Transitioning toward Evidence-Based Research in the Health Sciences for the XXI Century

Francesco Chiappelli,Olivia S Cajulis

doi:10.1093/ecam/nem123

Abstract

This article discusses some of the misconceptions of evidence-based research in the health sciences. It proposes that since not all treatments in medicine and dentistry can be evidence-based, clinical applications of the evidence-based process should become a specialty. The case is particularly evident in dentistry. Therefore dentistry is taken in this article as a model for discussion. We propose that to approach dentistry from the viewpoint of the patient-oriented evidence that matters (POEM) is perfectly acceptable so far as we also engage in the process of research evaluation and appraisal in dentistry (READ). We distinguish between dentistry based on the evidence, and evidence-based dentistry. We argue that when invoking an evidence-based approach to dentistry or medicine, it is not sufficient to establish the ‘levels of evidence’, but rather that all evidence-based clinical intervention must undergo the stringent process of evidence-based research so that clinical practice guidelines be revised based on the best available evidence.

Highlights

Evidence-based research in the health sciences is controversial for a variety of reasons that range from the perception that providing services to patients in medicine, dentistry, nursing and other health sciences has been based on research evidence for decades
Evidence-Based Research – research evaluation and appraisal in dentistry (READ) patient-oriented evidence that matters (POEM) viewed as a set of technical skills, undoubtedly the efficacy and effectiveness of our clinical interventions with patients with particular needs would be hindered
The outcome of the systematic review process is the generation of the consensus statement, which leads to revisions of the clinical practice guidelines based on the best available research evidence [Note: an early version of this figure was published in [10]; we present this modification here because it bests represents the READ process]

Summary

Cursory Evaluation of the Literature Based on the Levels of Evidence

The danger to the field of clinical medicine in general, and dentistry in particular, for certain patients groups, which conclusions based on the ‘level of evidence’ could bring, is clearly enormous. It is not sufficient to establish in one quick overlook whether the evidence was obtained by means of a clinical trial or an observational study It is insufficient, imprecise and dangerously simplistic to report a purported evaluation of the research evidence based merely on the ‘level of evidence’ [1,9,10]. The Journal of Evidence Dental Practice provides a good example of this process since it presents analysis and evaluation of research evidence both in terms of the ‘level of evidence’, and in the form of a detailed commentary and analysis of the research process and findings This journal, eCAM, provides complete systematic reviews, as well as instructional papers that guide readers and prospective evidencebased researchers in the field. Others may even purport it to be blatant research misconduct because this simplistic approach to overview the evidence is a Validation of data analyses

Systematic reviews

Implications for Patient Treatment

Toward READ

Findings

Toward POEMs