ADHA Access March 2012 : Page 16
Turning to the Evidence During Patient Care Incorporating evidence into clinical decision making at the point of patient care requires knowledge of where to look for up-to-date and credible information. Dental hygienists can use websites and online databases when searching quickly for research ¿ ndings and clinical recommendations. When accessing research chairside, the clinician should search for studies of higher quality ¿ rst, keeping the evidence hierarchy in mind. When time is limited during patient care, using keywords to search for current evidence is best and most practical. Using two or more keywords combined with “and” narrows a search, since the results will retrieve only studies that include all of the keywords; using “or” between keywords increases the number of studies retrieved, as all studies that include one or more of the keywords will be accessed. For example, conducting a search in PubMed (www.ncbi.nlm.nih.gov/pubmed/clinical) on “peroxide” alone yields 14,376 individual, clinical studies and 169 systematic reviews. Conducting a search using the keywords “peroxide and enamel erosion” yields only 17 clinical studies and no systematic reviews (as of February 2012). PubMed is a public database that houses more than 21 million citations from the biomedical literature. In addition to PubMed, several other online sites can be utilized to search for evidence on oral health topics. The National Center for Dental Hygiene Research and Practice’s dhnet (dent-web01.usc.edu/dhnet/) is a hub that lists multiple online resources for researching a particular topic. The dhnet’s research site describes and provides links to several reputable online databases, such as the Cochrane Oral Health Group (ohg.cochrane.org/) and the American Dental Association’s Center for Evidence-Based Dentistry (ebd.ada.org/). Dental hygienists can quickly access these websites (and many others) through the dhnet when striving to incorporate the most current evidence into their clinical decision making during patient care. Though many websites can help the oral health care practitioner ¿ nd evidence ef ¿ ciently, lack of time and computer access at chairside may make the process impractical. When additional time and technology are available, the dental hygienist can conduct a more detailed search for evidence on an oral health topic, beginning with the formulation of a speci ¿ c research question. Knowing how to create a good clinical question is the foun-dation for ¿ nding the most up-to-date and best available evidence on a topic. Table I. PICO Question Table “ In young adults aged 18-24, how does tooth brushing with peroxide as compared to over-the-counter À uoride toothpaste affect enamel erosion?” P I C O In how does compared with affect young adults aged 18-24 peroxide over-the-counter À uoride toothpaste enamel erosion tooth erosion Alternate search terms brushing with peroxide as compared to over-the-counter À uoride toothpaste affect enamel erosion?” In this instance, one assumes that the dental hygienist had an adolescent patient who had enamel erosion. To determine the appropriate intervention to help this pa-tient, the dental hygienist derived her clinical question and sought to compare two alternatives. The following steps in the PICO process were used. In the ¿ rst step, the dental hygienist describes the patient or pa-tient group [P]. In this case, the adolescent patient was 18-24 years of age. Patient characteristics that could in À uence the search results must be considered such as the patient’s primary problem, chief com-plaint, age, gender, race, current and past disease conditions, health status and medications. The second step in the PICO process is to determine the interven-tion [I]. In this example, peroxide is the primary intervention. The third phase of the process is to compare the primary intervention to another intervention. If there is only one intervention and no alterna-tive to consider, no comparison would be made so the “C” step is omitted. In Table I, two interventions are being compared: peroxide and over-the-counter À uoride toothpaste. The intervention is what the dental hygienist plans to do for the patient and is central to the PICO question as it addresses the patient’s desired outcome. The last phase of the PICO question is the outcome [O]. This includes the result(s) of what the clinician anticipates the intervention to accomplish, improve, or affect. The outcome must be measurable. In the Table I, the measurable outcome would be no further enamel erosion. Other examples of measurable outcomes of dental hygiene care could include improvements in probing and recession measure-ments, and bleeding on probing. Formulating Clinical Research Questions Dental hygienists ask questions related to patient care more often than they probably realize. In order to search for and evaluate the most up-to-date, quality research on an oral health topic, the dental hygienist should begin by formulating a good clinical question. Broad clinical questions must be re ¿ ned and narrowed to be answerable. The Patient, Intervention, Comparison and Outcome (PICO) approach is a useful technique for searching the literature to access research studies. PICO breaks down a clinical question into its component parts, assisting in: (1) clarifying the question, (2) identifying the information needed to answer the question, (3) translating the ques-tion into searchable terms, and (4) developing and re ¿ ning the search approach. PICO frames a question that focuses on what patients believe are the most important problems and the patients’ desired outcomes. 8 Table I depicts the PICO process as it is used to answer the follow-ing clinical question: “In young adults aged 18-24, how does tooth Evidence-Based Dental Hygiene Care To provide the best possible care to patients, EBDM in dental hygiene relies on the incorporation of the best available evidence; the clinician’s skills, knowledge, and experience; and the patient’s needs and preferences. Dental hygienists rely routinely on their clinical judgment, input from colleagues and dental industry representatives, and patient feedback when making clinical decisions. The piece of EBDM that often falls short is evaluation of the best and most current research. How can dental hygienists and the dental team stay current with emerging research to incorporate the best evidence into their clinical decision making? First, understanding and valuing the importance of evidence-based practice is paramount. One way to keep abreast of new research is through the regular reading of dental hygiene and evidence-based dentistry journals. Because many journals are now electronic rather than in print form, the use of websites, such as the National Center for Dental Hygiene Research and Practice’s dhnet, that provide easy access to oral health research and information is needed. These resources can assist the dental hygienist in making evidence-based decisions during patient care. They are also useful when conducting more elaborate searches involving speci ¿ c clinical questions prior to or following a patient’s appointment. Continu-ing education on evidence-based practice would bene ¿ t members { Knowing how to create a good clinical question is the foundation for ¿ nding the most up to date and best available evidence on a topic. 16 MAR 2012 access
Publication List
Using a screen reader? Click Here