Kanıta dayalı diş hekimliği; hastanın ağız sağlığı, tıbbi durumu ve geçmişi ile alakalı klinik olarak geçerli bilimsel kanıtın sistematik değerlendirmelerinin, diş hekiminin klinik uzmanlığı ile hastanın tedavi ihtiyaçları ve tercihleriyle makul bir şekilde bütünleşmesini gerekli kılan ağız sağlığına dair bir yaklaşımdır¹. En güncel bilimsel sonuçlara dayandırılmış, kişiye özel ağız bakımı ile birlikte, hasta odaklı bir tedavi sunar. Klinik sorunlara dair düşünme biçimimizin yeniden yapılandırılması ve mevcut en iyi bilimsel kanıta dayanarak kararlar alınmasıyla ilgilidir².
Okuyacağınız makale aslında diş hekimlerine hitaben yazılmış olmasına rağmen hastaların da yararlanabileceği güncel bilgiler içermektedir.
Günümüzde diş hekimliği pratiği; biyolojik bilimlerdeki, bilgi yönetimindeki, tedavi ve tanı teknolojilerindeki hızlı gelişmeler nedeniyle oldukça karmaşık bir hale gelmiştir. Bu nedenlerden ötürü, kanıta dayalı diş hekimliği (KDD); diş hekiminin klinik karar verme yeteneğinin artmasında, tanı hatalarının minimuma indirgenmesinde, tedavi ve terapiler hakkında optimal düzeyde kararın sağlanmasında önemli bir faktör alarak görülmektedir. KDD, günlük klinik pratikte tedavi hakkında en iyi kararın alınabilmesi için klinik bilimsel kanıtların, klinik ve hastayla ilgili faktörlerin birbirine entegre edilmesi esasına dayanmaktadır. KDD’nin nihai amacı; kanıta dayalı karar vermektir. Bu nedenle, kanıta dayalı diş hekimliğinin klinik uygulamalarda kullanılması, bu kavramın anlaşılmasını ve klinik soruların hazırlanması, mevcut kaynaklara ulaşma, kanıtların eleştirel değerlendirmesi, sonuçların klinik pratiğine uygulanması ve sürecin değerlendirilmesine yönelik becerilerin geliştirilmesini gerektirmektedir³.
Teknolojinin hızla ilerlediği ve bilgiye ulaşmanın aşırı kolaylaştığı günümüzde; doğru olana ulaşmanın kolay olduğu kadar, yanlış ve yanıltıcı olana da ulaşmak çok kolaylaşmıştır. Kişi; merak ettiği bir mevzu hakkında bilgi ararken, doğruluğundan emin olmadığı bir çok yazılı ve görsel kaynakla karşılaşmakta ve bu sayede aslında kendisini dipsiz bir kuyunun içinde bulmaktadır. Kanıta dayalı diş hekimliğinde, hekim bir tedavi yönteminin doğruluğunu ve yaklaşımını nasıl ele alıyorsa; hasta da bir şekilde ulaştığı bilginin doğruluğunu aynı biçimde ele almalıdır. Bu sebepten, yazılı ve görsel kaynaklarda (internet, TV, radyo, gazete, dergi vb) edinilen bilgilerin doğruluğu mutlaka sorgulanmalıdır. Kanıta dayalı diş hekimliğinde nasıl hasta önemli bir noktada konumlanmışsa, doğru bilgiye ulaşmanın en önemli noktalarından birinde de diş hekiminiz durmaktadır. Hangi bilginin doğru, hangi bilginin yanlış, hangisinin güvenilir olduğu konusunda ise doğru yerlerde arama yapmayı diş hekiminin de bilmesi gereken en önemli noktadır. En çok tavsiye edilen yöntem, bir konu ile ilgili arama yapılırken, “Review” adı verilen ve birden çok makalenin harmanlanması sonucu ortaya çıkmış yazıların takip edilmesi yönündedir. Aşağıda bilimsel kaynaklara ulaşılabilecek internet sitelerinin bir listesi verilmiştir (kaynakların hepsinin dili İngilizce’dir)⁴.
Table Evidence Locator | ||
Summaries of Systematic Reviews | ||
Resource | Link | Information Available |
EBD at ADA.org | www.ada.org/goto/ebd | Summaries of dental systematic reviews published elsewhere (new ADA-sponsored critical summaries are under development); additional Web resources |
Journal of Evidence-Based Dental Practice | http://journals.elsevierhealth.com/periodicals/ymed | Summaries of dental systematic reviews, plus commentary and analysis; critical evaluations of published articles on various topics |
Database of Abstracts of Reviews of Effectiveness (DARE) | http://www.crd.york.ac.uk/CRDWeb/ | Structured abstracts of systematic reviews; includes commentary on overall review quality |
National Library for Health—Oral Health Specialist Library | http://www.library.nhs.uk/oralhealth/ | Structured abstracts of systematic reviews |
Evidence-Based Dentistry journal (UK) | http://www.nature.com/ebd/archive/index.html | Systematic review summaries/analyses. |
Evidentista (Pan American Centers for Evidence-Based Dentistry) | http://us.evidentista.org/?o=1026 | Clinical questions and answers grouped by topic area |
Agency for Healthcare Research and Quality (AHRQ) | http://www.ahrq.gov/clinic/epcquick.htm | Summaries of AHRQ evidence reports on dental caries, dental patients who are HIV positive, scaling and root planning therapy, and others |
Bandolier: Dental and Oral Health | http://www.jr2.ox.ac.uk/bandolier/booth/booths/dental.html | Critical appraisals of systematic reviews and supporting studies on dental topics |
Cochrane Oral Health Group | http://www.ohg.cochrane.org/reviews.html | Abstracts and plain-language summaries of dental systematic reviews |
Centre for Evidence-Based Dentistry | http://www.cebd.org/?o=1069 | Evidence summaries from the Oral Health Specialist library grouped by topic and/or specialty area |
Table Evidence Locator | ||
Clinical Recommendations/Guidelines | ||
Resource | Link | Information Available |
National Guideline Clearinghouse | www.guidelines.gov | Clinical practice guidelines |
ADA Evidence-Based Clinical Recommendations | http://www.ada.org/prof/resources/ebd/clinical.asp | Evidence-based clinical recommendations on oral health topics, including topical fluoride and sealants |
PubMed Clinical Queries (National Library of Medicine) | http://www.ncbi.nlm.nih.gov/entrez/query/static/clinical.shtml#reviews | Clinical practice guidelines grouped by category |
National Institute for Health and Clinical Excellence (NICE) | http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7298&set=true | Clinical guidelines from UK on dental recall |
Centers for Disease Control and Prevention (CDC) Division of Oral Health | http://www.cdc.gov/oralhealth/guidelines.htm | Guidelines developed by CDC and the Task Force on Community Preventive Services |
Scottish Intercollegiate Guidelines Network | http://www.sign.ac.uk/guidelines/published/index.html#Dentistry | Clinical guidelines on dental topics available as full guidelines and in quick reference guide format |
Royal College of Surgeons (RCS) of England | http://www.rcseng.ac.uk/fds/clinical_guidelines | Clinical guidelines on common clinical situations |
Agency for Healthcare Research and Quality (AHRQ) | http://www.ahrq.gov/clinic/cpgsix.htm | Clinical practice guidelines from the National Guideline Clearinghouse, Department of Health and Human Services, and AHRQ |
SUMSearch | http://sumsearch.uthscsa.edu/ | Searches free online resources—PubMed (Medline), Database of Abstracts of Reviews of Effectiveness (DARE), National Institutes of Health (NIH) Guidelines Clearinghouse—to retrieve systematic reviews and/or clinical guidelines. |
Centre for Evidence-Based Dentistry | http://www.cebd.org/?o=1069 | Guidelines and consensus statements |
Table Evidence Locator | ||
Systematic Reviews | ||
Resource | Link | Information Available |
EBD at ADA.org | www.ada.org/goto/ebd | Abstracts of published systematic reviews on dental topics grouped by clinical topic areas, listed in A-Z format; full text available for systematic reviews published by the Journal of the American Dental Association |
Cochrane Oral Health Group (affiliated with the Cochrane Collaboration) | http://www.ohg.cochrane.org/reviews.html#reviews | Systematic reviews from the Cochrane Oral Health Group |
PubMed systematic review search page | http://www.ncbi.nlm.nih.gov/entrez/query/static/clinical.shtml#reviews | Systematic review abstracts, plus links to full-text copies where available. |
EviDents Search Engine for EBD | http://medinformatics.uthscsa.edu/EviDents/ | Searchable resource for systematic review abstracts and other studies |
TRIP Database, Oral Health page | http://www.tripdatabase.com/oral/specialismhomepage.html | Systematic reviews related to oral health |
SUMSearch | http://sumsearch.uthscsa.edu/ | Searches free online resources—PubMed (Medline), Database of Abstracts of Reviews of Effectiveness (DARE), NIH Guidelines Clearinghouse—to retrieve systematic reviews and/or clinical guidelines |
International Centre for Evidence-Based Oral Health (Eastman Dental Institute, UK) | http://www.eastman.ucl.ac.uk/∼pdarkins/iceph/ | “Publications” link includes full-text systematic reviews on clinical topics |
Google Scholar | http://scholar.google.com/ | Search tool for systematic reviews and other research |
Centre for Evidence-Based Dentistry | http://www.cebd.org/?o=1069 | Resources on dental systematic reviews |
AHRQ Evidence-based Practice Center (EPC) Reports | http://www.ahrq.gov/clinic/epcindex.htm#oral | Evidence-based reports on oral health topics |
Netting the Evidence | http://www.google.com/coop/cse?cx=004326897958477606950%3Adjcbsrxkatm | Customized Google search engine devoted to evidence-based practice |
Table Additional Resources | |
Evidence-Based Centers | |
Centre for Evidence-Based Dentistry | http://www.cebd.org/ |
Centre for Evidence-Based Medicine (Oxford University) | www.cebm.net |
Cochrane Collaboration | http://www.thecochranelibrary.com |
Agency for Healthcare Research and Quality | http://www.ahrq.gov/clinic/epcix.htm |
DSM-Forsyth Center for Evidence-Based Dentistry | http://www.forsyth.org/forsyth.asp?pg=100111 |
Centre for Health Evidence | http://www.cche.net/ |
International Centre for Evidence-Based Oral Health (Eastman Dental Institute—London, UK) | http://www.eastman.ucl.ac.uk/∼pdarkins/iceph/ |
Evidentista (Pan American Centers for Evidence-Based Dentistry) | http://us.evidentista.org/?o=1026 |
Centre for Evidence-Based Medicine (University of Toronto, Canada) | http://www.cebm.utoronto.ca/ |
Journals | |
Journal of Evidence-Based Dental Practice | http://www.elsevier.com/wps/find/journaldescription.cws_home/623234/description#description |
Evidence-Based Dentistry | http://www.nature.com/ebd/index.html |
Evidence-Based Medicine Online | http://ebm.bmjjournals.com/ |
Databases | |
Cochrane Library | http://www.thecochranelibrary.com |
PubMed (National Library of Medicine) | http://www.pubmed.com |
TRIP Database, Oral Health page | http://www.tripdatabase.com/oral/specialismhomepage.html |
Database of Abstracts of Reviews of Effectiveness (DARE) | http://www.crd.york.ac.uk/crdweb/ |
National Guideline Clearinghouse | www.guidelines.gov |
Other Resources | |
Evidence-Based Dentistry Resource Guide (Virginia Commonwealth University) | http://www.library.vcu.edu/tml/bibs/ebd.html |
Evidence-Based Medicine Resource Center | http://www.ebmny.org/ |
Evidence-Based On Call | http://www.eboncall.org/ |
Health Evidence Bulletins-Wales (oral health) | http://hebw.cf.ac.uk/oralhealth/index.html |
PrimeAnswers | http://www.primeanswers.org/primeanswers/index.cfm |
Tutorials | |
ScHARR Introduction to Evidence-based Practice on the Internet | http://www.shef.ac.uk/scharr/ir/netting/ |
Evidence-Based Clinical Practice Tutorial (Miner Library) | http://www.urmc.rochester.edu/hslt/miner/resources/evidence_based/index.cfm |
A Student’s Guide to the Medical Literature (University of Colorado Health Sciences Center) | http://grinch.uchsc.edu/sg/index.html |
Evidence-Based Medicine: Finding the Best Clinical Literature (University of Illinois Library of the Health Sciences) | http://www.uic.edu/depts/lib/lhsp/resources/ebm.shtml |
Introduction to Evidence-Based Medicine (Duke University Medical Center Library and Health Sciences Library, UNC-Chapel Hill) | http://www.hsl.unc.edu/services/tutorials/ebm/index.htm |
PubMed Tutorial | http://www.nlm.nih.gov/bsd/disted/pubmed.html |
Using Numerical Results from Systematic Reviews in Clinical Practice | http://www.annals.org/cgi/content/full/126/9/712 |
SUNY Downstate Medical Center Evidence-Based Medicine Tutorial | http://library.downstate.edu/EBM2/contents.htm |
Resources for Critical Appraisal and Evidence Analysis | |
Appraisal Tools—Critical Appraisal Skills Programme (CASP) | http://www.phru.nhs.uk/Pages/PHD/resources.htm |
AMSTAR (tool for the “assessment of multiple systematic reviews”) | http://www.biomedcentral.com/1471-2288/7/10 |
Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group publications | http://www.gradeworkinggroup.org/index.htm |
QUOROM Statement (“Quality of Reporting of Meta-Analyses”) | http://www.consort-statement.org/index.aspx?o=1346 |
Center for Evidence-Based Medicine, Critical Appraisal Tools | http://www.cebm.net/index.aspx?o=1023 |
CONSORT Statement (consolidated standards of reporting trials) | http://www.consort-statement.org/ |
Meta-analysis of Observational Studies in Epidemiology (MOOSE): A Proposal for Reporting | http://jama.ama-assn.org/cgi/content/full/283/15/2008 |
Glossaries of Terms | |
American Dental Association EBD Glossary of Terms | http://www.ada.org/prof/resources/ebd/glossary.asp |
Bandolier EBM Glossary | http://www.jr2.ox.ac.uk/bandolier/glossary.html |
British Medical Journal—Clinical Evidence Glossary | http://clinicalevidence.bmj.com/ceweb/resources/glossary.jsp |
Centre for Evidence-Based Medicine: Key Terms in Evidence-Based Practice | http://www.cebm.net/index.aspx?o=1116 |
Evidence-Based On Call (Glossary) | http://www.eboncall.org/CONTENT/glossary.htm |
Definitions of Evidence-Based Practice (University of Sheffield, UK) | http://www.shef.ac.uk/scharr/ir/def.html |
Kaynaklar:
¹ American Dental Association. http://www.ada.org/1754.aspx
² Virtanen Jorma I. Kanıta Dayalı Diş hekimliği / Kanıta Dayalı Bakım: Tanımı: Bölüm 2-1. Helsinki Üniversitesi, Oulu Üniversitesi, Finlandiya.
³ PEKER K, BERMEK G. Klinik Uygulamalarda Kanıta Dayalı Diş Hekimliği Yönteminin Uygulanma Aşamaları. İstanbul Üniversitesi Diş Hekimliği Fakültesi Dergisi Cilt: 43, Sayı: 3-4 Sayfa: 123-132. 2009.
⁴ Frantsve-Hawley J. Evidence Locator: Sources of Evidence-Based Dentistry Information. Journal of Evidence-Based Dental Practice Volume 8, Issue 3: 133–138, Eylül 2008.
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