1;Evidence-Based Practice: toward Optimizing Clinical Outcomes;2 2;Copyright;4 3;Foreword;5 3.1;References;7 4;Preface;8 4.1;References;9 5;Acknowledgements;10 6;Contents;11 7;PART 1: The Science of Research Synthesis in Clinical Decision-Making;13 7.1;1: Introduction: Research Synthesis in Evidence-Based Clinical Decision-Making;14 7.1.1;1.1 .Introduction: Evidence-Based Health Care;14 7.1.1.1;1.1.1 .The Example of Dentistry;14 7.1.2;1.2 .Probabilistic Models for Clinical Decision Making;17 7.1.3;1.3 .Logic Evidence-Based Decisions in Clinical Practice;20 7.1.4;1.4 .Conclusions;24 7.1.5;References;26 7.2;2: Overview, Strengths, and Limitations of Systematic Reviews and Meta-Analyses;28 7.2.1;2.1 .Introduction;28 7.2.1.1;2.1.1 .Background;29 7.2.1.2;2.1.2 .Overview of Statistical Terms and Approaches;31 7.2.1.2.1;2.1.2.1 .Continuous Data;31 7.2.1.2.1.1;2.1.2.1.1 .Heterogeneity;32 7.2.1.2.1.2;2.1.2.1.2 .Meta-Regression;33 7.2.1.2.1.3;2.1.2.1.3 .Funnel Plots to Measure Bias;34 7.2.1.2.2;2.1.2.2 .Categorical Data;35 7.2.1.2.3;2.1.2.3 .Time to Event Data;37 7.2.1.3;2.1.3 .Other Tests in Meta-Analysis;37 7.2.1.3.1;2.1.3.1 .Test for Interaction;37 7.2.1.3.2;2.1.3.2 .Test for Trend;38 7.2.1.3.3;2.1.3.3 .Sensitivity Analysis and "File-Drawer Effect";38 7.2.1.4;2.1.4 .Statistical Techniques to Account for Study Size and Quality;39 7.2.1.4.1;2.1.4.1 .Weighing of Evidence;39 7.2.1.4.2;2.1.4.2 .Random Effects;40 7.2.1.4.3;2.1.4.3 .Random Effects vs. Fixed Effects;41 7.2.1.5;2.1.5 .Bayesian Meta-Analysis;41 7.2.2;2.2 .Discussion;43 7.2.2.1;2.2.1 .Conclusion and Resources;43 7.2.3;References;44 7.3;3: Understanding and Interpreting Systematic Review and Meta-Analysis Results;45 7.3.1;3.1 .Introduction;45 7.3.1.1;3.1.1 .Example: Studies Characteristics and Descriptive Results;46 7.3.2;3.2 .Main Results: Overall Estimates of Effect;46 7.3.3;3.3 .Forest Plots;48 7.3.4;3.4 .Exploring Heterogeneity;49 7.3.5;3.5 .Fixed-Effects vs. Random-Effects;50 7.3.6;3.6 .Meta-Regression;51 7.3.7;3.7 .Funnel Plots and Publication Bias;53 7.3.8;3.8 .Exploring Influential Studies;57 7.3.9;3.9 .The Cochrane Collaboration Forest Plot;58 7.3.10;3.10 .Standardized Mean Differences;58 7.3.11;3.11 .Dichotomous Outcomes;58 7.3.12;3.12 .Concluding Remarks;59 7.3.13;References;60 8;PART 2: Making Evidence-Based Decisions;61 8.1;4: Making Evidence-Based Decisions in Nursing;62 8.1.1;4.1 .Introduction;62 8.1.1.1;4.1.1 .How Do Nurses Make Clinical Decisions?;63 8.1.2;4.2 .Why Is It Important to Nursing?;64 8.1.3;4.3 .Translating Knowledge Development into Knowledge Use;66 8.1.3.1;4.3.1 .Identifying the Issue;66 8.1.3.2;4.3.2 .Finding and Evaluating the Evidence;67 8.1.3.3;4.3.3 .Making the Change;69 8.1.3.4;4.3.4 .Evaluation and Maintenance;70 8.1.4;4.4 .Summary;71 8.1.5;4.5 .Addendum;72 8.1.6;References;73 8.2;5: A Model for Implementing Evidence-Based Decisions in Dental Practice;76 8.2.1;5.1 .Introduction;76 8.2.2;5.2 .Development of the Evidence-Based Model;76 8.2.2.1;5.2.1 .PICO Question;77 8.2.2.2;5.2.2 .Search Process and Selection of the Studies;77 8.2.2.3;5.2.3 .Appraisal of the Studies Selected;77 8.2.2.4;5.2.4 .Statistical Analysis;79 8.2.3;5.3 .Results from Assessment of the Effectiveness and Methodological Quality of SRs;79 8.2.3.1;5.3.1 .Main Results of the Studies Selected;80 8.2.3.2;5.3.2 .Agreement Between Referees;80 8.2.3.3;5.3.3 .Methodological Quality of SRs;80 8.2.4;5.4 .Applying Evidence in a Clinical Setting;80 8.2.4.1;5.4.1 .Decision Tree Approach;81 8.2.4.2;5.4.2 .Advantages of Decision Trees;81 8.2.5;5.5 .Discussion;81 8.2.6;5.6 .Grading the Quality of Evidence and the Strength of Recommendations;83 8.2.6.1;5.6.1 .SORT;83 8.2.6.2;5.6.2 .GRADE;83 8.2.6.3;5.6.3 .The Usefulness of Both Systems in Dentistry;84 8.2.7;5.7 .Economic Evaluation of Dental Health Services;84 8.2.7.1;5.7.1 .The Rationale for Incorporating Costs in the Decision-Making Process;84 8.2.7.2;5.7.2 .Cost-Effectiveness Analysis vs. Cost-Utility Analysis;84 8.2.7.3;5.7.3 .Decision