Evidence-Based Practice, Research Methods and Patient Safety
Evidence-Based Practice, Research Methods and Patient Safety tests whether you can appraise orthodontic evidence and apply it safely. It includes study design, bias, statistics, radiation safety, and clinical risk management.
Core rules
- Form a PICO question: population, intervention, comparison, outcome. Match the design to the question: randomized controlled trials for effectiveness, cohort studies for prognosis, case-control studies for rare outcomes, and systematic reviews for synthesis.
- Levels of evidence rank systematic reviews and RCTs above cohort, case-control, and case reports. Appraise randomization, allocation concealment, blinding, completeness of follow-up, and intention-to-treat analysis.
- Distinguish statistical significance from clinical importance. Check effect size, confidence intervals, sample size, and whether the outcome matters to patients.
- Safety includes ALARA radiation practice, infection control, sharps handling, latex and nickel allergy awareness, emergency protocols, informed consent, and record keeping. Report incidents and near misses.
Worked example
A split-mouth RCT compares two adhesives for bracket failure. Reasoning: split-mouth design controls patient factors but risks carryover effects between sides. Check random allocation of adhesive to side, blinding of outcome assessment, and whether the analysis accounts for clustering within patients. A statistically significant difference in failure rate may be clinically unimportant if the absolute difference is small.
Traps
- Treating statistical significance as proof of clinical benefit.
- Ignoring confounding or selective outcome reporting.
- Overlooking carryover effects in split-mouth trials.
- Neglecting radiation, allergy, or infection-control safety.