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- W4361027644 abstract "High-quality systematic reviews (SRs) are a cornerstone of evidence-based clinical decision-making.1Sriganesh K. Shanthanna H. Busse J.W. A brief overview of systematic reviews and meta-analyses.Indian J Anaesth. 2016; 60: 689-694Crossref PubMed Scopus (11) Google Scholar SRs are performed to identify and synthesize the best evidence on a particular clinical question and help identify gaps in our current knowledge. Over the past 2 decades, methods for conducting and reporting SRs have improved significantly.2Page M.J. Moher D. Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and extensions: a scoping review.Syst Rev. 2017; 6: 263Crossref PubMed Scopus (288) Google Scholar, 3Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool.Res Synth Methods. 2012; 3: 80-97Crossref PubMed Google Scholar, 4Lu G. Ades A.E. Combination of direct and indirect evidence in mixed treatment comparisons.Stat Med. 2004; 23: 3105-3124Crossref PubMed Scopus (1565) Google Scholar Although the methodology to conduct SRs is now well developed, less improvement has been achieved with another essential component of our evidence base—its currency.5Elliott J.H. Turner T. Clavisi O. Thomas J. Higgins J.P. Mavergames C. et al.Living systematic reviews: an emerging opportunity to narrow the evidence-practice gap.PLOS Med. 2014; 11e1001603Crossref Scopus (309) Google Scholar We propose ideas to improve evidence generation, synthesis, and dissemination in the orthodontics field to improve the currency of evidence available to practitioners. Clinical network studies with practitioners contributing prespecified data are effective vehicles for evidence generation. These networks provide a mechanism to expand the production of trial data beyond the “ideal setting” of universities to “real world” clinical practice settings. They also allow practitioners to propose research topics that reflect the relevant, real-life questions they want to be answered. Through these networks, clinicians and researchers can incorporate data from a much larger base of participants than from 1 clinic or institution. Therefore, the results will be more generalizable and be able to provide information on practice patterns.6Huang G.J. Richmond S. Vig K.W. Evidence-based orthodontics. 2nd ed. John Wiley & Sons, Hoboken2018Crossref Google Scholar Consider an orthodontist enrolled in a research network and trained to conduct a clinical trial on the effect of temporary anchorage devices in treating skeletal open bites. As part of the protocol, they collect prespecified records (photographs, radiographs, and other relevant information) to describe their patients’ characteristics and report on their treatment progress. In our proposed model, the primary care provider is embedded in a collaborative community studying open-bite treatments. The practitioner uploads information about their patient’s treatment to a database that is integrated with data from other practitioners. These data are analyzed by the clinical researchers and statisticians who have developed the particular study protocol. Synthesis of the available high-quality scientific evidence is required to keep practitioners’ knowledge current. However, synthesizing evidence is a tedious process and probably is not a responsibility that the average busy orthodontist wishes to or can undertake. To improve currency, some biomedical researchers have initiated “living” systematic reviews, in which a synthesis group dynamically monitors new relevant evidence as reported and incorporates it into published SRs. Instead of the sporadic efforts by authors to update conventional SRs, the intent of “living” systematic reviews is to focus on important topics undergoing active research.5Elliott J.H. Turner T. Clavisi O. Thomas J. Higgins J.P. Mavergames C. et al.Living systematic reviews: an emerging opportunity to narrow the evidence-practice gap.PLOS Med. 2014; 11e1001603Crossref Scopus (309) Google Scholar,7Bastian H. Glasziou P. Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up?.PLOS Med. 2010; 7e1000326Crossref PubMed Scopus (727) Google Scholar There are several methods that research groups are currently using to keep the evidence “living,” and we believe establishing an open synthesis community could be beneficial for orthodontics.8Nakagawa S. Dunn A.G. Lagisz M. Bannach-Brown A. Grames E.M. Sánchez-Tójar A. et al.A new ecosystem for evidence synthesis.Nat Ecol Evol. 2020; 4: 498-501Crossref PubMed Scopus (27) Google Scholar In our proposed model, teams of experienced academicians, clinical researchers, and statisticians periodically search for and incorporate new evidence into existing systematic reviews. Continuous surveillance of new research evidence through periodic and ongoing searches and the prompt inclusion of new information into reviews will facilitate the currency of SRs (Fig).9Bendersky J. Auladell-Rispau A. Urrútia G. Rojas-Reyes M.X. Methods for developing and reporting living evidence synthesis.J Clin Epidemiol. 2022; 152: 89-100Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar A “living” systematic review can only provide timely evidence if its results are disseminated efficiently. Once the results of a study are obtained, the open synthesis community’s network provides the ideal outlet for the continuous dissemination of evidence. Active dissemination through the network requires careful and intentional planning to ensure that the obtained study results reach the target clinicians. Professional organizations may create or update clinical practice guidelines on the basis of the most current evidence. These guidelines can be housed on websites, but they could also be actively disseminated via newsletters or email listservs.10Frantsve-Hawley J. Abt E. Carrasco-Labra A. Dawson T. Michaels M. Pahlke S. et al.Strategies for developing evidence-based clinical practice guidelines to foster implementation into dental practice.J Am Dent Assoc. 2022; 153: 1041-1052Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Finally, to further facilitate the application of evidence, “knowledge brokers” might also help bridge the gap between researchers and clinicians.11Gagnon M.L. Moving knowledge to action through dissemination and exchange.J Clin Epidemiol. 2011; 64: 25-31Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar,12Hoens A.M. Reid W.D. Camp P.G. Knowledge brokering: an innovative model for supporting evidence-informed practice in respiratory care.Can Respir J. 2013; 20: 271-274Crossref PubMed Scopus (16) Google Scholar “Knowledge brokers” could be people, such as orthodontists with websites that publish new research findings, or entities, like professional organizations that help to disseminate evidence through various channels. The goal is to work with researchers to ensure important evidence reaches clinicians promptly. Via this network synthesis community, we envision a future in which orthodontists could receive much more current evidence to support treatment decisions for individual patients. For this platform to be viable and sustainable, some challenges need to be addressed:1.Identifying funding to create and sustain the research platform.2.Clarifying roles, expectations, and processes for all stakeholders and participants.3.Recruiting clinical researchers, practitioners, and statisticians to participate.4.Refining and developing technology to reduce human workload.5.Managing issues related to data anonymity, confidentiality, and privacy.6.Implementing standardized outcome measures.7.Prioritizing topics for evidence syntheses.8.Implementing methods for faster and consistent dissemination of evidence. It will be challenging to secure funding to create a network/synthesis community to address the problem of currency of evidence in orthodontic research. A coordinated and sustained effort from many different entities and stakeholders will be required. However, we will need to be creative if we wish to maximize the value of information created every time a patient is treated and to have the most current information available to make clinical decisions. We have proposed some ideas for improving evidence generation, synthesis, and dissemination, but others could be considered. The main goals are to work collaboratively to train clinicians to participate in network research, collect data in an unbiased and consistent format across multiple sites, incorporate new evidence in a more timely manner, and develop methods to disseminate evidence more quickly once it is generated." @default.
- W4361027644 created "2023-03-30" @default.
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- W4361027644 date "2023-04-01" @default.
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- W4361027644 title "Improving the currency of orthodontic evidence" @default.
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- W4361027644 doi "https://doi.org/10.1016/j.ajodo.2023.01.005" @default.
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