1. EBD for Dental Staff Seminar 1: Educational prescription, structured questions and effective searching Dominic Hurst r.d.hurst@qmul.ac.uk evidenced.qm

2. Learning outcomes By the end of this seminar participants should be able to: 1.Explain the concept of EBD comprising patient values, clinicians’ expertise and research evidence 2.Demonstrate how the educational prescription can form part of treatment planning 3.Create a structured question using the PICO format 4.Identify key sources for identifying research evidence including medical databases and search engines 5.Demonstrate some of the common strategies for making a search efficient

3. Structure of the seminars Seminar 1 Recap of EBD Using an educational prescription Structured questions and search Seminar 2 Critical appraisal Seminar 3 Communicating evidence to patients Getting evidence into practice Workshop Focused work on one or more of these

4. EBD Patients, clinicians and the role of research

5. Context / Environment Shared decision- making

6. Systematic reviews of RCTs Randomised controlled trials Cohort studies Case-control studies Surveys, Case series Expert opinion / lab or animal studies Evidence hierarchy Prevalence? Risk factors? Prognosis? Qualitative?

7. The ideal approach… Ask a structured question Search for the best evidence Appraise its validity and results Apply to patient care (make an evidence-based decision with the patient) Evaluate how it worked

8. Reality…learning is haphazard GABBAY, J. & LE MAY, A. 2004. Evidence based guidelines or collectively constructed "mindlines?" Ethnographic study of knowledge management in primary care. BMJ, 329, 1013.

9. Educational prescription Bringing research into clinical decision-making

10. What is it? Structured approach to help students: 1.Ask a question that helps them… 2.Search effectively for relevant research that they… 3.Critically appraise to determine whether they should… 4.Use it with their patients in agreeing a way forward

11. Brief description of the problem e.g. the patient I am treating has tooth surface loss and seems to have GORD. I would like to know how effective proton pump inhibitors are at controlling this and what the side-effects might be Adult with GORD Proton pump inhibitors Nothing 1) Tooth surface loss 2) harms?

12. I think patients are likely to have less TSL because it seems logical that if there is less acid reflux there should be less TSL. Usually Cochrane +/- PubMed Can use medical or academic search engines too e.g. Google Scholar or TRIP Database Intervention Randomised controlled trial

13. Harvard: HURST, D. 2014. Research and other evidence in practice: the importance of our professional discourse and social relationships. Evid Based Dent, 15, 34. High / medium / low risk of bias? Why? External validity: is there something so different about the participants in this study that means these results may not be applicable to the patient(s) being treated in the setting where we work? E.g. Number Needed to Treat (NNT), Absolute risk reduction (ARR)

14. Shared decision-making: Patient at centre: what are their values and aims? How persuasive is the evidence? How has the students / tutors’ experience and expertise influenced this?

15. Assessment Case presentations 8-9/year 5 th year Course Unit Assessment Finals cases Case Presentation Formative assessment StudentTermDate Patient MRN GradeSatisfactoryUnsatisfactory Feedback Content Reflection Evidence

16. Case based discussions As part of case presentations and discussions Helping students put the research into context Strength of evidence Our experience and expertise Reflecting on patient wishes

17. Educational prescription and you 1.How might you use this? 2.What are the barriers to using it?

18. evidenced.qm

20. Structured questions Turning clinical problems into answerable questions

21. Why structure questions? Helps clarify the question Helps create more effective search strategies

22. PICO Think of a clinical situation where you have some uncertainty over what is best to do P What is the core issue or problem? Or which group of patients does it concern? Or which population of people is it about? I/E What intervention are you interested in knowing about, if at all? Or what has the patient or population been exposed to? C Is there a comparison or control you’d like to compare the intervention or exposure to? O What outcome(s) interests you?

23. Effective searching Life’s too short: learning to find research with minimal effort

24. Where to search: Databases

25. Where to search: medical search engines

26. Where to search: Google….

27. Strategy: Boolean logic PI / ECO GORDProton Pump InhibitorNilTooth surface loss OR GERDOmeprazoleErosion OR Gastro-oesophageal refluxLansoprazoleTooth wear OR Gastro-esophageal reflux (GORD OR GERD OR “Gastro-oesophageal reflux” OR “Gastro-esophageal reflux”) AND (“Proton Pump Inhibitor” OR omeprazole OR Lansoprazole) AND [maybe…] (“Tooth surface loss” OR erosion OR tooth wear)

30. Strategy: Filters

32. Mobile TRIP

33. More help?

34. Key messages Research is just one part of decision-making, but an important one The educational prescription provides a structure to help students bring research into treatment planning Structured questions help communication and searching Various databases and search engines can be used to find research but use a strategy for improved efficiency wherever searching

35. Thanks for participating Dominic Hurst r.d.hurst@qmul.ac.uk