The journal of evidence-based dental practice
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J Evid Based Dent Pract · Sep 2012
CommentModest reduction in risk for ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation following topical oral chlorhexidine.
The sample (N = 547) included patients older than 18 years (328 men and 219 women from a total population of 10,913) admitted to 3 intensive care units (ICUs) (medical, surgical/trauma, and neuroscience) at Virginia Commonwealth University Medical Center. The sample size required to detect an interaction (ie, the effect of chlorhexidine and toothbrushing in combination) was determined to be larger than that required to detect main effects (ie, chlorhexidine alone or toothbrushing alone) for a test at a given level of significance. The study was designed to detect an interactive effect resulting in a 0.755 difference in mean Clinical Pulmonary Infection Score (CPIS) at a power of 80% and a significance level of .05. An interim analysis was done and a Bonferroni adjustment was used to avoid inflation in the overall significance level related to interim analyses; for this reason, the level of significance for final analysis was .025. This was a randomized controlled clinical trial with a 2 × 2 factorial design. Patients were randomized to treatment within each ICU according to a permuted block design developed by the biostatistician before the start of the study. Staff who performed interventions (oral care) had no knowledge of patients' CPIS. Patients receiving mechanical ventilation were enrolled within 24 hours of intubation and were followed for up to 14 days. Dates of recruitment were not disclosed. ⋯ Chlorhexidine oral swabbing was effective in reducing early ventilator-associated pneumonia (VAP) (after 3 days of intervention) in patients in medical, surgical/trauma, and neuroscience ICUs who did not have evidence of lung infection at baseline. This effect was not observed after day 3. Toothbrushing did not reduce the incidence of VAP, and combining toothbrushing and chlorhexidine did not provide additional benefit over use of chlorhexidine alone.
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J Evid Based Dent Pract · Jun 2010
Randomized trials published in the journal of dental research are cited more often compared with those in other top-tier non-specialty-specific dental journals.
Randomized controlled trials (RCTs) are viewed as the gold standard for clinical research. Oftentimes the citation counts serve as an important measure for assessing the significance of an RCT to promote the dissemination of science. This study attempts to identify the factors associated with the number of times RCTs are cited within the first 24 months since publication. ⋯ Based on our initial analysis of 4 journals, publishing randomized trials in high-impact journals will likely provide better dissemination of research findings.
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J Evid Based Dent Pract · Jun 2010
Patient-reported outcomes (PROs) in dental clinical trials and product development: introduction to scientific and regulatory considerations.
Although typically measured with objective assessments, treatment efficacy and disease progression may also be examined using reports directly from the patient (patient-reported outcomes or PROs). PROs can enhance clinician and researcher understanding of an illness and its treatment in multiple ways, ranging from an assessment of core signs and symptoms to assessment of impairments and impacts across a variety of domains (eg, physical, social, occupational, emotional). Regulated drug and medical device development programs are increasingly using PROs as endpoints to support label claims. ⋯ The goals of this article were to introduce the concept of PROs and to provide an introduction to PRO scientific and regulatory principles. These principles can be used as a blueprint for using PROs in clinical research and for evaluating trials that have implemented PROs. When used appropriately, PROs may be useful in understanding the patient's perspective on illness and interventions and this perspective may be critical in fully evaluating the efficacy of dental treatments.
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J Evid Based Dent Pract · Sep 2007
Practice GuidelineThe evidence-based clinical decision support guide: mucogingival/esthetics making clinical decisions in the absence of strong evidence.
Although evidence-based decision-making in dentistry is quickly evolving, large gaps remain in our clinical knowledge base regarding every day decisions and procedures. Especially in the absence of strong evidence, as is the case with mucogingival conditions, risk assessment and identification are important components of the clinical decision-making process. Utilization of clinical decision support (CDS) guides, frameworks and systems enhances chairside decision-making and improves delivery of patient care. ⋯ This CDS guide delineates treatment strategies based upon evidence-based risk assessment and when possible, risk management. It provides the clinician with a framework that will support decision-making at the point of care. Recommendations for consultation, treatment and referral are reviewed.
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J Evid Based Dent Pract · Mar 2007
Clinical decision support complements evidence-based decision making in dental practice.
Dental professionals as well as consumers of dental health care are driving the demand for access to reliable information so they can make more informed decisions. Clinical decision support (CDS) includes a variety of printed and electronic tools, systems, products, and services that make knowledge and information available to the user. CDS is the main way people will be able to access important facts, ideas, concepts, and the latest thinking about personal and population-based health subjects. CDS has its greatest potential at the point of care where it can facilitate good-quality evidence-based decision-making.