Evidence-based dentistry: Part IV. Research design and levels of evidence. Identifying trial recruitment uncertainties using a James Lind Alliance Priority Setting Partnership – the PRioRiTy (Prioritising Recruitment in Randomised Trials) study Health and mental health social workers need information literacy skills. Online Alcohol Assessment and Feedback for Hazardous and Harmful Drinkers: Findings From the AMADEUS-2 Randomized Controlled Trial of Routine Practice in Swedish Universities Ten years of evidence to guide physiotherapy interventions: Physiotherapy Evidence Database (PEDro) Reporting quality of randomised controlled trials published in prosthodontic and implantology journals. International Journal of Implant Dentistry
Previous papers in this series on evidence -based dentistry have discussed the first 2 steps in seeking answers to clinical problems formulating a clear question and strategically search ing for evidence . The next step , critical appraisal of the evidence , is made easier if one underst and s the basic concepts of clinical research design . The strongest design , especially for questions related to therapeutic or preventive interventions , is the r and omized , controlled trial . Questions relating to diagnosis , prognosis and causation are often studied with observational , rather than experimental , research design s. The strongest study design should be used whenever possible . Rules have been established to grade research evidence . This paper , the fourth in the series , presents an overview of research methodology most commonly used in the dental literature Background Despite the problem of inadequate recruitment to r and omised trials , there is little evidence to guide research ers on decisions about how people are effectively recruited to take part in trials . The PRioRiTy study aim ed to identify and prioritise important unanswered trial recruitment questions for research . The PRioRiTy study - Priority Setting Partnership ( PSP ) included members of the public approached to take part in a r and omised trial or who have represented participants on r and omised trial steering committees , health professionals and research staff with experience of recruiting to r and omised trials , people who have design ed , conducted , analysed or reported on r and omised trials and people with experience of r and omised trials methodology . Methods This partnership was aided by the James Lind Alliance and involved eight stages : ( i ) identifying a unique , relevant prioritisation area within trial methodology ; ( ii ) establishing a steering group ( iii ) identifying and engaging with partners and stakeholders ; ( iv ) formulating an initial list of uncertainties ; ( v ) collating the uncertainties into research questions ; ( vi ) confirming that the questions for research are a current recruitment challenge ; ( vii ) shortlisting questions and ( viii ) final prioritisation through a face-to-face workshop . Results A total of 790 survey respondents yielded 1693 open-text answers to 6 questions , from which 1880 potential questions for research were identified . After merging duplicates , the number of questions was reduced to 496 . Questions were combined further , and those that were su bmi tted by fewer than 15 people and /or fewer than 6 of the 7 stakeholder groups were excluded from the next round of prioritisation result ing in 31 unique questions for research . All 31 questions were confirmed as being unanswered after checking relevant , up-to- date research evidence . The 10 highest priority questions were ranked at a face-to-face workshop . The number 1 ranked question was “ How can r and omised trials become part of routine care and best utilise current clinical care pathways ? ” The top 10 research questions can be viewed at www.priority research .ie . Conclusion The prioritised questions call for a collective focus on normalising trials as part of clinical care , enhancing communication , addressing barriers , enablers and motivators around participation and exploring greater public involvement in the research process In recent years , social work has moved in parallel with medicine and the health sciences to use evidence -based criteria to determine the actions of practitioners ( Institute of Medicine , 2001 ; Parker-Oliver & Demiris , 2006 ) . Consequently , social workers employed in health and mental health setting s are compelled to use evidence -based practice s in their work . For many practitioners , evidence -based practice means the application of empirically based service models and a trend toward interventions demonstrated to be effective in changing behavior and ameliorating clients ' problems . However , social workers , including those in medical and mental health services , are often not involved in the research that informs these practice s , and their ability to shape promoted practice s is virtually nonexistent . Health and mental health social workers increasingly view evidence -based practice as prescriptive , with research ers in centers of scholarship developing research for practitioners . This situation has exacerbated the rift between research ers and social workers who are expected to carry out empirically supported practice s , although they are not involved in the production of research or even in the synthesis of evidence that supports particular practice s and rejects others . People with research expertise and the re sources to conduct empirical inquiry are generally located in academic institutions and do not necessarily call on practitioners themselves to critically examine evidence -based practice models . When these prescribed practice s move from the rarified conditions under which r and omized controlled trials are conducted into agency setting s , they confront real-world organizational realities , Real-world " intrusions " may limit fidelity to the model produced by this " gold st and ard " of research . As a result , technology transfer , or reliability for replication of evidence -based practice s , may be compromised . Perhaps most disheartening is how this situation encourages passivity among people in the field to engage in research or remain fluent with current research . Continuing knowledge development is a shared responsibility at all levels of the social work profession ( Lewis , 2003 ) , and current education and practice structures are not encouraging practitioners to be partners in this process . We assert that people closest to direct services are best positioned to point out practice realities that distort programs . Although practice s may be supported by high-level empirical evidence , they may not prove effective or even feasible under real-world conditions . Originally , evidence -based practice was proposed for physicians to make use of the convergence of an explosion of information and technology , so that clinicians could use the growing body of research available through online data bases . Ultimately , other health professionals were supposed to formulate clinical questions , critically assess empirical studies , and decide on the best approaches to bring to a dialogue with clients . The clients were meant to be active partners in decision making about their own care . The institution of the Cochrane Collaboration ( http://www : cochrane.org./index.htm ) and the Campbell Collaboration ( http://www . campbellcollaboration.org/ ) formalized this process , and both apply rigorous , transparent st and ards to their review s of research studies . Although they are meant to serve policymakers , health workers , and people who use services , the extent to which medical social workers consult their readily available Web sites is unclear . Unlike nursing , speech therapy or rehabilitation therapy , or other health professions that have produced a burgeoning literature on information literacy skills as a central concern for educators ( Jacobs , Rosenfeld , & Haber , 2003 ; Nail-Chiwetalu & Bernstein Ratner , 2007 ) , the social work literature is for the most part silent in this area . With the exception of two recent texts that promote a bottom-up approach to evidence -based practice ( Courneyer , 2004 ; Gibbs , 2003 ) and Gary Holden 's remarkable informatics Web site for social workers ( http://www : nyu . Background Previous research on the effectiveness of online alcohol interventions for college students has shown mixed results . Small benefits have been found in some studies and because online interventions are inexpensive and possible to implement on a large scale , there is a need for further study . Objective This study evaluated the effectiveness of national provision of a brief online alcohol intervention for students in Sweden . Methods Risky drinkers at 9 colleges and universities in Sweden were invited by mail and identified using a single screening question . These students ( N=1605 ) gave consent and were r and omized into a 2-arm parallel group r and omized controlled trial consisting of immediate or delayed access to a fully automated online assessment and intervention with personalized feedback . Results After 2 months , there was no strong evidence of effectiveness with no statistically significant differences in the planned analyses , although there were some indication of possible benefit in sensitivity analyses suggesting an intervention effect of a 10 % reduction ( 95 % CI –30 % to 10 % ) in total weekly alcohol consumption . Also , differences in effect sizes between universities were seen with participants from a major university ( n=365 ) reducing their weekly alcohol consumption by 14 % ( 95 % CI –23 % to –4 % ) . However , lower recruitment than planned and differential attrition in the intervention and control group ( 49 % vs 68 % ) complicated interpretation of the outcome data . Conclusions Any effects of current national provision are likely to be small and further research and development work is needed to enhance effectiveness . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 02335307 ; http://www.is rct n.com/IS RCT N02335307 ( Archived by WebCite at http://www.webcitation.org/6ZdPUh0R4 ) Clinicians are increasingly using evidence from high- quality clinical research to guide clinical decision making . Recent articles in this journal have examined research evidence to assist in clinical decisions as diverse as the prescription of running shoes,1 exercise therapy in the treatment of chronic disease2 and the use of protective equipment to prevent concussion.3 The most valid information about the effectiveness of healthcare interventions is provided by r and omised controlled trials and systematic review s of r and omised controlled trials.4 The Physiotherapy Evidence Data base ( PEDro ; http://www.pedro.org.au ) provides easy access to r and omised controlled trials and systematic review s of physiotherapy interventions . PEDro also includes links to evidence -based clinical practice guidelines . October 2009 marked the 10th anniversary of the launch of PEDro . PEDro is freely available on the internet . The data base indexes citation details , author abstract s and , where available , links to full text for r and omised controlled trials , systematic review s and practice guidelines in physiotherapy . Although the PEDro data base is design ed primarily for health professionals , a subsite , called Physiotherapy Choices ( http://www.physiotherapychoices.org.au ) , provides information in lay terms directly to consumers of physiotherapy services . As of August 2009 , more than 15 000 records ( 12 408 trials , 2060 review s and 603 guidelines ) have been indexed on PEDro . Each record is coded according to the subdiscipline(s ) of physiotherapy it addresses . PEDro now includes 615 r and omised controlled trials and 102 The purpose of this study was to examine the reporting quality of r and omised controlled trials ( RCTs ) published in prosthodontic and implantology journals . Thirty issues of nine journals in prosthodontics and implant dentistry were search ed for RCTs , covering the years 2005 - 2012 : The Journal of Prosthetic Dentistry , Journal of Oral Rehabilitation , The International Journal of Prosthodontics , The International Journal of Periodontics & Restorative Dentistry , Clinical Oral Implants Research , Clinical Implant Dentistry & Related Research , The International Journal of Oral & Maxillofacial Implants , Implant Dentistry and Journal of Dentistry . The reporting quality was assessed using a modified Consoli date d St and ards of Reporting Trials ( CONSORT ) statement checklist . Data were analysed using descriptive statistics followed by univariable and multivariable examination of statistical associations ( α = 0·05 ) . A total of 147 RCTs were identified with a mean CONSORT score of 69·4 ( s.d . = 9·7 ) . Significant differences were found among journals with the Journal of Oral Rehabilitation achieving the highest score ( 80·6 , s.d . = 5·5 ) followed by Clinical Oral Implants Research ( 73·7 , s.d . = 8·3 ) . Involvement of a statistician/ method ologist was significantly associated with increased CONSORT scores . Overall , the reporting quality of RCTs in major prosthodontic and implantology journals requires improvement . This is of paramount importance considering that optimal reporting of RCTs is an important prerequisite for clinical decision-making The International Journal of Implant Dentistry is a peer- review ed open access journal published under the SpringerOpen br and . The journal is dedicated to promoting the exchange and discussion of all research areas relevant to implant dentistry in the form of systematic literature or invited review s , prospect i ve and retrospective clinical studies , clinical case reports , basic laboratory and animal research , and articles on material research and engineering .
Due to the low quality , small sample sizes or lack of adequate reporting of the outcome data , the evidence is inadequate to cl aim or refute a difference in postoperative sensitivity between different dental liners .
Since August 2009 , members of the Primary Care Dentistry Research Forum ( www.dentistry research .org ) have taken part in an online vote to identify questions in day-to-day practice that they felt most needed to be answered with conclusive research .