A practitioner's guide to developing critical appraisal skills: translating research into clinical practice

BACKGROUND AND OVERVIEW: To understand research and develop skills in adopting research findings, clinicians must overcome a series of challenges. First is determining exactly what constitutes evidence-based care. The amount of often contradictory research findings and "expert" opinion that is available can be overwhelming and should not always be taken as best evidence. Accessing the best evidence has its own set of difficulties. Then there is the final challenge of actually incorporating that best evidence into practice, as knowing what should be done rarely is enough to bring about an immediate change in what is done. However, there are means available to help overcome these barriers. CONCLUSIONS AND PRACTICE IMPLICATIONS: Critical summaries of systematic reviews, along with evidence-based treatment recommendations, have emerged as highly condensed, easily accessible vehicles for staying current with research findings. There also is emerging evidence of effective strategies for implementing research findings in practice, as well as organizations with which clinicians can engage to ensure that their patient care is based on the best scientific information available.     

A practitioner's guide to developing critical appraisal skills: Interventional studies

Background and OverviewRandomized controlled clinical trials are considered to provide the highest level of evidence for clinical practice, public health policy and evidence-based systematic reviews. Although all randomized controlled clinical trials share basic design characteristics, to assess the outcome of a particular trial one must carefully evaluate specific details of its design and analysis that might bias the study and influence its results. In this article, the authors review key points that practitioners should consider when assessing randomized controlled clinical trials so they can determine the applicability of study results to clinical practice.Conclusions and Practice ImplicationsDentists encounter a variety of types of evidence when trying to assess the utility of new therapeutic agents and procedures for their clinical practice. This article provides a background to use in evaluating data and selecting studies that provide the most rigorous clinical support for safety and effectiveness.     

A practitioner's guide to developing critical appraisal skills: the fundamentals of research

BACKGROUND AND OVERVIEW: This is the first of a series of articles summarizing the basic principles and methods of research with an emphasis on clinical investigation. In today's environment of evidence-based practice, the prevention of, diagnosis of, prognosis for and treatment of oral diseases must be based on a critical evaluation of available research. The purpose of this series is to help practitioners understand research and develop skills in interpreting research published in the medical and dental literature. CONCLUSIONS AND PRACTICE IMPLICATIONS: Research involves systematic investigation and can be categorized in different ways. Primary research may take several forms and includes basic and applied research. Basic research seeks fundamental knowledge without having a specific application; applied research is conducted for the purpose of a specific application and often is predicated on basic research findings. Applied research may take several forms and includes clinical research, which seeks to inform patients, clinicians, public health workers and policymakers about methods of preventing and treating diseases. Secondary research involves the use of existing data and results of published scientific studies. Systematic literature reviews are a form of secondary research that attempt to remove bias often associated with narrative reviews.     

A practitioner's guide to developing critical appraisal skills: Reviews of research

Background and overviewThis article describes the different types of reviews of research that are available in the literature: systematic reviews and traditional reviews. Systematic reviews have become the reference standard for evidence to inform clinical practice. In this article, the authors set out guidance on appraising the quality and relevance of systematic reviews to help readers make decisions about their clinical practice.Conclusions and practical implicationsSystematic reviews are of variable quality, although evaluations of reviews by the Cochrane Collaboration generally are of the highest quality. An assessment tool described in this article appears currently to be the most useful tool to guide clinicians to assess systematic reviews and therefore to decide whether the evidence is appropriate to change practice.     

A practitioner’s guide to developing critical appraisal skills: How to interpret the magnitude of clinical study results

BackgroundIn the oral health literature, researchers sometimes report measures of association that are inappropriate for their study design. Clinicians using evidence to inform their practice should be able to interpret clinical study results on the basis of the types of measures of association, independent of what the researchers of a study reported.Types of Studies ReviewedThe authors summarized which measures of association can be derived from experimental and observational studies and how to interpret them in the context of different study designs. They also suggested how inferences can be made on the basis of particular designs.ResultsMeasures of association derived from randomized controlled trials and cohort studies differ from those of case-control and cross-sectional studies. These differences can be attributed to the temporality between exposures and outcomes inherent in the respective study designs. Different measures of association reported from the same study may lead to different clinical decisions. Furthermore, the same measure of association with the same effect estimate derived from different study designs may contribute to different clinical decisions.Conclusions and Practical ImplicationsMeasures of association should be interpreted in the context of a particular study design. Study designs and specific measures of association should be considered when drawing conclusions from clinical studies. Clinicians using the literature to inform practice should be cognizant of measures of association reported for a particular study design and whether the authors have interpreted the measure of association correctly in the context of their chosen study design.