Guiding handout
Introduction to
EBD – Part One
Prof. Shereen Ali
This handout is just for guidance, and you
should be fully committed to the previously
announced and uploaded sources of studying
MSc Program
Fall 2023
Evidence based dentistry – EBD
Definition:
Approach to oral health care that requires the integration of systematic assessments
of clinically relevant scientific evidence with the dentist's clinical expertise & the
patient's treatment needs and preferences.
Steps of EBD approach:
▪ Ask a research question related to a clinical problem
▪ Acquire an answer by searching the literature
▪ Appraise the available evidence
▪ Apply and integrate in your practice
▪ Assess the overall results of the used evidence
Research question
Definition:
It is a disciplined attempt to solve problems through the collection and analysis of
primary data for the purpose of description, explanation, generalization and
prediction
Problems:
o How common is the disease?
o What is the cause of the disease?
o Does this intervention help?
1
o What are the harms of the intervention?
Page
Guiding Handout “EBD” –Prof Shereen Ali
o Is the diagnostic test accurate?
Research question must be:
▪ Clear: can easily understand its purpose without needing additional
explanation.
▪ Focused: narrow enough to be answered thoroughly.
▪ Concise: expressed in fewest possible words.
▪ Converted into a measurable form
Framing research question “elements of research question”:
PICOTS format:
P = Patient, Population (What are the most important characteristics of the patient?)
I = Intervention (What main intervention are you considering?)
C = Comparison (gold standard or placebo.)
O = Outcome (What are you trying to measure, improve or affect?)
T = Time frame
S = Study type
PICO format is:
▪ Helpful tool that assists in organizing and focusing the research question into
a searchable query.
▪ PICO elements helps identify search terms to use in the search of the literature.
2
Page
Guiding Handout “EBD” –Prof Shereen Ali
Variants of PICO format:
PIO / PEO
Population (P)
Interventions (I) or Exposures (E)
Outcomes (O)
PIRT
P = Patient/Population
I = Index test
R = Reference test
T = Target condition/diagnosis
FINER criteria:
Feasible “Can be done & completed”
o Possibility of recruiting required number of subjects within the planned
timeframe
o Availability of facilities (equipment, supplies, requirements)
o Required expertise
o Affordable cost
o Advisable single 1ry objective, can be supplemented with 2ry objectives
(avoid too many objectives)
3
Page
Guiding Handout “EBD” –Prof Shereen Ali
Interesting
Must be of interest to Investigators & Scientific community
Novel
o Contribute new information – Add to the existing body of knowledge
o Not necessarily hasn’t been done before
o Most of good studies are neither “original” nor “simple duplication”
o Progress of science is incremental, with knowledge gradually building up
from different studies.
Ethical
o Ethical issues must be addressed
o At early stages of selecting the research topic & then In planning the
research
Relevant
Research must have potential to:
o Advance scientific knowledge
o Influence clinical management
o Influence health policy
o Guide further research
4
Page
Guiding Handout “EBD” –Prof Shereen Ali
Types of studies
Case series / Case reports
▪ Studies single case or few cases
▪ No comparison/control
▪ May be followed by clinical trials.
▪ Used to:
✓ illustrate unique or new aspect of a condition or the treatment
✓ report rare conditions for which trials may not be feasible
Strengths:
identify unusual situation
Weaknesses:
1. Generally short-term
2. Investigators self-select (bias!)
3. Generally no controls
Cross-sectional study
▪ Is a study in which outcome & exposure status are measured simultaneously in
a given population.
▪ Provides a “snapshot” of the outcome and the exposure “risk factor” at a
particular point in time.
▪ One time point or over a short period
▪ Used to:
5
Page
✓ Investigate associations between risk factors & outcome of interest
Guiding Handout “EBD” –Prof Shereen Ali
✓ Assess the prevalence of the outcome in a population
Strengths:
1. Inexpensive and simple;
2. Quick
3. Ethically safe
4. Can assess multiple outcomes
Weaknesses:
1. No temporality: establishes association, impossible to infer causality
2. Potential bias: recall bias, non-responsive bias
3. Confounders
4. Not good for rare diseases
5. Poor for diseases of short duration
Case-Control study
▪ It identifies factors that may contribute to a condition by comparing subjects
who have that condition/disease (the 'cases') with patients who do not have the
condition/disease but are otherwise similar (the 'controls').
▪ Patients are grouped according to the outcome & study the presence of
exposure “risk factor”
▪ Retrospective in nature
▪ Used to: feasible method for very rare disorders or those with long lag between
exposure & outcome
6
Page
Guiding Handout “EBD” –Prof Shereen Ali
Strengths:
1. Inexpensive
2. Quick
3. Smaller sample than cross-sectional studies
4. Good for rare diseases
5. Can assess multiple exposures
Weaknesses:
1. No temporality
2. Confounders
3. Potential bias: recall, selection
4. Can only assess one outcome
Cohort study
▪ The gold standard of observational research
▪ It begins with a group of people who do not have the disease, takes baseline
measurements, then follows them over time to determine the absolute risk of
disease appearance.
▪ Patients are grouped according to the exposure (risk factor) & wait for appearance
of the outcome “outcome doesn’t appear yet”
▪ A cohort: is a group of people who share a common characteristic or experience
within a defined period.
▪ Comparison group: may be the general population from which the cohort is
drawn, or may be another cohort of persons thought to have had little or no
exposure, but otherwise similar.
7
Page
Guiding Handout “EBD” –Prof Shereen Ali
▪ Used to:
✓ identify risk factors of diseases
✓ determine causes of diseases!!
✓ evaluate outcome/impact of treatment, when RCTs are not possible
✓ Identify new cases “incidence”
Strengths:
1. Best evidence between observational studies
2. Temporality demonstrated
3. Can assess multiple outcomes & multiple exposures
Weaknesses:
1. Expensive
2. Large sample size
3. Time intensive
4. Not suitable for rare diseases, large sample sizes or long follow-up necessary
5. Confounders
Randomized Controlled Studies “RCT”
▪ The “gold standard” in medical research.
▪ Experimental comparative study in which participants are allocated to
treatment/intervention or control/placebo groups using a random mechanism
▪ Used in: Best to study the effect of different therapies or interventions.
8
Page
Guiding Handout “EBD” –Prof Shereen Ali
Strengths:
1. Unbiased distribution of confounders;
2. Blinding more likely;
3. Randomization facilitates statistical analysis.
Weaknesses:
1. Expensive, time;
2. Volunteer bias;
3. Ethically problematic at times.
References:
Thabane, L., Thomas, T., Ye, C., & Paul, J. (2009). Posing the research question:
not so simple. Canadian journal of anaesthesia = Journal canadien d'anesthesie,
56(1), 71–79. https://doi.org/10.1007/s12630-008-9007-4
Jepsen, P., Johnsen, S. P., Gillman, M. W., & Sørensen, H. T. (2004). Interpretation
of observational studies. Heart (British Cardiac Society), 90(8), 956–960.
https://doi.org/10.1136/hrt.2003.017269
Lu C. Y. (2009). Observational studies: a review of study designs, challenges and
strategies to reduce confounding. International journal of clinical practice, 63(5),
691–697. https://doi.org/10.1111/j.1742-1241.2009.02056.x
Mann C. J. (2003). Observational research methods. Research design II: cohort,
cross sectional, and case-control studies. Emergency medicine journal : EMJ, 20(1),
54–60. https://doi.org/10.1136/emj.20.1.54
9
Page
Guiding Handout “EBD” –Prof Shereen Ali
Harald O. Stolberg, Geoffrey Norman, and Isabelle Trop (2004). Fundamentals of
Clinical Research for Radiologists. Randomized Controlled Trials. American
Journal of Roentgenology 2004 183:6, 1539-1544
Bhide, A., Shah, P. S., & Acharya, G. (2018). A simplified guide to randomized
controlled trials. Acta obstetricia et gynecologica Scandinavica, 97(4), 380–387.
https://doi.org/10.1111/aogs.13309
10
Page
Guiding Handout “EBD” –Prof Shereen Ali
