary.com/

4 Individual (primary) studies

Studies represent unique research conducted to answer
specific clinical questions.
 Medline/PubMed: http://www.ncbi.nlm.nih.gov/pubmed
 EMBASE: http://www.embase.com/
 Proquest: http://proquest.com
 Scopus: http://www.scopus.com

Search the evidence
Search the
Focused PICO Define Keywords evidence in most
likely resources
MeSH Thesaurus or
Text Word
Type of Records your
question findings
Combine with
Boolean operators
(AND/OR/NOT).
Best study Eligibility

Limits, truncation, or
design screening
wildcards

P I C O
Patient/ Problem/ Intervention/ Comparative Outcome
Population Index Test/ Indicators intervention
How would I Which main What is the What can I

describe a intervention main hope to
group of (or index test alternative to accomplish?
patients or indicators) compare with
similar to am I the or
mine? considering? intervention?
What could
this exposure
really affect?

Type of Article and Best study design

Type of Question Type of Study/Methodology
Therapy Information needed about Systematic review and Meta-
treatments (effectiveness, cost, analysis of RCTs
etc.) Double-Blind RCT
Diagnosis Information needed about a Cross-sectional study with
diagnostic test (sensitivity, random or consecutive sample
accuracy, etc.)
Prognosis Information needed about the Cohort/survival study
course of the disease over time,
expected complications, etc.
Etiology / Information needed about RCTs

Harm causes of disease or Cohort study
contributing factors of disease
Clinical Epidemiology and Case-control Study
Evidence-Based Medicine (CEEBM) Unit
Define keywords
Problem/
Population
meningitis sone
meningitis coid
List the synonyms for each components of PICO

Combining terms with Boolean

Operators OR
Keyword 1 Keyword 2
Bacterial meningitis OR Haemophilus meningitis
= search results

Combining terms with Boolean

Operators AND
Keyword 1 Keyword 2
Bacterial meningitis AND Dexamethasone
= search results

Build your search strategy
Problem/
Population
meningitis sone
OR OR
meningitis coid
Set of results for Set of results for Set of results for Set of results for
P AND I AND C AND O

General Structure of Search

(Population OR Synonym 1 OR Synonym 2 OR ...) AND
(Intervention OR Synonym 1 OR Synonym 2 OR ...) AND
(Comparison OR Synonym 1 OR Synonym 2 OR ...) AND
(Outcome OR Synonym 1 OR Synonym 2 OR ...)
(bacterial meningitis OR haemophilus meningitis) AND

(dexamethasone OR glucocorticoid) AND (hearing loss)

http://www.ncbi.nlm.nih.gov/pubmed
atau www.pubmed.gov
Search results
Clinical questions on Diagnosis, Therapy, Prognosis
(based on available RSCM’s resources)
Acuan PPK
1. PNPK
Summaries 2. Jika tidak ada #1
Pedoman Nasional Pelayanan Kedokteran (PNPK) 3. Jika tidak ada #2
4. Jika tidak ada #3
5. Jika tidak ada #4
Atau kombinasi tergantung
ketersediaan evidence
1
Summaries: Summaries:
DynaMed Clinical Practice Guidelines
2
Synthesis:
Systematic Reviews/Meta-Analysis
3
Studies:
4 Individual (primary) studies
PPK RSCM 5 Konsensus expert panel

Thank you ☺

How to install DynaMed application
on your mobile phone (1)
(1) Download and

install the DynaMed
app from the iTunes
Store or Google
(2) Access DynaMed

from the internet
browser on your
mobile phone and go
to EBSCOhost
website:
search.ebscohost.com
(3) Login using RSCM

user ID and password
(4) Click on the Mobile

link in the DynaMed
toolbar at the top of
the screen.
(5) Enter your email

address and click Send.
An authentication link
is emailed to you.
(6) Open the email

from your mobile
device and tap the
authentication link to
authenticate the app.
(7) Click ‘I Accept’

(8) The DynaMed App

opens on your device
and begins the initial
content download.
Note: It is
recommended that
you are on a Wi-Fi
connection for the
initial download of
DynaMed content as
well as when updates
become available.
(9) Now you can

access DynaMed
from your mobile
phone

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Competence and Credible, Excel in Organization, Excel in Operation, Beyond Expectations, Management by Objective

Searching for the Evidence

Drg. Melissa Adiatman, PhD

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

EVIDENCE BASED DENTISTRY

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

How would I Which main What is the What can I

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

List the synonyms for each components of PICO

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Resources for EBP: 6S Pyramid

Not yet very common

DynaMed; UpToDate; National Guideline

Cochrane Systematic Reviews

ACP Journal Club; Evidence Updates

Standar Pelayanan Kedokteran yang bersifat

Permenkes No 1438 tahun 2010

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

2 Summaries and Guidelines

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

2 Summaries and Guidelines

Summaries Clinical Practice Guidelines

 Regularly updated online  Usually focused on a specific

resources topic or disease

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

▪ > 17,000 clinical practice guideline listings organized by clinical

▪ Streamlined access to additional relevant information sources

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

2 Summaries and Guidelines

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Syntheses is commonly referred to as a systematic review, a

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

4 Individual (primary) studies

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Search the evidence

Best study Eligibility

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

How would I Which main What is the What can I

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Type of Article and Best study design

Etiology / Information needed about RCTs

List the synonyms for each components of PICO

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Combining terms with Boolean

Bacterial meningitis OR Haemophilus meningitis

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit

Combining terms with Boolean

Bacterial meningitis AND Dexamethasone

Clinical Epidemiology and Evidence-Based Medicine (CEEBM) Unit