EBD Midterm Flashcards by A G

The available body of facts or information indicating whether a belief or proposition is true or valid

Evidence

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Evidence has varying degrees of credibility, and the strongest evidence comes from a __________ of high quality, credible sources rather than a single source

portfolio

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What 3 components guide evidence based practice?

Clinical expertise
Best research evidence
Patient values & preferences

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An approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences

Evidence based dentistry

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Evidence based dentistry is essential for a practitioner’s life-long (self) __________

learning

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EBD skills can be learned, practiced, and __________

improved

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EBD shapes decisions and __________ related to dental practice

policies

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In short, EBD is an approach or _________

decision

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EBD is NOT:

“Cook-book” dentistry
About telling practitioners what they should or should not do.
A standard of care (though related)
“Cost-cutting” dentistry
Only about randomized trials
A rigid methodological evaluation of scientific evidence
Already being universally practiced
Impossible to practice

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EBD leads to better quality of pt care. It enhances the quality and evaluation of the ________ underlying clinical care

science

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EBD improves the quality of ____________

decision-making

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EBD contributes to a __________ in variations in clinical practice

reduction

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EBD promotes greater ___________ among dental professionals

accountability

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T/F: EBD helps manage healthcare costs and efficiency, enabling better care to be delivered more effectively

True

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T/F: EBD supports advancements in research and the dissemination of scientific information

True

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What are the 5 steps for EBD?

Ask a clinical question
Acquire the best evidence
Appraise the evidence
Apply the evidence
Assess your performance

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How do you ask a clinical question?

PICO

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What does PICO stand for?

Patient/population/problem
Intervention/exposure
Comparison/control
Outcome

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You should acquire the best evidence from a _____ of sources

range

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What do the following questions help you do in the EBD process?

Was this study done well enough that I can be confident in the findings?

How useful is this to me?

Appraise the evidence

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Dentists must understand all possible treatment options and predict their ________. This necessitates clinical trials and patient-centered __________

outcomes; research

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All treatment decisions involve uncertainty. Evidence helps ________, but not eliminate, this uncertainty

reduce

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When building a PICO question, what part goes with the word “among”?

Patient/population/problem

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When building a PICO question, what part goes with the word “does”?

Intervention/exposure

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When building a PICO question, what part goes with the word "versus"?

Comparison

When building a PICO question, what part goes with the word "affect"?

Outcome

When building a PICO question, what part goes with the words "length of intervention, exposure, etc"?

Time (not always in the PICO question)

The more specifically the intervention or exposure is defined, the more _________ the evidence

relevant

What are the following examples of in a PICO? Over 65 (Elderly) Advanced Periodontitis (Condition) Diabetes (Health) Urban (Geographic Location)

Patient/population/problem

What are the following examples of in a PICO? exposure to disease diagnostic test prognostic factor treatment patient perception risk factor

Intervention/exposure

What are the following examples of in a PICO? Standard of care Placebo Absence of risk factor

Comparison

What are the following examples of in a PICO? Risk of disease Accuracy of diagnosis Rate of occurrence of adverse outcomes Reduced infection rate

Outcomes

T/F: A PICO question always requires a "C"

FALSE, you don't always need a "C" or something to compare to

What part of a PICO question must be measurable?

"O" (outcomes)

What are the 3 characteristics of answerable questions?

Short Sharp Clear

T/F: PICO questions must only ask one thing

True

T/F: Always include a product's active ingredient in your search term

True

What questions are NOT PICO questions?

Background questions (The questions are often very broad with only one or two PICO components) Ex: How do I treat gingivitis?

What questions are PICO questions?

Foreground questions (The questions contain multiple elements of PICO and addresses specificity)

What type of question does the following study match with? RCT

Therapy

What type question does the following study match with? RCT > Cohort study > Case control

Prevention Etiology/harm

What type question does the following study match with? Prospective, blind controlled trial comparison to gold standard

Diagnosis

What type question does the following study match with? Cohort study > Case control study > Case report

Prognosis

What type question does the following study match with? Economic analysis

Cost analysis

What studies provide the best answers to clinical questions when available?

Meta-analyses Systematic reviews

A good research question should pass the _________ test. Getting the answer should contribute usefully to our state of knowledge

‘‘So what?’’

__________ seeking in evidence-based practice and research involves systematically finding and evaluating the best available evidence to answer a specific clinical question

Information

An approach to dental care that thoughtfully integrates the best available scientific evidence with the dentist's clinical expertise and the patient's unique needs and preferences

EBD

EBD improves __________ care, reduces _______, supports ___________, and promotes lifelong __________.

patient, bias, decision-making, learning

What evidence is at the top of the pyramid because it has the highest reliability?

Clinical practice guidelines Meta-analysis Systematic review

Which evidence on the pyramid is filtered/synthesized, secondary, or pre-appraised?

Top (Clinical practice guidelines, Meta-analysis, Systematic review)

What evidence is at the middle of the pyramid because it is primary research?

RCT Cohort studies Case control studies

Which evidence on the pyramid is made up of experimental and observational studies?

Middle (RCT, Cohort studies, Case control studies)

What studies are cohort studies and case control studies considered to be?

Observational studies (a form of primary studies)

What evidence is at the bottom of the pyramid because it has the lowest reliability?

Case reports Animal and lab studies

Which evidence on the pyramid is made up of unfiltered information and background resources?

Bottom (Case reports, Animal and lab studies)

Which evidence on the pyramid has no design?

Case reports

Which evidence on the pyramid has no humans involved?

Animal and lab studies

Statistically combines and analyzes the results of multiple studies on the same topic, providing the highest level of evidence

Meta-analysis

A rigorous review of all relevant scientific literature on a specific clinical question, designed to minimize bias

Systematic review

Recommendations based on systematic reviews and expert input, intended to help practitioners make decisions

Clinical practice guidelines

Meta-analysis or systematic review? Should be conducted in context of a systematic review, although not required

Meta-analysis

Meta-analysis or systematic review? Quantitative

Meta-analysis

Meta-analysis or systematic review? Heterogeneity is acceptable and can be addressed

Meta-analysis

Meta-analysis or systematic review? Does not need a meta-analysis, but can include one

Systematic review

Meta-analysis or systematic review? Qualitative or quantitative

Systematic review

Meta-analysis or systematic review? Studies can be heterogeneous

Systematic review

What are the following strengths associated with? Comprehensive synthesis of existing research Reduces bias through structured methodology Enhances statistical power (meta-analysis) Identifies gaps in literature Supports evidence-based clinical decisions

Meta-analysis Systematic review

What are the following weaknesses associated with? Quality depends on included studies Susceptible to publication bias Heterogeneity may limit conclusions Time-consuming to conduct May oversimplify complex clinical questions

Meta-analysis Systematic review

What is the gold standard of experimental designs/interventions?

Randomized control trials (RCTs)

Prospective, experimental studies where subjects are randomly assigned to a treatment or control group

RCTs

Purpose is to test the effectiveness of a new treatment or intervention

RCTs

Minimizes bias by ensuring the groups are as similar as possible, making it more likely that any differences in outcomes are due to the treatment

RCTs

Participants don't know which group they're in

Single blind RCT

Participants and researchers don't know who receives the tx or placebo, reducing bias

Double blind RCT

Participants, researchers, and data analysts are unaware of group assignments, further minimizing bias

Triple blind RCT

Groups are randomized to study conditions, and observations are taken from members w/o cross-over btwn groups or study arms

Parallel group trials

Which RCT? Mimic usual clinical practice to inform real world decision-making by pts, clinicians, and policymakers; assess the effectiveness of available meds

Pragmatic RCTs

What are the following strengths associated with? Evaluate casual relationships High internal validity Investigator control over pt exposure Prospective data collection, which allows for standardization of exposure and outcome collection Attempted balance through randomization btwn known and unknown confounding factors btwn groups

RCTs

What are the following weaknesses associated with? Higher cost than observational studies Limited external validity and generalizability, due to strict inclusion and exclusion criteria and application of interventions by protocol Ethical considerations related to assigning pts to particular care approaches Shorter follow-up than observational studies Inefficiency of detection of rare or delayed outcomes, due to smaller sample size

RCTs

Researchers observe subjects without intervening. These designs are helpful for understanding risk factors and outcomes in real-world settings

Observational studies

What are the 2 types of observational studies?

Cohort studies Case control studies

Follows a group of people over time to see who develops a disease or condition

Cohort studies

What are the 2 types of cohort studies?

Prospective and retrospective

Outcome measure is usually a risk ratio/relative risk (RR)

Cohort studies

Compares people who have a condition (cases) to those who do not (controls) to identify potential risk factors from the past

Case control studies

Outcome measure is an odds ratio (OR)

Case control studies

What are the following weaknesses associated with? Lack of generalizability, not always applicable Biased due to opinion/personal experience Limited data No experimental controls

Case reports Animal and lab studies

T/F: Lower evidence does not mean it has no value

True, we can still utilize lower evidence

Aka bench studies

Animal and lab studies

These studies lay the foundational groundwork for medical research but their results may not always translate to humans

Animal and lab studies

These documents describe individual patients or small groups with a specific condition or treatment, providing a snapshot but not establishing cause-and-effect

Case reports

Ranked as the lowest level of evidence because it's based on individual judgment and not on experimental data collected from controlled studies

Expert opinion

The Hierarchy of Evidence is a ________, not an absolute rule. The best available evidence should always be considered in the context of the clinical question

guides

Any characteristic, number, or quantity that can be measured or classified; something that varies

Variable

Examples: Pocket depth between tooth & gum (millimeters) Salivary pH levels (6.2 – 7.6) Canceled appointment (yes/no) Tooth decay presence (yes/no) Patient care satisfaction (4-point scale: Not Satisfied at All to Very Satisfied) Daily sugar intake Plaque index

Variable

Which type of variable? Infinite values within a given range

Continuous

What are the 2 types of variables?

Continuous Categorical

Which type of variable? Discrete categories that represent things or categories

Categorical

Which type of variable? Pocket depth (mm) Salivary pH level Time taken for anesthesia onset

Continuous

Which type of variable? Gender of pt Tooth type (incisor, canine, premolar, molar) Dental anxiety scale

Categorical

What are the 2 subtypes of categorical variables?

Nominal Ordinal

Which categorical variable? Classification w/ no order

Nominal

Which categorical variable? Type of toothbrush (manual, electric, sonic)

Nominal

Which categorical variable? Rank order

Ordinal

Which categorical variable? Caries severity classification (incipient, moderate, extensive)

Ordinal

What are the 4 levels of measurement?

Nominal Ordinal Interval Ratio

Which level of measurement? Labels w/o order

Nominal

Which level of measurement? Ordered categories, but intervals not equal

Ordinal

Which level of measurement? Equal intervals, but no true zero

Interval

Which level of measurement? Equal intervals and true zero

Ratio

Which level of measurement? Presence of ortho appliance (yes/no)

Nominal

Which level of measurement? Pt rating pain (mild, moderate, severe)

Ordinal

Which level of measurement? Temperature of a dental clinic

Interval

Which level of measurement? Number of teeth present

Ratio

Displays the distribution of a continuous variable

Histogram

What are the steps associated with? 1. Organize values into bins 2. Count the number of cases in each bin 3. Draw bars for each bin

Histograms

What are the 2 types of statistics?

Descriptive Inferential

Which type of statistic? Summarize, organize, and present data in a meaningful way

Descriptive

Which type of statistic? Inferences, predictions, or generalizations about a population based on sample data

Inferential

Which type of statistic? Involves probability theory and hypothesis testing

Inferential

What are 3 measures of central tendency?

Mean Median Mode

What are 3 measures of variability?

Variance Standard deviation Range

Measures spread about the mean and should only be used only when the mean is chosen as the measure of center

Standard deviation

Equals 0 when all scores are the same, or no spread

Standard deviation

Like the mean, is not resistant outliers can make it very large

Standard deviation

Equal to the highest value in a distribution minus the lowest value in a distribution

Range

Can be used to estimate percent of scores falling from mean

Standard deviation

99.7% of data is within _____ standard deviations of the mean

95% of data is within _____ standard deviations of the mean

68% of data is within _____ standard deviations of the mean

Which type of statistic? Purpose is to summarize data

Descriptive

Which type of statistic? Scope is the sample

Descriptive

Which type of statistic? Methods include measures of central tendency and variability, graphs (histogram), and %

Descriptive

Which type of statistic? Dental example: Average DMFT score of 30 pts

Descriptive

Which type of statistic? Purpose is to make predictions or generalizations

Inferential

Which type of statistic? Scope is the sample -> population

Inferential

Which type of statistic? Methods include hypothesis testing, confidence intervals, regression, and correlations

Inferential

Which type of statistic? Dental example: Predicting DMFT score for the entire population

Inferential

Which type of statistic? Selection of samples from the desired population (patients, dental assistants, staff). Estimation of statistics based on sample. Base decisions on population from the sample data

Inferential

Who we generalize

Target population

Determine how closely the accessible group represents the broader theoretical population

Sampling approach

Consider whether probability (random) or non-probability (convenience, purposive) sampling is used, and how this impacts representativeness

Sampling method and bias

Decide what participant characteristics will qualify or disqualify individuals (exclude patients with systemic health conditions that affect oral outcomes)

Inclusion and exclusion criteria

Balance statistical power with practical constraints like time, cost, and recruitment resources

Sample size and feasibility

Standard _______ of the mean is the standard deviation of sample means from the population (theoretical estimate)

error

Degree of uncertainty with sample mean

Standard error of the mean

Expected standard deviation of sampling errors

Standard error of the mean

Equal to standard deviation divided by square root of the sample size.

Standard error of the mean

Affected by sample size and standard deviation

Standard error of the mean

_________ sample sizes will reduce size of standard error of measurement

Larger

__________ mean more likely to represent population mean

Sample

What are the 2 types of hypotheses?

Directional Non-directional

Which type of hypothesis? Direction of the predicted relationship between variables specified

Directional

Which type of hypothesis? Dental students who use virtual simulation training will score higher on cavity prep competency tests than students who receive traditional lecture-based instruction

Directional

Which type of hypothesis? Patients receiving resin-based composite restorations will report lower postoperative sensitivity than patients receiving amalgam restorations

Directional

Which type of hypothesis? Direction of the relationship between variables is not specified

Non-directional

Which type of hypothesis? There will be a difference in cavity prep competency test scores between dental students who use virtual simulation training and those who receive traditional lecture-based instruction

Non-directional

Which type of hypothesis, directional or non-directional? There will be a difference in postoperative sensitivity between patients receiving resin-based composite restorations and those receiving amalgam restorations

Non-directional

The hypothesis we test

Null

The hypothesis we seek to confirm

Alternative

Which hypothesis, null or alternative? No competency score differences across dental students who use virtual simulation training than students who receive traditional lecture-based instruction

Null hypothesis

Which hypothesis, null or alternative? Postoperative sensitivity will not differ across patients receiving resin-based composite restorations than patients receiving amalgam restorations

Null hypothesis

Which hypothesis, null or alernative? Dental students who use virtual simulation training will score higher on cavity prep competency tests than students who receive traditional lecture-based instruction

Alternative hypothesis

Which hypothesis, null or alternative? Patients receiving resin-based composite restorations will report lower postoperative sensitivity than patients receiving amalgam restorations

Alternative hypothesis

Probability of observing a result as extreme as (or more extreme than) the one obtained, if the null hypothesis (H₀) is true

p-value

Reflects the strength of evidence against H₀ (not the probability that H₀ is true)

p-value

_______ p-values suggest stronger evidence against the null hypothesis

Smaller

A researcher-specified pre-set threshold, often 0.05 in biomedical/dental research

Alpha level (α)

If p ____ α → reject H₀ → evidence suggests a significant effect/difference

≤

If p ____ α → fail to reject H₀ → evidence insufficient to conclude an effect/difference

Rejecting the null hypothesis when it is actually true (false positive)

Type I error

Failing to reject the null hypothesis when it is actually false (false negative)

Type II error

Consequences include wasted resources, patients may receive an ineffective or unnecessary treatment

Type I error

Consequences include missed opportunity to adopt a better treatment, slower advancement of dental practice

Type II error

Concluding that a new fluoride varnish reduces caries incidence more than the standard varnish, when in fact both are equally effective

Type I error

Concluding that there is no difference in postoperative sensitivity between composite and amalgam restorations, when in fact composite results in significantly less sensitivity

Type II error

Which words narrow your search?

And Not

Which word broadens your search?

What do the following refer to when acquiring data on a search? Entry terms Synonyms Increase breadth of search results

Natural language terms (sensitivity!)

T/F: Synonyms = more search terms = more results = more research

True

What are the following used for when looking at research? Currency of the study Bias Similarity of study population to your pt Size of study Whether the study type is appropriate for your clinical question

Appraise

What must a systematic review have?

Flow chart

What must a meta-analysis have?

Forest plot

Which importance of evaluating limitations? Limitations reveal the weaknesses and constraints impacting the validity and reliability of research outcomes

Study constraints

Which importance of evaluating limitations? Acknowledging limitations demonstrates researcher transparency and fosters critical thinking in the scientific community

Transparency

Which importance of evaluating limitations? Identifying limitations helps pinpoint areas requiring further study to advance scientific knowledge effectively

Future research

Which importance of evaluating limitations? Evaluating limitations assists in determining if findings apply to broader populations or specific clinical settings

Generalizability

T/F: It may very well be that the strongest evidence was NOT published within the last 5 years

True! If that is the case, be able to defend the selection of a study that does not fit within a 5-year timeframe

Disease process not removable whenever there is a state of dysbiosis

Caries disease

Damaged tissue (can be treated); lesions can be stabilized

Carious lesion

What are the 4 D's of current caries disease management?

Determine Detect Decide Do

Which D? Caries risk

Determine

Which D? Assess lesions

Detect

Which D? A personalized care plan

Decide

Which D? Preventive and tooth preserving care

Which method of caries diagnosis? Light source/magnification Clean Dry

Visual inspection

Which X-rays are most reliable for interproximal posterior caries and 2nd most used for occlusal caries?

Bitewings

Which X-Rays are 2nd most reliable for interproximal anterior caries?

PAs

T/F: Explorer can cause enamel destruction leading to future caries development

True

T/F: A catch with the explorer may be due to non-carious anatomical features of pits and fissures

True

T/F: Using an explorer has NOT shown to improve the accuracy of caries diagnosis

True

Which method of caries diagnosis? With blunt ended probe when needed for: Surface irregularities Cavitation Biofilm

Tactile inspection

What is an example of adjunctive diagnostics?

Fiber optic transillumination

The percentage of true positives. A method’s ability to correctly identify all surfaces damaged by caries

Sensitivity

The percentage of true negatives. A method’s ability to correctly identify all sound surfaces

Specificity

What is the gold standard for detecting occlusal caries lesions?

Visual inspection

What is the gold standard for detecting anterior caries lesions?

Visual inspection

What do you do if you don't have a diagnosis?

Monitor

What do the following help you determine? Plaque Opacity Roughness

Active vs inactive lesion

Patient level (disease management) or tooth level (lesion management)? Caries risk assessment recommendations

Patient level (disease management)

Patient level (disease management) or tooth level (lesion management)? Preventive care for the whole mouth; includes hygiene, fluoride (systemic/topical), diet, behavior change

Patient level (disease management)

Patient level (disease management) or tooth level (lesion management)? Treat active lesions whether non-operatively or operatively

Tooth level (lesion management)

What do the following refer to? Accessibility Language Culture and believes Coordination Dignity Fear Authority Community Family Dependence Cost Previous experience

Patient level considerations

What do the following refer to? Severity / Stage: non-cavitated & cavitated lesions Activity: active & arrested/inactive Location: Occlusal/ Proximal/Facial Caries Risk: High/ Moderate/ Low

Tooth level considerations

What type of invasiveness? Dietary control Biofilm control Mineralization control

Non-invasive

What type of invasiveness? Sealing Infiltration

Micro-invasive

What type of invasiveness? Restorative

Invasive

What type of invasiveness? Non-restorative caries control; Hall technique

Mixed intervention

EBD Midterm Flashcards

(219 cards)