grunnlag for kliniske avgjørelser- evidens basert eller ...jokstad.no/smm8ere.pdf · –bøker...
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Evidens-basertodontologi
…og kliniske retningslinjerAsbjørn Jokstad
Institutt for klinisk odontologiUniversitetet i Oslo
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Informasjonseksplosjon
Enorm vekst av vitenskapelige publikasjoner i biomedisin - inkludert i odontologi
1. Antallet helsepersonnel og forskere stiger
ogAntall publikasjoner er nøkkel til penger og ære
2. Antall publikasjoner fordoblet hvert 10. år
3. Antall tidsskrift øker kontinuerlig
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Tannlegetidsskrift i sirkulasjon
0100200300400500600700800900
1000
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2003
N=993
Kilde: Ulrich’s International Periodicals Directory
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Vi må ikke bare ta stilling til
mengden av informasjon vi mottar
men også
kvaliteten på denneinformasjonen.
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Kanskje kandette nye“EBM” hjelpe?
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Evidens basert medisin :
Hvordan vi skal forholdeoss til kontinuerligeforandringer . . .
…uten at vi noengang fårvite hva fasitsvaret er
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Hvordan utøve evidens-basert praksis?
1. Lære selv hvordan evidens-basertodontologi utføres–Bøker –Seminarer–Internett
• Online link-lister• Online kurs• Online ressurser
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Hvordan utøve evidens-basert praksis?
1. Lære selv evidens-basert odontologi2. Søke og anvende evidens-baserte
sammendrag utarbeidet av andre. 1. Fagtidsskrift som kritisk
evaluerer primærstudier2. Systematiske oversikter• Cochrane Collaboration • Nat. Health Serv. R&D • Litteratur
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Online secondary publication - EBD:
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The Cochrane Collaboration
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Hvordan utøve evidens-basertpraksis?
3. Akseptere og anvende kliniskeretningslinjer som er baserte påevidens-baserte prinsipper
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Agency for Healthcare Research & Quality, USA
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Wisdom tooth extractions
Why do you remove/retain
"wisdom teeth"?
A question of prognosis
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How many reports related to wisdom tooth extraction and prognosis can be identified?
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www.fdiworldental.org
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N=17 vs. N=280 vs. N=27
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How many reports related to the topic can be identified?
How are these approximately 300 reports characterized according to study design?
15 245
80
160
SRRCTCCTReviewOther
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How many reports related to the topic can be identified?
How can these reports be characterized. Which study design? How many reports are included within each category?
What is the methodological scientific quality of these reports?
How many reports can be excluded due to questionable methodological validity?
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Prognosis
• An inception cohort of persons, all initially free of the outcome of interest
• Follow-up of at least 80 per cent of patients until the occurrence of either a major study criteria or the end of the study
• A statistical analysis consistent with the study design.
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baoms 1995
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1997anaes
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SIGN 2000
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Nhs hta
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dgzmk 2001
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Selection of papers
CCTs + Clinic trials
60BAOMS, UK, 1995
CCTs + Clinic trials
77ANAES, France, 1997
RCTs + CCTs
64SIGN, Scotland, 2000
RCTs + Reviews
52NHS R&D, UK, 2000
SRs + Clinic trials
23DGZMK, Germany, 2001
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11
9
18
17
1997 (n=77)
1995 (n=60)
2000 (n=64)
5
(total: n=171)
2000 (n=52)
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USA1979: NIH Consensus dev. Conference for removal of third molars
1995: Am.Acad.Oral Med.Surg. Parameters of Care
1991 Am.Acad.Oral Med.SurgParameters of Care
1993: Am.Acad.Or.Med.Surg. Workshop on the managem. of patients with third molar teeth
2000: SIGN Guidelines
1980 1990 20001995: Br. Assoc.Oral Med. Surg. Pilot Clinical Guidelines
1996: NHS R&D. National guidelines
Sept 1997: FacDentSurg RoyCollSurg(Eng)
1998: Effectiveness Matters 3(2)
2000: NHS R&D HTA Programme2000: NICE Guidelines
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We have learned:
Systematic reviews and guidelines are not necessarily known to the community of dental practitioners
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Who’s responsibility to disseminate new research findings to the community of dental practitioners?
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Who’s responsibility for disseminating new research findings to the community of (dental) practitioners?
… and verify its implementation?
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Nhs hta
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Nice
2001
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www.agreecollaboration.org
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foroppmerksomheten!