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OBJECTIVE: The American Dental Hygienists' Association (ADHA) National Dental Hygiene Research Agenda (NDHRA) is a working document that guides research efforts of the dental hygiene profession. The purpose of this study was to update the NDHRA to reflect current research priorities aimed at meeting national health objectives and to systematically advance dental hygiene's unique body of knowledge. METHODS: Forty-nine dental hygiene experts and key opinion leaders representing all domains of the profession, participated in the Delphi study to update and gain consensus on the NDHRA. The study was carried out electronically in 3 phases: a development phase, 2 rounds of mailed questionnaires to gain consensus on topics during the second phase, and a third phase to prioritize topics. Responses were analyzed using descriptive statistics and instrument reliability was analyzed using the Pearson Product Moment Correlation Coefficient and Cronbach's Alpha for internal consistency. RESULTS: One hundred twelve topics reflecting the research agenda categories were identified during Phase I. Through Phase II, 36 topics were eliminated and consensus was reached on 42 of the remaining 76 topics. Return rates of 95% and 100% were achieved for the 2 survey rounds. Instrument reliability was established at .76 and internal consistency at .87. During Phase III participants attempted to rank the 42 topics as to their level of priority, however results of this phase were not usable. OUTCOMES: Each category comprising the NDHRA was represented by the 42 topics. Thus, consensus on the national agenda was achieved. Ideally, identified priorities on the revised NDHRA will be used to direct future research efforts, identify research funding initiatives, and guide education and practice. [ABSTRACT FROM AUTHOR]

The term evidence-based has become a popular phrase in the title of many articles. Some articles discuss the process, whereas others lead readers to believe that evidence-based methodology was used in conducting the research or in presenting a synthesis of the findings, which may not be the case. The purpose of Part I of this two-part report is to define evidence-based decision-making (EBDM), discuss the evolution of the evidence based movement, and to describe the distinguishing characteristics of evidence-based publications. In doing so, articles using an evidence-based format, article summaries found in evidence-based journals and systematic reviews, such as those published by the Cochrane Collaboration, will be presented. Part II reviews the findings from the Cochrane Review on manual versus powered toothbrushing for oral health and discusses the strengths and weaknesses of systematic reviews. [ABSTRACT FROM AUTHOR]

PURPOSE: A systematic review examining the clinical effectiveness of power versus manual toothbrushes was conducted by the Cochrane Collaborations Oral Health Group. Their review examined clinical trials conducted through 2001 and used international standards to identify, access, evaluate, analyze, and report the data. Part I of this series discussed distinguishing characteristics of evidence-based publications, such as systematic reviews, whereas this report provides a summary of the Cochrane Review, its importance to the profession, and discusses the strengths and limitations of systematic reviews. METHODS: Search strategies to identify published clinical trials on power toothbrushes were developed, and manufacturers were contacted for additional published and unpublished information. Trials were selected based on pre-established criteria; including whether they compared power versus manual toothbrushes used a randomized research design tested products in the general population without disabilities, provided data on plaque and gingivitis, and were at least 28 days in length. Six reviewers independently extracted information in duplicate. Indices for plaque and gingivitis levels were expressed as standardized mean differences for data distillation. Data distillation was accomplished using a meta-analysis, with a mean difference between power and manual toothbrushes as the measure of effectiveness. RESULTS: Searches identified 354 trials, of which 29 met inclusion criteria. These trials involved 2.547 participants who provided data for meta-analysis. Results indicated that for both plaque and gingivitis, all types of power toothbrushes worked as well as manual toothbrushes, however only the rotating oscillating toothbrush consistently provided a statistically significant though modest benefit over manual toothbrushes in reducing plaque (7%) and gingivitis (17%). None of the battery powered toothbrush studies met the inclusion criteria. CONCLUSION: The Cochrane systematic review used international standards to examine more than 30 years of published studies. A concern is that only one type of electric toothbrush, the rotating oscillating toothbrush consistently demonstrated a statistically significant benefit over manual toothbrushes, and the majority of studies did not meet the standards for inclusion in moving forward it will be important to conduct methodologically sound studies demonstrating the ability of power toothbrushes to reduce the incidence and prevalence of caries and periodontal disease. [ABSTRACT FROM AUTHOR]

METHODS: A pre-tested, validated 62-item survey was mailed to a 1% national random sample of licensed dental hygienists, (n = 960). Four complete mailings of the instrument resulted in a 74.4% percent return rate of which 65% percent were usable (n = 464). Respondents provided information on their knowledge of oral cancer risk assessment factors, their use of health history questions to assess patients' oral cancer risks, how they conduct oral cancer examinations, and their beliefs about their oral cancer training. Data were analyzed using descriptive and inferential statistics and evaluated at a significance level of p < or = 0.05. RESULTS: Based on responses to 14 questions, the average score on knowledge of oral cancer risk factors was 7.92, with a significant difference found among age groups and year of graduation, (p = 0.006). On average, dental hygienists assessed five of eight risk assessment items with 'use of alcohol' receiving the least attention. Although nearly 100% percent agreed that oral cancer examinations for adults 40 years of age or older should be provided annually, only 66% percent reported doing so for patients on their initial appointment. Seventy-four percent believed they were adequately trained to provide oral cancer examinations, while only 27 percent agreed that they were prepared to provide tobacco cessation counseling. There was no significant correlation between knowledge of oral cancer risk factors and probing these risk factors when conducting a health history. CONCLUSIONS: Results from this study indicate that interventions are needed to increase dental hygienists' knowledge of oral cancer risk factors, correct misinformation, and close the gap between their knowledge and its application in providing prevention and early detection services. The majority believed that they are not as knowledgeable as they could be and are interested in attending an oral cancer continuing education (CE) course. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this article is to highlight key aspects of the white paper prepared in 1999 for the American Dental Hygienists' Association (ADHA) Institute for Oral Health on Evidence-Based Decision Making and its Application to Dental Hygiene Education, Practice, and Research. These aspects include the need for evidence-based decision making, how it supports contemporary practice and education, basic evidence-based concepts, and strategies for integrating evidence-based decision making into dental hygiene. METHODS: A review of the biomedical literature, evidence-based Internet sites and textbooks, and clinical guideline development was systematically conducted to identify models of evidence-based practice, skills needed to practice and teach evidence-based decision making (EBDM), and challenges faced by those implementing an EBDM approach. These resources were then analyzed and synthesized to develop a model for initiating the development of evidence-based dental hygiene practice. RESULTS: The need for using an evidence-based decision making approach was well supported throughout the literature. Consistency was found in how EBDM methodology and levels of evidence were defined and in the skills required for evidence-based practice. Implied in the use of an evidence-based approach were corresponding requirements in three areas: 1) redesigning educational programs to better prepare students and current practitioners to integrate the most current knowledge into their clinical decision-making; 2) conducting research for areas in which evidence applicable to clinical practice is lacking or limited; and 3) designing more effective dissemination tools making relevant research findings more easily accessible and part of every day practice. CONCLUSIONS: Variations in practice patterns, difficulties in keeping current with the scientific literature, and providing students with knowledge, skills, and competencies necessary for contemporary practice are challenges facing the health care professions today, including dental hygiene. To address these problems, an evidence-based approach has been recommended by national organizations. This paper reviews the issues and proposes a model and strategies for engaging dental hygiene clinicians, educators, and researchers in EBDM. Those involved in each area will need training in EBDM concepts and skills before this approach can be fully integrated into education and practice or used to guide research activities. National leadership will be needed to coordinate and prioritize research strategies, promote curricular changes, and improve access to clinically relevant information so that an EBDM approach can become the norm in practice. [ABSTRACT FROM AUTHOR]

Previous research has confirmed strong associations between periodontitis and diabetes mellitus (DM), supporting DM as a risk factor for periodontal disease and suggesting a bidirectional relationship. Causal relationships have not been confirmed., Aim: The aim of this paper is to review the most current evidence of the nature of this relationship and examine whether non-surgical periodontal therapy (NSPT) significantly lowers glycemic (HbA1c) control., Methods: The PICO question was, "For individuals with type 2 diabetes mellitus (T2DM) and periodontitis, will non-surgical periodontal therapy (NSPT), as compared to no treatment, improve the individual's glycemic control as measured by HbA1c." Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials (RCTs) or umbrella reviews of SRs and MAs of RCTs published in the English language between 2007 and 2019 were included. Several databases were searched as per their protocols. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality., Results: Of 54 records retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 5 SRs/MAs and 3 umbrella reviews of SRs/MAs were selected. All 5 SRs/MAs reported reductions in HbA1c levels 3 months following NSPT, but effect sizes were small and 2 were not statistically significant. The 3 umbrella reviews consistently reported small reductions in HbA1c, but high levels of heterogeneity and moderate to high risk of bias. The Bradford Hill criteria failed to support a causal relationship between periodontitis and T2DM., Conclusions: Whether NSPT compared with no treatment in persons with T2DM improves the individual HbA1c remains unclear as does the exact nature of the relationship between periodontitis and T2DM., Competing Interests: The authors have declared no conflicts of interest., (Copyright © 2021 CDHA | ACHD.)

Background: Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist., Objective: This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work., Methods: An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work., Results: Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters., Conclusions: This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.

Purpose: Dental hygiene graduates often experience significant psychological stress while transitioning from the educational setting to clinical practice environments. The purpose of this study was to characterize the duration of dental hygiene activities and tasks and explore efficiency within appointments, by students in educational programs. Methods: Right-handed female dental hygiene students were recruited from two dental hygiene education programs. Each participant was video recorded while providing patient care during 3 sessions, once per term, over 3 consecutive terms. Activities, tasks, and student postures and positions were coded across the patient visit. Descriptive analyses were conducted to characterize overall durations and distributions across each category. Time spent on non-dental hygiene related activities was compared to other durations, as well as across the education/training time points and by patient type. Results: Fifty-three videos were analyzed from nineteen participants. The average patient visit length was 155.06 ± 35.63 minutes; approximately half the visit was dedicated to instrumentation activities. Nearly 20% of the visit was categorized as activities or tasks unrelated to education or patient care. Although most participants completed the patient visit more quickly by the third time point, the percentage of non-dental hygiene activities did not decrease, and there were no associations between patient category type and the duration of the patient visit. Conclusion: Patient visits were roughly three times the length of the typical dental hygiene care appointment, indicating a disconnect between training and practice. In addition to spending more time on hand scaling tasks, participants spent a lot of time on equipment setup and interacting with or waiting for faculty members. These findings have implications for improving efficiency in educational settings, particularly to facilitate a successful transition to clinical practice., (Copyright © 2020 The American Dental Hygienists’ Association.)

Previous position papers have confirmed to varying degrees associations between periodontal microbes and respiratory tract infections such as nosocomial or hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and chronic obstructive pulmonary diseases (COPD). Causal relationships have not been confirmed and have been the source of much confusion for the medical and oral health professions., Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal microbes and respiratory diseases, with a focus on HAP and VAP., Methods: The PICO question was "For patients in hospitals, nursing homes or long-term care facilities who are at high risk for respiratory infections, will an oral care intervention such as toothbrushing, administration of antimicrobial agents, and/or professional care, as compared to no oral care intervention (or usual oral care) reduce the risk for respiratory infections?" Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality., Results: Of 47 respiratory studies retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 10 SRs were selected, 9 of which included MAs. Although there was evidence that administration of chlorhexidine gluconate (CHX) reduced the risk for VAP, none existed for HAP. Limitations included inconsistencies among studies in population groups, CHX concentration, frequency of administration, number of applications, and insufficient evidence for use of povidone iodine or toothbrushing in ventilated patients. While some studies reported other patient-centred outcomes (i.e., ICU mortality, length of ICU stay or duration of mechanical ventilation), findings were positive only for cardiac surgery ventilated patients, who did not meet the inclusion criteria., Conclusions: Bradford Hill criteria analysis failed to support a causal relationship between periodontal microbes/oral health care and respiratory diseases such as pneumonia., Competing Interests: The authors have declared no conflicts of interest, (Copyright © 2020, CDHA | ACHD.)

Previous position papers have confirmed associations between periodontal disease and adverse pregnancy outcomes. Causal associations have not been confirmed and have been the source of much confusion for the profession and public., Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and adverse pregnancy outcomes., Methods: The PICO question was "For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving non-surgical periodontal therapy, lower their risk for adverse pregnancy outcomes?" Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality., Results: Of 37 records retrieved for adverse pregnancy outcomes, 9 met the criteria for inclusion and were analysed. None showed that NSPT lowers the risk for adverse pregnancy outcomes., Conclusion: Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and adverse pregnancy outcomes based on the most current evidence available., Competing Interests: The authors have declared no conflicts of interest., (Copyright © 2020, CDHA | ACHD.)

Previous position papers have confirmed associations between periodontal disease and cardiovascular disease. Causal associations have not been confirmed and have been the source of much confusion for oral health professionals and the public., Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and cardiovascular disease., Methods: The PICO question was "For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving NSPT, lower their risk for cardiovascular diseases?" Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality., Results: Of 53 cardiovascular disease studies retrieved, 7 met the inclusion criteria, of which 6 contained MAs. Results were mixed for various periodontal interventions lowering the risk for cardiovascular outcomes. Only one SR used cardiovascular events as a direct outcome; the other 6 used various surrogate measures., Conclusions: Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and cardiovascular disease., Competing Interests: The authors have declared no conflicts of interest., (Copyright © 2020, CDHA | ACHD.)

Introduction: The Rapid Upper Limb Assessment (RULA) is an ergonomic assessment tool used to screen for risk of musculoskeletal injury due to working posture. The RULA is traditionally applied once during a work task to approximate overall risk. No method exists for estimating a RULA score for work requiring frequent shifts in posture across an extended period of time., Purpose: The goal of this study was to identify an optimal sampling method for applying the RULA across a long time-period that accurately represents overall risk., Methods: Four right-handed female dental hygiene students were video recorded from three angles while performing hand scaling during patient clinic visits (88.97 minutes on average). RULA was continuously scored across the entire session, updating the score when a significant postural shift lasting for more than 15 seconds occurred. A time-weighted average (TWA) RULA score was calculated. Three sampling methods were evaluated: equivalent interval samples, random samples, and random samples selection weighted within "clock positions." Each method was compared to the TWA using a paired samples t-test and percent difference., Results: TWA RULA across the four students ranged from 3.4 to 4.3. Preliminary sampling averages using 10 samples were all within 0.2 of the TWA. Further iterations evaluating various sample sizes is ongoing., Discussion: Preliminary results suggest that all three sampling methods provide a reasonably accurate approximation of the TWA score at the sampling rate tested. Future iterations of this analysis will be continued to identify the minimum required sampling rate to meet our TWA criterion.

Background: The authors' objective in this systematic review was to describe the evidence for preventive and rehabilitative interventions for musculoskeletal disorders in oral health care., Types of Studies Reviewed: The authors conducted systematic search, screening, and eligibility processes to identify experimental, quasiexperimental, observational, and survey research studies in which the investigators either directly evaluated or predicted the effects of preventive or rehabilitative interventions on the reduction of musculoskeletal symptoms in oral health care professionals., Results: The authors identified and screened 3,571 unique abstracts, assessed 256 full-text articles for eligibility, and included 34 articles in the review. Investigators in 17 experimental studies described the results of preventive or rehabilitation interventions and in 17 survey research studies predicted or correlated preventive or protective techniques to a reduction in musculoskeletal symptoms. The primary techniques evaluated in the studies included equipment modification, ergonomic training, and physical exercise., Conclusions and Practical Implications: The evidence suggests that magnification loupes and indirect-vision techniques have a positive effect on the reduction of musculoskeletal symptoms. In terms of evaluating intervention efficacy, other techniques have mixed evidence or are limited by low-level study design., (Copyright © 2019 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts., Methods: A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence., Results: The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers)., Conclusions and Practical Implications: With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts., Methods: The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects., Practical Implications and Conclusions: For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: To implement the REDD+ mechanism (Reducing Emissions for Deforestation and Forest Degradation, countries need to prioritize areas to combat future deforestation CO2 emissions, identify the drivers of deforestation around which to develop mitigation actions, and quantify and value carbon for financial mechanisms. Each comes with its own methodological challenges, and existing approaches and tools to do so can be costly to implement or require considerable technical knowledge and skill. Here, we present an approach utilizing a machine learning technique known as Maximum Entropy Modeling (Maxent) to identify areas at high deforestation risk in the study area in Madre de Dios, Peru under a business-as-usual scenario in which historic deforestation rates continue. We link deforestation risk area to carbon density values to estimate future carbon emissions. We quantified area deforested and carbon emissions between 2000 and 2009 as the basis of the scenario., Results: We observed over 80,000 ha of forest cover lost from 2000-2009 (0.21% annual loss), representing over 39 million Mg CO2. The rate increased rapidly following the enhancement of the Inter Oceanic Highway in 2005. Accessibility and distance to previous deforestation were strong predictors of deforestation risk, while land use designation was less important. The model performed consistently well (AUC > 0.9), significantly better than random when we compared predicted deforestation risk to observed. If past deforestation rates continue, we estimate that 132,865 ha of forest could be lost by the year 2020, representing over 55 million Mg CO2., Conclusions: Maxent provided a reliable method for identifying areas at high risk of deforestation and the major explanatory variables that could draw attention for mitigation action planning under REDD+. The tool is accessible, replicable and easy to use; all necessary for producing good risk estimates and adapt models after potential landscape change. We propose this approach for developing countries planning to meet requirements under REDD+.

Unlabelled: Health care providers can enhance their critical thinking skills, essential to providing patient centered care, by use of motivational interviewing and evidence-based decision making techniques., Background and Purpose: The need for critical thinking skills to foster optimal patient centered care is being emphasized in educational curricula for health care professions. The theme of this paper is that evidence-based decision making (EBDM) and motivational interviewing (MI) are tools that when taught in health professions educational programs can aid in the development of critical thinking skills. This paper reviews the MI and EBDM literature for evidence regarding these patient-centered care techniques as they relate to improved oral health outcomes., Methods: Comparisons between critical thinking and EBDM skills are presented and the EBDM model and the MI technique are briefly described followed by a discussion of the research to date., Conclusions: The evidence suggests that EBDM and MI are valuable tools; however, further studies are needed regarding the effectiveness of EBDM and MI and the ways that health care providers can best develop critical thinking skills to facilitate improved patient care outcomes., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The desire to improve the oral health of clients begins with the hygienist's commitment to keeping current with useful scientific knowledge. The challenge is mastering the skills to discriminate between the many claims and what actually has been shown to be effective. One approach is through evidence-based decision-making (EBDM), which helps practitioners find relevant clinical evidence when it is needed for treatment decisions and for answering client questions. The purpose of this article is to discuss EBDM and its use in practice, potential challenges, future developments and resources that will assist in keeping current.

Background: Cervical cancer is the second most common cancer among women up to 65 years of age and is the most frequent cause of death from gynaecological cancers worldwide. A woman's risk of developing cervical cancer by 65 years of age ranges from 0.69% in developed countries to 1.38% in developing countries. Although screening by Pap smear should mean early detection at a curable stage for most women, many still present with advanced or metastatic disease with a worse prognosis. The addition of platinum-based chemotherapy to radiotherapy has improved outcome compared to radiotherapy alone; however, 30% to 50% fail to respond to treatment or develop recurrent disease. There are no standard treatment options for these patients, although platinum-based chemotherapy is frequently used and trials are on-going., Objectives: To compare different types and combinations of cytotoxic chemotherapy for the treatment of metastatic/recurrent cervical cancer., Search Methods: We searched the Cochrane Gynaecological Cancer Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2012), MEDLINE (1950 to January 2012) and EMBASE (1980 to January 2012). The reference lists from these and those of review articles were also checked., Selection Criteria: All randomised controlled trials (RCTs) involving chemotherapy for metastatic/recurrent cervical cancer. Trials involving radiotherapy, chemoradiotherapy, intra-arterial chemotherapy, biological agents or immunomodulators were excluded., Data Collection and Analysis: Three review authors independently reviewed trials for inclusion and data extraction and assessed risk of bias., Main Results: There were no data comparing best supportive care with chemotherapy. Cisplatin-based regimens are the most widely used and therefore we have concentrated on these trials. In terms of response rates some non-platinum regimens are equivalent but toxicity is higher. The most common cisplatin regimen was 50 mg/m(2) day 1 q21days. Higher doses had similar survivals. There was no direct comparison between single-agent cisplatin and carboplatin. Overall survival (OS) and progression-free survival (PFS) were not adequately reported and quality of life (QoL) outcomes were incompletely documented. Combination regimens were more toxic than single agents, but in the limited reported data this did not appear to adversely affect QoL.No significant difference in response rate by site of recurrence was found, although there was a trend towards improved response when the main site of disease was beyond the previously irradiated pelvis., Authors' Conclusions: Combination cisplatin-based chemotherapy could be a viable option for patients of good performance status with recurrent/metastatic cervical cancer, but further trials that report adequate survival and QoL data are sought. Response rates and improvements in survival are low. Cisplatin-based combinations have significant toxicity. Outcomes are poor and novel cytotoxic/biological agents and optimal scheduling need further investigation. Future trials need to stratify for and perform planned subgroup analysis with respect to previous treatment and site of recurrence.

Introduction: A regimen of concurrent chemoradiation for definitive treatment of cervical cancer is widely used. This retrospective review has been conducted to determine the outcomes and late toxic effect associated with the specific regimen of whole-pelvic external beam radiotherapy of 45 Gy in 25 fractions with parametrial boosts of 5.4 or 9 Gy and HDR brachytherapy (BT) of 30 Gy in 5 fractions to point A delivered by tandem and ring. This protocol is accepted by the Gynecological Oncology Group and endorsed by the American Brachytherapy Society, but no late toxic effect data have been reported., Materials and Methods: The electronic records of sequential patients treated definitively at the Sunnybrook Odette Cancer Centre between January 2006 and December 2008 were reviewed. Patient-, tumor-, and treatment-related details (including external beam radiotherapy, BT, and chemotherapy) were obtained. Outcome measures included disease-free status, dates and sites of first recurrence, survival, and grade 3/4 late toxic effect results (Common Terminology Criteria Adverse Events 3.0 criteria). Exclusion criteria were no follow-up or a planned alternative regimen., Results: One hundred twenty-two patients (+11 excluded) were treated with a median follow-up of 18 months from diagnosis. The actuarial 2-year disease-free survival rate was 70%. The median time to recurrence was 8 months (range, 2-22 months). The median time to toxic effect was 10 months (range 4-27 months). Grade 3/4 toxic effect was observed in 13 patients (11%). The actuarial grade 3/4 toxic effect rate at 2 years was 14%., Conclusions: Despite a relatively short follow-up, the toxicity of this regimen seems high compared with other retrospective series, although pelvic control is good. Consideration should be given to a reduction in BT dose alternatively when feasible image-guided BT may allow maintenance of tumor dose with reduced dose to organs at risk.

This is the second of 2 articles that focus on strategies to integrate an evidence-based decision-making (EBDM) approach into your practice. The previous article provided an overview of EBDM concepts and identified strategies for finding evidence to answer clinical questions, the first 2 steps in the evidence-based process. The next steps are to determine the credibility and usefulness of the evidence and to apply the evidence to patient care. The purpose of this article is to discuss those steps by reviewing the critical appraisal criteria used to assess the methodological quality of a study. A case scenario will be used to demonstrate how appraising the evidence helps to answer questions and how to translate the evidence into everyday practice. Characteristics of an evidence-based practice and educational tips are provided along with a glossary of terms related to appraising the literature. Together, the two articles can serve as a primer for integrating EDBM into your practice. Generally, the most frequently asked clinical questions are related to the effectiveness of a certain technique, medication, diagnostic test, treatment, material, or product. The type of scientific evidence may include systematic reviews and critically appraised topics; clinical practice guidelines and protocols; article reviews; pharmaceutical and drug interaction information; and individual studies addressing questions about therapy, prevention, diagnosis, prognosis, and harm/etiology. Once the most current evidence has been found, the next step in the EBDM process is to understand what you have and its relevance to your patient.

The purpose of this section of the ADA Champions Pre-Conference is to review the basics of Evidence-based dentistry (EBD), research designs and levels of evidence, and identify the skills necessary for clinicians to efficiently use an evidence-based approach in practice. This session of the pre-conference preceded the session on the skills needed to define a clinical question and search for the evidence to answer that question.

This is the first of 2 articles that focuses on strategies that can be used to integrate an evidence-based decision making [EBDM] approach into practice. The articles will focus on EBDM methodology and enhancing skills, including how to find valid evidence to answer clinical questions, critically appraise the evidence found and determine if it applies. In addition, online resources will be identified to supplement information presented in each article. The purpose of this article is to define evidence-based decision making and discuss skills necessary for practitioners to efficiently adopt EBDM. It will provide a guide for finding evidence to answer a clinical question using PubMed's specialized searching tools under Clinical Queries.

MSDs are so prevalent among dental professions that they are considered an occupational problem. Often the culprits in MSDs are poor body alignment and faulty movement mechanics that place abnormal stress on pain-sensitive tissue that becomes chronic if not corrected. As preventive specialists, dental hygienists need to be aware of their own potential health risks and take action to prevent or minimize injuries that can shorten their careers. In changing habits, the focus must be on you and your position. Once your position is established, adjust the patient, the patient's chair, and the use of your equipment to accommodate your alignment. Increasing the use and proficiency of indirect vision may also allow you to maintain a neutral spine and avoid awkward positions.

The management and immediate treatment of an avulsed permanent tooth will determine the long-term survival of the tooth. The aim of this study was to evaluate the knowledge of oral health professionals on the new guidelines for emergency treatment of avulsed teeth. A 12-item questionnaire was distributed among general dentists, specialists, dental hygienists and dental assistants attending Continuing Education courses at the School of Dentistry, University of Southern California, between 2003 and 2004. This study reports only on the general practitioners who comprised 83% of the participants. The results revealed an uneven pattern of knowledge among them regarding the emergency management of an avulsed tooth. Statistically significant associations were related to the participants' previous dental trauma education and their age. In conclusion, there is a need to improve the knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth.