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Oral Health Research


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First of two library lectures for Oral Research UGs at McGill

Published in: Health & Medicine
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Oral Health Research

  1. 1. DENT-125/225 ORAL HEALTH RESEARCH Martin Morris |
  2. 2. Objectives By the end of this session you will have a better understanding of: • key points in the history of medical information • the research cycle and how medical knowledge is produced; and • how that evidence is disseminated 2
  3. 3. First things first… • What is research? • Have you ever conducted any? • Do you read any? • Why should you do research? 3
  4. 4. Did you know? The word “research” comes from the French “recherche” which means to travel through, or survey.
  5. 5. Definitions of “research” • To search or investigate exhaustively • To investigate or examine a subject from different viewpoints • Undertake to discover, establish or confirm a fact or principle • The systematic and rigorous study or investigation into a field of knowledge 5
  6. 6. Some history… …or 5000 years in 5 minutes. 6
  7. 7. Medieval cures for toothache Which of the following did medieval dentists recommend for toothache? • Ground up ant eggs, blown into the mouth with a quill? • Baked newts and woodlice? • Rosemary boiled in wine? 7
  8. 8. The Ancient World • Evidence from the ancient world of empirical observation • Ancient Greeks rejected spirits/demons as cause of disease • Science based on logic and reason 8
  9. 9. Edwin Smith papyrus c. 1500 BC
  10. 10. Greek/Roman medicine Hippocrates (460 – 377 BC) “The Father of Medicine” Galen (129 – 200 AD) Theories dominated until the Renaissance 10
  11. 11. The Dark Ages • In West: move towards belief that disease is “God sent” • While in Arabic world, empiricism and investigation thrive in medicine 11
  12. 12. Avicenna ( ا(بن سینا • Avicenna (980 – 1037 AD) was a Persian medical researcher (and general polymath) • Wrote the Canon of Medicine, was still in use 500 years later 12
  13. 13. The Renaissance and beyond! Scientific renaissance • Andreas Vesalius (1514-1564) • Giovanni Morgagni (1682-1771) • William Harvey (1578-1657) …and later on… • Bacon, Copernicus, Galileo, Newton • Lind conducts first clinical trial (1747 – related to scurvy) 13
  14. 14. We doctors have always been a simple, trusting folk! Did we not believe Galen implicitly for more than 1500 years and Hippocrates for more than 2000 years? William OSLER “ ”
  15. 15. 20th Century Medicine The biomedical model • Health defined as “the absence of disease”. Some now consider this to be insufficient (e.g. First Nations Health) • Disease caused by pathogens • Behavioural sciences, interdisciplinarity Plus • The rise of information! • Economics of providing health care 15 New viewpoints are emerging about how we define “health”
  16. 16. Some takeaways • Science and dentistry/medicine depend intimately on one another • Knowledge and discovery have accelerated since the Renaissance • Medical knowledge is built on previous evidence • We cannot practice Evidence-Based Dentistry without reliable evidence 16
  17. 17. Evidence-Based Dentistry 17 American Dental Association: “…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 American Dental Association (2008). ADA Policy on Evidence Based Dentistry. Viewed: Oct. 1, 2012 Clinical Expertise Patient‘s Preference Research Evidence (including Resources) EB D
  18. 18. How is scientific knowledge produced? 18
  19. 19. Research happens because… • A problem to be solved • A desire to find a solution • Agreement on validity/paradigm • Methods and techniques appropriate to finding out • A wish to disseminate the findings 19
  20. 20. What makes a good research question? 20
  21. 21. What makes a good question? A good research question specifies: • the boundaries of the research, • the kinds of information that will be sought, and • the types of settings/people which will be included 21
  22. 22. SMART objective • Specific (or significant) • Measurable (or manageable) • Achievable • Relevant • Time-bound (or has a Timeframe) 22
  23. 23. What is PICO? Patient or Population Intervention Comparison Outcome 23
  24. 24. A PICO example Martin is a 43-y/o librarian who drinks way too much coffee and is concerned at the staining this is causing to his teeth. He has heard that whitening strips are a good alternative to home bleaching kits. What do you advise? 24
  25. 25. Constructing the PICO Martin is a 43-y/o librarian who drinks way too much coffee and is concerned at the staining this is causing to his teeth. He has heard that whitening strips are a good alternative to home bleaching kits. Which therapy will you recommend? Elderly female stroke patient with arm weakness Virtual Reality Exercise therapy Improved arm function 25 In elderly stroke patients with arm weakness, does virtual reality as compared to exercise therapy improve arm function?
  26. 26. A PICO example In patients with tooth discoloration would teeth-whitening strips compared to home bleaching kits lead to whiter teeth? 26
  27. 27. Good and Bad Questions What causes tooth loss? How can we make people in Montreal clean their teeth more regularly? Is there a connection between repeated reuse of cooking oil and increased incidence of oral cancers? 27
  28. 28. Good and bad research questions EXERCISE
  29. 29. EXERCISE Create examples of good and bad research questions linked to: • Encouraging better oral hygiene • Materials for dental implants • Oral health of prisoners, OR • Your own area of interest! 29
  30. 30. The agreed way to investige 30
  31. 31. The Scientific Method 31 Question Lit Search Hypothesis Method Data Collection Observations Conclusion What do we want to learn more about? Gathering of information A suggested explanation based on limited evidence A carefully planned and followed experiment to test the hypothesis Information collected during the experiment A record of what was noticed during the experiment Does the hypothesis still hold, or not? Possible new question?
  32. 32. Inductive, deductive research 32 Theory Test, experiment, intervention Results, outcomes Observations Context Hypothetico-deductive Inductive From: Allen, A.K., (2012) Research Skills for Medical Students, London: Learning Matters, SAGE. p.10
  33. 33. Basic types of research QUALITATIVE Descriptive Interpretative Oriented towards reasons, emotions Numbers not the primary focus QUANTITATIVE About numbers Statistical Oriented towards cause and effect Quantifies data, attempts to generalise it 33
  34. 34. Basic types of research #2 • Examples of quantitative studies – Clinical trials, meta-analyses of CT’s –Epidemiological studies • Examples of qualitative studies –Psychological effects of oral cancer – What does “good health” mean to First Nations people? 34
  35. 35. The evidence pyramid is used to illustrate the evolution of the literature. ► As you move up the pyramid the amount of available literature decreases… ► …but the relevance Sys Rev RCT Cohort study Case-control study Case series Case report Expert opinion for its application in Animal research health related settings increases. Bench-top research Stronger Weaker Study Design 35
  36. 36. Matching design with question Interventions ► (treatment, prevention) Harm ► (etiology, cause) Prognosis Diagnosis, Assessment Economics Meaning Quantitative Systematic review of RCT or RCT Quantitative: Cohort, case control Quantitative: Cohort, case control Quantitative: Comparison to standard Quantitative: Cost-effectiveness Study Qualitative: Case studies etc. 36
  37. 37. How is research disseminated? 37
  38. 38. DEVELOP an idea PRESENT preliminary research REPORT research PUBLISH research GENERALISE INTEGRATE 38
  39. 39. DEVELOP an idea PRESENT preliminary research REPORT research PUBLISH research GENERALISE INTEGRATE 39 Lab Notebooks Grant Proposals Conference Papers Theses, Dissertations Journal Articles Books Encyclopaedias Textbooks
  40. 40. Scope of information sources Encyclopedias Dictionaries Books (General Topic) Books (Specific Topic) Books (Collections of essays) Newspapers Magazines Journals 40 General Specific
  41. 41. Choosing an info source • Stage of your research – Your level of background knowledge – How focused your research question is • What type of information you are looking for – Scope of the information (ex. encyclopedia vs. journal article) – Information time-line (current vs. retrospective) 41
  42. 42. Key Resources at McGill 42 START HERE!
  43. 43. Don’t forget your librarian! • Liaison librarians have expertise in your area of research • Available for one-on-one research consultations • Contact your librarian with your questions! 43
  44. 44. Activity! • Discover various types of resources by completing the exercises on the “Scavenger Hunt” • I’ll ask for volunteers to show me how they approached the tasks – don’t be shy! 44
  45. 45. Why all those databases? • Subject areas • Journal coverage • Date coverage • Geography 45
  46. 46. Databases Medline Embase J O U R N A L S 46
  47. 47. Database overlaps 9505 titles Journal of Clinical Bioinformatics Gut Pathogens Biomagnetic Research and Technology Thyroid Research International seminars in surgical oncology Environmental Entomology Conflict and Health Journal of Physiotherapy Journal of the History of Biology Journal of Translational Medicine ACC Cardiosource Review Journal Advances in Hematology Actualites Pharmaceutiques Hospitalieres Journal of Pharmacy Technology Cancer Cell International ActaToxicologica 7687 titles PubMed Embase 47
  48. 48. Grey Literature “That which is produced on all levels of government, academics, business and industry in print and electronic formats, but which is not controlled by commercial publishers.” (i.e. where publishing is not the primary activity of the producing body.) The Fourth International Conference on Grey Literature, (Luxembourg, 1997) 48
  49. 49. Grey literature Type of Info Examples Helpful Links Data and statistics • Statistics Canada • Health Canada y/find/edrs Government and NGO information • Canadian Laws • United Nation policy statements y/find/govinfo Health technology assessment • Health tech assessment websites • Clinical trial registries Grey Matters: sources/grey-matters Theses and dissertations • McGill theses • Other theses y/find/theses 49
  50. 50. References • Anderson, T. (2004) Dental Treatment in Medieval England. British Dental Journal. 197, 419 – 425. doi:10.1038/sj.bdj.4811723 • History of Medicine slides adapted from Giustini’s here: 2013 • “Mad Scientist” – uploads/2012/12/mad-scientist-movie1.jpg • Edwin Smith Papyrus: • Various icons from the Noun Project ( 50