This document summarizes a journal club presentation about critically appraising papers on dental therapy. It discusses key questions to consider when evaluating randomized controlled trials and systematic reviews relating to new therapeutic interventions. These include whether patient allocation was randomized, all patients were accounted for, blinding was used, groups were similar at outset, clinically important outcomes were assessed, and results can be applied to patients. It also reviews criteria for assessing systematic reviews, such as whether a clear question was asked, inclusion criteria were appropriate, search was comprehensive, study validity was evaluated, and findings were combined correctly.
Randomized Control Trials
Enigma of Blinding Unraveled
Introduction
RCT
Steps in a RCT
Allocation Concealment
Bias in RCT
Phases in RCT
Types of RCT
Study Designs of RCT
Blinding
Methods of Blinding in different trials
Assessment of Blinding
Un-blinding
Current Scenario of Blinding
CONSORT
Conclusion
References
Randomized Control Trials
Enigma of Blinding Unraveled
Introduction
RCT
Steps in a RCT
Allocation Concealment
Bias in RCT
Phases in RCT
Types of RCT
Study Designs of RCT
Blinding
Methods of Blinding in different trials
Assessment of Blinding
Un-blinding
Current Scenario of Blinding
CONSORT
Conclusion
References
How to scientifically conduct a clinical professional research trial? In the current era of Collaborate or parish, we need to keep this design in our mind.
Enjoy
@copyLeft
Evidence based decision making in periodonticsHardi Gandhi
INTRODUCTION TO EVIDENCE BASED DENTISTRY
EVIDENCE BASED PERIODONTOLOGY
NEED, PRINCIPLES, GOALS AND ADVANTAGES OF EBDM
SKILLS NEEDED FOR EBDM
ASSESING THE EVIDENCE
INCORPORATING INTO THE PRACTICE
Evidence- based periodontology is a bridge from all the available literature to clinical practice. It is a tool which can be used for decision making from available evidence during clinical practice.It should be scientifically sound and patient focussed.
How to scientifically conduct a clinical professional research trial? In the current era of Collaborate or parish, we need to keep this design in our mind.
Enjoy
@copyLeft
Evidence based decision making in periodonticsHardi Gandhi
INTRODUCTION TO EVIDENCE BASED DENTISTRY
EVIDENCE BASED PERIODONTOLOGY
NEED, PRINCIPLES, GOALS AND ADVANTAGES OF EBDM
SKILLS NEEDED FOR EBDM
ASSESING THE EVIDENCE
INCORPORATING INTO THE PRACTICE
Evidence- based periodontology is a bridge from all the available literature to clinical practice. It is a tool which can be used for decision making from available evidence during clinical practice.It should be scientifically sound and patient focussed.
JOURNAL CLUB ON CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH ...Shilpa Shiv
CORONALLY ADVANCED FLAP vs THE POUCH TECHNIQUE COMBINED WITH A CONNECTIVE TISSUE GRAFT TO TREAT MILLER'S CLASS I GINGIVAL RECESSION, JCP 2014;41(4):387-395.
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoec...Shilpa Shiv
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoectomy andRoot-End Fillings in the Treatment ofDeep Localized Gingival Recession withApex Root Exposure
A presentation on what is a Medical Journal Club and its value in clinical and academic training with the headings necessary for inclusion in a PowerPoint presentation.
Also contains Hyperlinks to useful CAT sites.
Periodontal disease susceptible group present advanced periodontal breakdown even though they achieve a high standard of oral hygiene. Various destructive enzymes and inflammatory mediators are involved in destruction. These are elevated in case of periodontal destruction. Host modulation aims at bringing these enzymes and mediators to normal level.
This ppt aims in highlighting the various host modulatory agents that can be put to use in periodontal therapy.
Excelsior College PBH 321 Page 1 EXPERI MENTAL E.docxgitagrimston
Excelsior College PBH 321
Page 1
EXPERI MENTAL E PIDE MIOLOGICAL STUDIE S
Epidemiologic studies are either observational or experimental. Observational studies, including ecologic,
cross-sectional, cohort, and case-control designs, are considered “natural” experiments, but experimental
studies are considered true experiments. We will spend the next 2 modules discussing these designs.
Before we begin to discuss study designs, we need a brief introduction to a concept that we will spend more
time discussing in later modules -- bias. The definition of bias is:
“Deviation of results or inferences from the truth, or processes leading to such deviation. Any trend in the
collection, analysis, interpretation, publication, or review of data that can lead to conclusions that are
systematically different from the truth.” (Last, J.M., A Dictionary of Epidemiology, 4th ed.)
Epidemiologists are naturally concerned whether the results of an epidemiologic study are biased, since many
important public health decisions are often drawn from epidemiologic research. The severity of the bias, that
is - how much it influences or distorts the results, is related to the study design as well as how information is
analyzed.
Experimental Studies
The defining feature of experimental studies is that the investigator assigns exposure to the study subjects.
Experimental studies most closely resemble controlled laboratory experiments and serve as models for the
conduct of observational studies, thus they are the “gold standard” of epidemiologic research. Experimental
studies have high validity (i.e., less bias), and can identify even very small effects. The most well known type of
experimental study is a randomized trial (sometimes referred to as a randomized controlled trial), where the
investigator randomly assigns exposure to the study subjects. In this type of study, the only expected
difference between the experimental and control groups is the outcome variable being studied.
Experimental designs like the randomized trial can assess both preventive interventions, where a prophylactic
agent is given to healthy or high-risk individual to prevent disease, or can assess effects of therapeutic
treatment, such as those given to diseased individuals to reduce their risk of disease recurrence, or to improve
their survival or quality of life.
Preventive intervention: Does tamoxifen lower the incidence of breast cancer in women with high risk profile
compared to high risk women not given tamoxifen?
Therapeutic intervention: Do combinations of two or three antiretroviral drugs prolong survival of AIDS
patients as well as regimens of single drugs?
The investigator can assign exposures (or allocate interventions) to either individuals or to an entire
community.
Individual-level assignment: Do women with stage I breast cancer given a lumpectomy alone survive as long
without recurrence of disease as women given a lumpec ...
Error/Bais in Rsearch Methodology and pharmaceutical statisticsakashpharma19
Error/Bais in Rsearch Methodology and Pharmaceutical Statistics .
A biased estimate is
one which, on the average, does not equal the population parameter.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
1. DEPARTMENT OF
PERIODONTICS
SCHOOL OF DENTAL SCIENCE
SHARDA UNIVERSITY
JOURNAL CLUB:- EVIDENCE -BASED
DENTISTRY:PART V.CRITICAL APPRAISAL OF THE
DENTAL LITERATURE:PAPERS ABOUT THERAPY
PRESENTED BY:Dr NISHA SINGH
PG 1st year
5. Critical appraisal can be used to rapidly assess and
discard reports of research studies that are irrelevant
or of poor quality
6. Questions relating to therapy
When considering a new therapeutic or preventive
intervention the highest levels of evidencerandomized controlled trials and systematic reviews
should be sought before subjecting patients to
possibly useless,and harmful treatments.
8. Was the allocation of patients to study group
random?
The first thing to consider is whether or not the
treatment allocation was truly randomized.was the
assignment of each patient to either the treatment
group or the control group decided completely by
chance,by flip of a coin or by some other similar
method.
This assignment helps to ensure that people in the
treatment and control groups are similar at the
outset and that differences at the end of the trial are
due to the intervention and not to some selection
factor
9. If randomization done by flip of coin,coded,sealed
envelopes,random number tables or a computer
generated sequence then it is appropriate.
any method of allocation where the sequence could
be guessed by anyone it is inappropriate
10.
11. Were all the patients who entered the trial
accounted for and analysed at the end of the
study?
It is not uncommon to read a study began with certain
number of patients and ended with a lesser number
with a mere statement that particular number of
patients were “not available for the follow up”
Reason for loss to follow up may be extremely
important.patients who donot complete trials may
provide more information about the intervention than
those who do.
12. Patient may have dropped out because of side
effects(placebo) or because they benefitted from the
intervention and resolution of their problem or
condition,chose not to return for follow up
Follow up of less than 80% of the patient enrolled at
the beginning is generally considered unacceptable
13. It is also important that patient be analysed in the
group to which they were orignally randomaly
allocated,even if they switched groups or were
noncompliant with either the experimental or the
control treatment.
This is the intention to treat principle and it serves
to preserve the powerful function of randomization.
This consistency prevents the intervention from
appearing to be effective when it is not and makes
the results of the study more conservative and more
believable.
14. Were patients,clinicians and study personnel
“blinded”?
Patient should be blinded whether they are in the
active or the control group to minimze the placebo
effect
Clinician assesing the outcome should be blinded to
reduce measurement bias
The greater the extent of blinding of all study
personnel,the more rigorous the trial
15. Were the groups similar at the outset and
treated equally throughout the study?
Co-interventions are additional treatments other
than those being investigated that are used by or
given to patients.
Co-interventions are problematic if they are given
differentially to either the treatment and control
group and are much less of a problem in double blind studies.
It is helpful to the reader if allowed co-interventions
are described in the methods section and the extent
of use of non permissible co-interventions is
documented in the results.
16. Success of blinding can be assessed by the
investigators asking both clinicians and patients after
completion of the study what group they thought the
patient was in and comparing the answers with the
actual allocation.
If the result of the analysis show that more patients
or clinicians guessed correctly than one would
expect by chance(more than one person in 20
guessed correctly,p>0.05),then the method used for
blinding didn’t really work
17. Were clinically important outcomes assesed?
A clinically important outcome is one that is important
to the patient.
Carious tooth is important to patient not cariogenic
bacterial count,mobility and loss of teeth are important
not radiographic measurement of bone loss
18. Microbiological and radiographic end points are
“surrogate or secondary end points”
19. These substitute outcome measures are important to
study early on in the research to help understand the
disease process,they are often chosen inappropriately
in more definitive trials because a difference can be
shown between the treatment and the control group
using smaller sample sizes and shorter follow up times
The differences shown are not relevant to the patient
20. Can the result of my study be applied to my
patients?
by looking at the study’s inclusion and exclusion
criteria,we can make a reasonable judgement
whether or not the result of study are useful in the
management of the patient problem at hand
If result can be generalised to our patient ,then it is
important to consider if the benefit is greater than
any potential harm,added cost or inconvenience
22. Systematic reviews
A systematic review is a thorough, comprehensive,
and explicit way of interrogating the dental
literature.
It typically involves several steps, including
1. asking an answerable question (often the most
difficult step)
2. identifying one or more databases to search
23. 3. developing an explicit search strategy,
4. selecting titles, abstracts, and manuscripts
based on explicit inclusion and exclusion
criteria
5. abstracting data in a standardized format.
24. This will enable us to judge the validity and usefulness
of a systematic review of randomized controlled trials
addressing issues of therapy
25. Meta-analysis
A "meta-analysis" is a statistical approach to
combine the data derived from a systematic-review.
Therefore, every meta-analysis should be based on
an underlying systematic review, but not every
systematic review leads to a meta-analysis
26. Was a clearly stated question asked?
The question being addressed by the review should be
focused in terms of
1. The population being studied
2. The intervention given
3. The outcomes being considered
27. Were the inclusion criteria appropriate?
Specific inclusion and exclusion criteria related to the
population,intervention,outcome and acceptable
study design must be well defined and clearly stated
This allows the reader to decide if the appropriate
studies were included
In addition ,this permits the review to be replicated
and avoids preferential citation of studies that
support a particular viewpoint.
28. Was a comprehensive literature search
done?
It is important to include all pertinent studies and
that important ones have not been missed.
The author of the overview should clearly state their
. Search strategy
. Including key words
. Databases used
29. Ideally the search should include other sources such
as
. Multiple databases
. References list from relevant papers
. Conference proceedings
. Personal contacts with experts
30. Was the validity(quality) of the primary
studies assessed?
It is important to know the quality of the included
studies.
If many of the included studies are weak ,then their
combined result is not believable
It is helpful to the reader if a study-by study critique
is presented in a table or a thorough discussion of
the methodological quality of the included studies
31. Was the assessment of the studies reproducible
and free of bias?
Decisions regarding the inclusion criteria,validity and
the meaning of data within each primary study
involve judgment on the part of the reviewer
All such judgment are susceptible to error and
unintentional bias
To overcome this ,2 or more authors of the review
should perform each step independently,blinding to
each other’s decision and then come to agreement
by consensus.
32. Ideally the names of the authors of the primary
studies and their affiliated institutions should be
deleted during review process.
33. Were the result similar from study to study?
Even with strict inclusion criteria there is bound to
be some variation in the result of the eligible studies
The author should present the salient features of
each study in terms of:1. included patient
2. stage or severity of disease
3. the intervention(the route,dose or timing)
4. the way in which the outcome was measured
5. they should try to explain the variability of the
result
34. Were the findings of the studies combined
appropriately?
To combine a studies in a systematic review,one
should keep in mind that no 2 studies can never be
exactly the same.
If the studies seems too dissimlar,they should not
be combined mathematically
A statistical test can be done to see if the results are
different merely by chance
35. If this test indicates that the study results are similar
enough to combine mathematically a meta -analysis
is done.
A “vote count”that is vote counting the number of
positive studies versus the number of negative
studies is not appropriate.
The reason for this is that small studies may be
“underpowered” because there may not have been a
large enough sample size for the study to have
sufficient power to detect a difference in treatment
effect between experimental and control group.
36. Major advantages of meta-analysis is that the result
of a number of small but similar studies can be
combined to achieve a large enough sample to
detect an effect.
37. Were the author’s conclusion supported by
the data?
The result of each study must be reported in enough
detail to allow the reader to judge the grounds for
the reviewer’s conclusions.
38. Will the result help in caring for patients?
With all research,we need to decide if our patients
and our practice setting are similar to the patients of
studies included in the review.
Are we able to implement the intervention in our
practice
Are the potential benefits worth any potential harm
or cost.
39. conclusion
A well-designed randomized controlled trial is the
strongest research design for clinical trials.
The Systematic review is a powerful way to assemble
multiple studies and synthesize their findings.
In both cases the credibility of the research needs to
be determined through the use of critical appraisal
techniques.
40. References
Evidence-based Dentistry: Part V.Critical
Appraisal of the Dental Literature Papers
About Therapy susan E. sutherland DDS
Greenhalgh T. How to read a paper: getting
your bearings (deciding what the paper is
about). BMJ 1997; 315(7102):243-6.
41. Carranza's Clinical Periodontology tenth edition by
Perry R. Klokkevold, Michael G. Newman, Henry
Takei
Evidence-Based Practice: Step by Step: The Seven
Steps of Evidence-Based Practice
Melnyk, Bernadette Mazurek PhD, RN,
CPNP/PMHNP, FNAP, FAAN; Fineout-Overholt, Ellen
PhD, RN, FNAP, FAAN; Stillwell, Susan B. DNP, RN,
CNE; Williamson, Kathleen M. PhD, RN
Core-centre for outcome research and education site