Faggion Clóvis M, Tu Yu-Kang
Leeds Dental Institute and Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds.
J Dent Educ. 2007 Jun;71(6):825-31.
Making decisions in dentistry should be based on the best evidence available. The objective of this study was to demonstrate a practical procedure and model that clinicians can use to apply the results of well-conducted studies to patient care by critically appraising the evidence with checklists and letter grade scales. To demonstrate application of this model for critically appraising the quality of research evidence, a hypothetical case involving an adult male with chronic periodontitis is used as an example. To determine the best clinical approach for this patient, a four-step, evidence-based model is demonstrated, consisting of the following: definition of a research question using the PICO format, search and selection of relevant literature, critical appraisal of identified research reports using checklists, and the application of evidence. In this model, the quality of research evidence was assessed quantitatively based on different levels of quality that are assigned letter grades of A, B, and C by evaluating the studies against the QUOROM (Quality of Reporting Meta-Analyses) and CONSORT (Consolidated Standards of Reporting Trials) checklists in a tabular format. For this hypothetical periodontics case, application of the model identified the best available evidence for clinical decision making, i.e., one randomized controlled trial and one systematic review of randomized controlled trials. Both studies showed similar answers for the research question. The use of a letter grade scale allowed an objective analysis of the quality of evidence. A checklist-driven model that assesses and applies evidence to dental practice may substantially improve dentists' decision making skill.
牙科决策应基于现有的最佳证据。本研究的目的是展示一种实用的程序和模型，临床医生可以通过使用清单和字母等级量表对证据进行批判性评估，将高质量研究的结果应用于患者护理。为了展示该模型在批判性评估研究证据质量方面的应用，以一个涉及成年男性慢性牙周炎的假设病例为例。为了确定该患者的最佳临床治疗方法，展示了一个基于证据的四步模型，包括以下内容：使用PICO格式定义研究问题、搜索和选择相关文献、使用清单对已识别的研究报告进行批判性评估以及证据的应用。在该模型中，通过以表格形式对照QUOROM（报告元分析的质量）和CONSORT（报告试验的统一标准）清单评估研究，根据不同质量水平对研究证据质量进行定量评估，质量水平分别被赋予A、B和C的字母等级。对于这个假设的牙周病病例，该模型的应用确定了临床决策的最佳可用证据，即一项随机对照试验和一项随机对照试验的系统评价。两项研究对研究问题给出了相似的答案。使用字母等级量表可以对证据质量进行客观分析。一个由清单驱动的、评估并将证据应用于牙科实践的模型可能会显著提高牙医的决策技能。
