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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 46-48

Evidence-based decision-making – A review


1 J.K.K. Nattaraja Dental College and Hospitals, Nammakal, Tamil Nadu, India
2 Saveetha Dental College, Chennai, Tamil Nadu, India

Date of Submission22-Nov-2021
Date of Acceptance28-Jan-2022
Date of Web Publication26-Mar-2022

Correspondence Address:
Dr. Praveenkumar Kannan
J.K.K. Nattaraja Dental College and Hospitals, Komarapalayam, Nammakal, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcd.ijcd_25_21

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  Abstract 


Evidence-based decision-making gained its popularity because of its unique strength which throws proofs and evidences in the limelight for improving practices. This concept evolved in relation to the necessity for increasing the health-care quality, and also, it should have the acceptance of the changes done by the present-day projects which helps in the utilization of bounded resources. Foremost decisions taken during objective care should be assisted by classical scientific evidence which can improve possibilities of victorious patient results. Evidence usually includes journals, articles, and publications which provide present-day pertinent information based on search. It imparts us the plan of action for ameliorating the effectiveness of combining present evidences into receiver's care more quickly which makes you to tackle an immense high quantity of information. It helps us in innovating new treatment plans and contributing treatment and counsel evidences which are practically defensible. In the era of technological advancements which can give us answers to scientific questions even within a minute in our hands, evidence-based current research provides a best flexible method which will aid to find alternative treatment options, newer technologies/materials, and also clinical decisions too.

Keywords: Decision, dentistry, evidence, information


How to cite this article:
Kannan P, Gokulkrishanan K G, Sushanthi S. Evidence-based decision-making – A review. Int J Community Dent 2021;9:46-8

How to cite this URL:
Kannan P, Gokulkrishanan K G, Sushanthi S. Evidence-based decision-making – A review. Int J Community Dent [serial online] 2021 [cited 2022 May 26];9:46-8. Available from: https://www.ijcommdent.com/text.asp?2021/9/2/46/340986




  Introduction Top


In the last few decades, study on evidence-based decision-making gained its popularity because of its unique strength which throws proofs and evidences in the limelight for improving practices. Present existing readily available literature puts on massive knowledge about the advantages of evidence-based practices and gives us a gist of how it is extracted and dispersed in general. An easy example can make us dismantle the term evidence-based decision-making in better.[1] When a head officer gives a competitive task to complete within a stipulated time to two team leaders, one makes a decision with knowledge constraints and the other chooses wisely his path through evidence and facts he collected by research about the project. This can also have a major disadvantage where sometimes the evidence might be outdated or purely based on individual decisions which might alter the project completely on the wrong side. This can also lead to a burden of information and facts which are difficult to assess the best possible solution too.[2] One should be careful while selecting a particular evidence and the reason for selecting the evidence should also be clear.

Two stages of evidence-based practice were available.

  1. First phase of creating evidence which reckons completely on academic knowledge
  2. Phase of incorporating evidence into practice which helps to convert decisions into practice.



  What Comprises Evidence? Top


It is a consequence of perfectly frames and well-managed evaluations of research. Single article does not subscribe to the evidence, preferably it is actually a combination of facts and knowledge collected and assembled in a specific article. Evidence usually is not a permanent theory or definition; rather, it changes its theory depending upon the present date changes and evolution too. Formerly when the results are obtained, the compiled evidence can succor us for a conclusion whether particular chosen evidence is suitable or not for effective treatments/diagnosis.[3],[4]


  Requirement of EBDM Top


This concept evolved in relation to the necessity for increasing the health-care quality, and also, it should have the acceptance of the changes done by the present-day projects which helps in the utilization of bounded resources. Following are the four themes that drive for the improvement which include changes in practice, unhurried shift and relocation of evidence, control of the burdened information, and acquaintance of the changing educational concepts of evidences.[4]


  Levels of Evidence Top


One main golden rule is not permanently couched as information/evidence. Conventional evidence like printed books, material and personal journals which may not be obtained after proper research evidence. Sometimes, personal in-person experience can provide the ability to make treatment-based decisions in clinical practice.[5] Systematic review and meta-analysis always hold the first position in the level of evidence, whereas randomized controlled trials and cohort and case–control studies hold the following positions, respectively.[6]

Evidence-based decision-making is not simply a brand new term for an old story which accommodates the changes as per the current trend of patients' preferences and need.

  1. More affluent searching expertise is needed to sort the needed evidence
  2. Evaluating skills are immediately needed to distinguish between useful and not useful.



  Evidence-Based Decision-Making Process in Clinical Practice Top


Foremost decisions taken during objective care should be assisted by classical scientific evidence which can improve possibilities of victorious patient results. Evidence usually includes journals, articles, and publications which provide present-day pertinent information based on search.[7] In clinical practice, as we always depend upon the potency and success of newer materials in their respective field and treatment options, literature holds a vital component in.


  Evidence-Based Decision-Making Top


A perspective of health care needs the amalgamation of systematic evaluations of the most reliable evidence which connects the patients' conditions and their history with the health expertise of the need of the treatment and their preferences. The present definition states that the combination of the prime evidence in research with clinical proficiency and patient preference.[8],[9] Nevertheless, the above definitions and its uses, the prime purpose of the present day finest evidence which would not restore their values and experiences but furnish a different dimension to the conclusion making process which also includes patients predilection.

The fundamental notion of evidence-based decision prefers to build health-based conclusions includes the combination of both internal and external evidence.[10] Internal evidence is acquired from conventional training, education princess, and patient–dentist/doctor relationship, whereas external evidence is the acquired information from the research process. Clear utilization of reasonable evidence acquainted externally amalgamated with existing internal evidence states “EVIDENCE BASED DECISION” based on clinical decisions.

Evidence-based decision-making process = Scientific evidence + Patient preferences and values of Clinical/Patient circumstances + Experience and judgment.


  What Evidence-Based Decision-Making is Not? Top


Evidence-based practice usually not only utilizes systematic reviews and trials, but this can also play a vital aspect. It is a slant that includes patients' preferences and their needs. Major disadvantage is that it cannot impart answers when evidence is not available nor it cannot also be substituted in place of high clinical skills.[11]


  Evidence-Based Decision-Making versus Traditional Decision-Making Top


Basically, prime standard research and the way of utilization of evidence are rudimentary to both evidence-based and conventional decision-making. The basic variance between these perspectives emerges from how research appraises clinical practice. EBD confesses that it utilizes both strengths and limitations of the evidence and derives the conclusion. Traditional evidence cannot reduce the bias by gathering all information in one table, whereas evidence-based decision-making has the ability to convene all the information and capacity to reduce and decrease the bias.


  Components Top


The first step in evidence-based decision-making is realizing the breach in comprehension. When the needed information is collected, soundness of the research should be contemplated in two regions, namely internal validity and external validity. The method and a particular way a treatment was performed and when it was massive, it cannot be practical to mimic the same costly procedure in other regions too. After the results were drawn in clinical practice, it should definitely divulge the effectiveness of the outcome in achieving the result.[11]


  Mixed-Level Theory of Evidence-Based Decision-Making Top


Once the starting stages are completed in assessing evidence, processing of the acquired evidence in decision-making comes as the next stage. In the proposed mixed model of decision making, it is seen as a dynamic multilevel model which collects, interprets, and utilizes as the core for decision-making. It does not follow the common six-step approaches which include specifying the problem, finding and calculating the criteria, and bringing about alternatives which can help to make adequate decisions. This is meant as the common decision makings were not followed in proper settings. This aims only to transform the evidence into conclusions of management within their context. This is originally constructed as a multilevel phenomenon in the view of individual level which also imparts cross-level phenomenon at all three individual, international, and organizational levels without anyone's help and also in a coordinated manner. It includes five characteristics of the process of decision-making – transparency, participation, clearness, leadership quality, and definition of the process.[12]


  Phases of Decision-Making Process Top


Evidence acquaintance

  • Gather the important existing research evidence
  • Reconfirmation of selected evidence for credibility and replica.
  • Credible information was gathered for making prime decision makings.


Elucidating the acquired evidence

  • Strength and weakness of the collected evidence should be considered
  • Preferences and their treatment needs are also considered.


Application of evidence

  • Considering contextual evidence, best available research evidence, and experimental evidence and utilizing it in its best possible position.


Two general approaches

  • Intuitive approach is the process of deciding the treatment modalities based upon their outcome in which the patient's current condition and their characteristics are associated with one another. In such cases, alternatives need not be taken into count but their clinical occurrence and adequate in terms of care
  • Analytic approach – another side where the current condition and characteristics of the patient are unquestionably certain in the outcome of treatment modality in which their harms are unknown.



  Decision Analysis Top


Decision analysis also includes the data with utility and data of the price. In case of evidence-based dentistry, outcome of the decision runs first by finding utility and its cost and also both. This calculation is completed where the visual decision is made in the decision node.[7],[8]


  Benefits of EBDM Top


It imparts us the plan of action for ameliorating the effectiveness of combining present evidences into receiver's care more quickly which makes you to tackle an immense high quantity of information. It helps us in innovating new treatment plans and contributing treatment and counsel evidences which are practically defensible. It also helps to improve with present research findings, which assist in reducing the distance between what is being in use and what we acquired by research. EDBM is not only about finding out the solutions but also realizing the art of framing perfect questions which will aid us in discovering needed information which will impart a positive impact in the future decisions.[13]


  Conclusion Top


In the era of technological advancements which can give us answers to scientific questions even within a minute in our hands, evidence-based current research provides a best flexible method which will aid to find alternative treatment options, newer technologies/materials, and also clinical decisions too.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Martin GP, McKee L, Dixon-Woods M. Beyond metrics? Utilizing 'soft intelligence' for healthcare quality and safety. Soc Sci Med 2015;142:19-26.  Back to cited text no. 1
    
2.
Mackey A, Bassendowski S. The history of evidence-based practice in nursing education and practice. J Prof Nurs 2017;33:51-5.  Back to cited text no. 2
    
3.
CDC. Injury Prevention & Control: Division of Violence Prevention. Available from: https://vetoviolence.cdc.gov. [Last assessed on 2021 Jul 12].  Back to cited text no. 3
    
4.
Gabbay J, Le May A. Practice-Based Evidence for Healthcare: Clinical Mindlines. Abingdon: Routledge; 2011.  Back to cited text no. 4
    
5.
Barends E, Rousseau D, Briner R. Evidence-based management: The basic principles. In: Kovner A, D'Aunno T, editors. Evidence-Based Management in Healthcare: Principles, Cases and Perspectives. Chicago, IL: Health Administration Press; 2017. p. 3-20.  Back to cited text no. 5
    
6.
Masic I, Miokovic M, Muhamedagic B. Evidence based medicine – New approaches and challenges. Acta Inform Med 2008;16:219-25.  Back to cited text no. 6
    
7.
Eddy DM. Evidence-based medicine: A unified approach. Health Aff (Millwood) 2005;24:9-17.  Back to cited text no. 7
    
8.
Warren JI, McLaughlin M, Bardsley J, Eich J, Esche CA, Kropkowski L, et al. The strengths and challenges of implementing EBP in healthcare systems. Worldviews Evid Based Nurs 2016;13:15-24.  Back to cited text no. 8
    
9.
Rackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine: How to Practice and Teach. 2nd ed. Edinburgh: Churchill-Livingstone; 2000.  Back to cited text no. 9
    
10.
Tsesis I, Nemkowsky CE, Tamse E, Rosen E. Preserving the natural tooth versus extraction and implant placement: Making a rational clinical decision. Refuat Hapeh Vehashinayim (1993) 2010;27:37-46, 75.  Back to cited text no. 10
    
11.
Iqbal MK, Kim S. A review of factors influencing treatment planning decisions of single-tooth implants versus preserving natural teeth with nonsurgical end- odontic therapy. J Endod 2008;34:519-29.  Back to cited text no. 11
    
12.
Hofer TP, Kerr EA, Hayward RA. What is an error? Eff Clin Pract 2000;3:261-9.  Back to cited text no. 12
    
13.
Angelos P. Complications, errors, and surgical ethics. World J Surg 2009;33:609-11.  Back to cited text no. 13
    




 

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  In this article
Abstract
Introduction
What Comprises E...
Requirement of EBDM
Levels of Evidence
Evidence-Based D...
Evidence-Based D...
What Evidence-Ba...
Evidence-Based D...
Components
Mixed-Level Theo...
Phases of Decisi...
Decision Analysis
Benefits of EBDM
Conclusion
References

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