Why can't I see clearly now? I have a meta-analysis!

Barriers involved in the application of evidence-based dentistry principles: A systematic review

BACKGROUND

The authors' objective in this systematic review was to investigate the barriers involved in the application of evidence-based dentistry principles, as reported by dentists. The authors registered the protocol in the PROSPERO database.

TYPES OF STUDIES REVIEWED

Eligible studies included qualitative and quantitative approaches, constituting information about barriers, collected through interviews, questionnaires, or conversation sessions. The authors searched databases and reference lists of preselected studies. After the selection process, the authors evaluated the included studies for potential risk of bias and collected either qualitative or quantitative data.

RESULTS

After the selection process, the authors included 35 studies, of which 16 were reported in this article. The authors synthesized and classified the barriers in 4 categories: self-related, evidence-related, context-related, and patient-related barriers. Shortage of time and financial constraints were the barriers most frequently studied. However, the quantification of these barriers, as well as others, was not possible because of the variability of the results and methodological issues of the included studies.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The authors suggest the development of valid questionnaires and their use in representative samples to quantify the effects of specific barriers. The authors encourage practitioners to participate in educational programs focused on training in evidence-based dentistry abilities, in addition to seeking accessible and synthesized formats of reliable scientific knowledge.

Prevention and management of ventilator-associated pneumonia

Worldwide, the increasing rates of microbial resistance represent a serious public health problem. Therefore, measures to prevent ventilator-associated pneumonia gain increasing importance. Because antimicrobial treatment in the ICU is a major source of microbial resistance, prevention should be understood not only as the sum of preventive measures but also as part of any management strategy. In this year of review, several important contributions have been made to a better understanding of the relative role of preventive measures. This is particularly true of noninvasive ventilation, continuous aspiration of subglottic secretions, and closed endotracheal suctioning. Management strategies for ventilator-assisted pneumonia remain highly controversial. Despite two decades of vigorous research, there is still no evidence that invasive bronchoscopic techniques should form part of a routine approach to suspected ventilator-assisted pneumonia. Moreover, an impact in terms of important outcome variables could not be consistently demonstrated. In the authors' view, the controversy regarding the relative validity of diagnostic tools should end, and the focus should shift to strategies that define low-risk patients with suspected ventilator-assisted pneumonia who can safely be treated by short-term monotherapy. Finally, several contributions have refined the established treatment regimen. Several new drugs for the treatment of ventilator-assisted pneumonia caused by Gram-positive multiresistant pathogens have been evaluated with promising results.

Nosocomial Pneumonia: More Than Just Ventilator-Associated

We reviewed literature published from 1995 through 2000 on developments in ventilator-associated pneumonia. There is no gold standard with which to compare the accuracy of various invasive procedures performed for diagnosis. Moreover, leaders in the field are calling for an outcomes-based analysis to assess the utility of invasive procedures. Two things are clear: 1) adequate empiric therapy is beneficial, and 2) changes in therapy based on recovery of pathogens by invasive means do not affect outcome. Clinicians are urged to review local antimicrobial resistance patterns and to initiate empiric therapy on the basis of those data.