In D733, a Clinical Case Analysis of a clinical materials problem will be expected. A written description of a clinical problem the student has encountered in their clinical experience, a related PICO question to the clinical problem, and the search strategy used to find the best available evidence to guide the analysis will be turned in for approval before completing the rest of the analysis. A full description of the assignment is available in the Assignments section for this course in Canvas.
The objectives for this Clinical Case Analysis include:
1. Identify a clinical failure, problem, or concern directly related to restorative materials and create a PICO question for it.
2. Search for best evidence to contribute to decision making – create a reference list of your evidence.
3. Annotate the two best pieces of evidence from your search.
4. Select the two pieces of evidence that represent the best available for your PICO and explain the rational for selecting them.
5. Propose steps or actions to be taken in relation to the failure/problem/concern after considering the evidence including a discussion of limitations and generalizability.
The steps to complete this assignment:
1) Select a clinical failure, problem, or concern related to restorative dental materials that you have personally experienced or seen during the examination or treatment of one of your assigned patients. Write a short description (< 100 words) of the situation and a specific (PICO) question related to it. No patient identifiers should be used in presenting the material. However, IF QUERIED, you should be able to provide faculty or teaching assistants with patient identification to allow for a chart review. This description and question must be uploaded into Canvas by 11:00 pm on Monday, January 28, 2019 for formative evaluation. Late submissions will be evaluated but will receive no points toward the final grade.
2) Complete a search for evidence to guide your decision making. This will be uploaded separately as a .cvs file into Canvas by 11:00 pm on Monday, January 28, 2019. Further instructions for completing the search can be found at Search Submission Instructions
3) Provide a full reference list and an annotated bibliography entry for each of two pieces of evidence that you located and used in your decision making.
4) Clearly identify the two entries you considered to be the most important or best evidence that you located and explain the rational as to why they were selected.
5) Based on your evidence, give an explanation and justification of steps or actions to be taken in relation to your clinical scenario. Include a discussion of the limitations and generalizability of the stated steps or actions.
Structure your analysis in the order given above and as laid out in the grading rubric (except for the search as a separate file); 1-scenario and PICO; 2-search (in separate file); 3-annotations; 4-best evidence and why; 5-clinical recommendation. 6-full reference list. The analysis has no minimum length but must be appropriately referenced. All portions of the analysis must be prepared and uploaded into the Canvas assignment no later than 11:00 pm on Friday, March 29, 2019. The grading rubric that will be used to score this activity has been provided as an attachment to this assignment in Canvas. You are strongly encouraged to be familiar with this rubric before submitting your response.
Use a library link for Pubmed, particularly if you’re off campus
Make sure you’re in Pubmed and not PMC
DON’T pay for an article. Order through ILL
DON’T use “natural language”
DON’T use general search words like “comparison”, “cause”, or “versus”
DON’T apply limiters unless you need to
DON’T get too specific too quickly
Think about the variables in your question for initial search words. Is it more important to find specifics based on things related to the “P” or the “I”?
Type of tooth (molar, incisor, etc.) is usually one of the least helpful words to search
Some limiters need to be turned on and/or added
DON’T use the “Free full text” limiter
Limit by “Article Type” first (high level evidence: systematic review, meta-analysis, RCT)
“Review” is usually not the same as “Systematic Review”
Boolean Logic (AND, OR, NOT)
The default is AND
To use a Boolean in Pubmed it must be ALL CAPS (OR, NOT)
Characters like “+” cannot substitute for Booleans
Make sure you’re in Pubmed. If you’re in MeSH, you’ll see your MeSH history, not your actual Pubmed history
To grade them, we must be able to read and understand your searches well enough to recreate them
The Clinical Case Analysis and search history should be submitted as two attachments in Canvas. The search history should be submitted as a .csv file. Instructions for saving your PubMed search history are as follows:
Annotated Bibliography for Electronic Cigarettes PICO/Search
[CITATION - make sure the citation is in the proper style (AMA, APA, etc.)]
Franck C, Budlovsky T, Fillion KB, Windle SB, Eisenberg MJ. Electronic cigarettes in North America: history, use, and implications for smoking cessation. Circulation. 2014; 129(19): 1945-52.
[DESCRIPTION & EVALUATION - every annotation should include information about the resource, why it is inherently good and why it is good in the context of your research. It should not just be a restating of the abstract.]
This study is a systematic review of the literature on electronic cigarettes and the use of electronic cigarettes in smoking cessation, published in 2014 in the peer-reviewed journal Circulation, a journal of the American Heart Association. The authors are associated with the Lady Davis Institute for Medical Research, the research arm of McGill University, Montreal, QC, Canada. The intended audience is health care specialists and in particular physicians, nurses and others interested in cardiovascular medicine. The authors clearly outline their search strategy as well as inclusion and exclusion criteria. The review was limited by the fact that only 7 studies met the inclusion criteria, and of these only 1 was a randomized controlled trial. One of the authors disclosed funding from a company that manufactures a tobacco cessation drug, which could lead to bias against the effectiveness of e-cigarettes as a cessation adjunct.
[CLINICAL APPLICATION - NOT EVERY ANNOTATED BIBLIOGRAPHY ANNOTATION WILL HAVE THIS!! Only include this if you actually have a scenario and PICO question as your research objective.]
I selected this study/article for inclusion in my annotated bibliography because it was the only systematic review that I found with my search. While only one of the studies included in the review was a RCT, other studies did assess the possible modification of smoking behavior among selected populations. The authors included discussions of limitations to generalization, including the populations studied and overestimated power calculations, and conclude that there is insufficient research on electronic cigarettes to determine their contribution to smoking or to smoking cessation at this time. While the evidence may look somewhat promising, I would not recommend an electronic cigarette to my patients as an effective cessation aid.