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So how do you put that into practice? The American Dental Hygienists’ Association published a white paper—Evidence-based Decision Making (EBDM) in Dental Hygiene Education, Practice, and Research by Jane L. Forrest, RDH, EdD and Syrene A. Miller, BA—offering steps to take in implementing evidence-based care. 1. Identify a patient with a problem. 2. Develop a specific question regarding the patient. The “PICO” format is helpful here… * Patient (or problem). The patient has bad breath. * Intervention (or cause/prognosis). Tongue scraping. * Comparison (or control). Don’t scrape tongue. * Outcome(s). Reduce bad breath. You then write the question from these four statements: In a patient with bad breath, does scraping the tongue as compared with not scraping the tongue reduce bad breath? 3. Complete an evidenced-based search on PubMed or Medline. PubMed has an excellent tutorial to guide you through the most efficient way to do a search. Don’t let Boolean operators—and, or, and not—hinder your search. If you search for “rats or mice” you will find articles that have only rats or only mice. If you say “rats and mice” you will find articles that talk about both rats and mice. If you choose rats not mice, you will find articles on rats but not mice. You also have to exclude some words. For example, if you were searching for tooth implants, you would have to exclude all other types of implants. 4. Evaluate the articles for reliability, validity, and applicability. Evaluate the quality of the journal and the quality of the researchers. Also, take note that there is a hierarchy of quality research methods, with the randomized clinical trial at the top and the case study at the bottom. 5. Integrate the evidence with clinical expertise, patient preferences and apply it to practice. 6. Evaluate your performance. There you have it! This basic protocol should be followed. WANT MORE? There are so many more resources available to those interested in learning more about evidence-based care. The University of Minnesota offers this interprofessional online tutorial on evidence-based practice. You also can subscribe to the Journal for Evidence-Based Dentistry or the Journal of Evidence-Based Dental Practice. Those of you who are more web-savvy can surf the Web site for the Center for Evidence-Based Dentistry. Shirley M. Beaver, RDH, PhD, is an Associate Professor and Director of the Kennedy-King College Dental Hygiene Program at the University of Illinois Chicago College of Dentistry.
1. Sackett, D.L. et al. (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312 (7023), 13 January, 71-72). This paper is also available on the Web at: http://cebm.jr2.ox.ac.uk/ebmisisnt.html
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