Perceptions and competence in evidence-based medicine: a survey of the American Urological Association Membership

PURPOSE

We investigated the attitudes and opinions of urologists toward evidence-based medicine to help guide future efforts of the American Urological Association and other organizations vested in the education and training of urologists.

MATERIALS AND METHODS

From August to November 2006 we performed a mail survey of a random sample of 2,000 members of the American Urological Association. Questions in the survey addressed the role of evidence-based medicine in urology, participants' self-assessed understanding of evidence-based medicine related terminology, their familiarity with and use of web based evidence-based medicine resources, as well as their evidence-based medicine competence based on their understanding of core concepts such as randomization and blinding.

RESULTS

A total of 889 respondents completed the survey resulting in a response rate of 45%. There was widespread agreement that practicing evidence-based medicine improves patient care (median score 8; IQR 7, 10) and that every urologist should be familiar with critical appraisal techniques (median score 9; IQR 8, 10). The percentage of respondents who indicated that they "understand and could explain to others" the terms number needed to treat, power and level of evidence was 42%, 29% and 18%, respectively. The American Urological Association Guidelines were used regularly by 35% and on occasion by 51% of respondents. Of the participants 44% were unaware of the PubMed(R) search engine and only 14% used it regularly, while 76% were unaware of the Cochrane Database of Systematic Reviews and only 8% had ever used it. The mean evidence-based medicine competence score for all respondents was 67.2% +/- 17.0%.

CONCLUSIONS

The findings of this survey confirm that urologists have a favorable attitude toward evidence-based medicine. However, understanding of evidence-based medicine terminology, concepts and use of related resources among American Urological Association members leaves room for improvement. Increased efforts to promote an understanding of evidence-based medicine through workshops, publications and web based resources specifically for a urological audience appear indicated.

Fluoride release from glass-ionomer and compomer restorative materials: 6-month data

OBJECTIVES

To investigate the daily fluoride release of two glass ionomers (Ketac-Fil and ChemFil Superior) and two compomers (Compoglass and Dyract Restorative) over 6 months.

METHODS

A pilot study evaluated the time taken for sample solutions to equilibrate to establish an appropriate time period for sample solution storage between fluoride ion measurements. In the main study storage water replacement and fluoride ion determination was made daily using a specific ion electrode, TISAB buffer and standard solutions for calibration.

RESULTS

Equilibration of fluoride concentration in aqueous solution occurred in under 48 h for all materials. Total fluoride released (microgram mm-2) after 6 months by Ketac-Fil (30.6, s.d. 4.9) was significantly greater than ChemFil Superior (12.7, s.d. 2.5), Compoglass (10.4, s.d. 1.0) and Dyract Restorative (7.7, s.d. 1.7) (P < 0.05). Daily fluoride release at 24 h and 10 days was significantly higher for the glass ionomers than the compomers (P < 0.05). After 40 days the daily fluoride release (microgram mm-2) from ChemFil Superior (0.05, s.d. 0.01) was not significantly different from Compoglass (0.04, s.d. 0.01) and Dyract Restorative (0.03, s.d. 0.00) (P > 0.05). Daily fluoride release from Ketac-Fil remains significantly higher than the compomers at 3 and 6 months (P < 0.05).

CONCLUSIONS

Specimens stored in water equilibrate rapidly, suggesting the rate at which storage water is changed may alter the relative fluoride release rates of materials. This important fact is often overlooked. Fluoride release from the glass ionomers is initially higher than for the compomers. Fluoride release from glass ionomers falls rapidly to approach levels released by compomers. Compomers produce no initial burst of fluoride and levels of release remain relatively constant.

Sampling strategies for water quality monitoring in lakes: the effect of sampling method

Five different water sampling techniques have been compared in a series of lakes. In deep lakes, no significant differences were observed between mean summer nutrient concentrations measured in (i) a tube sample integrating over the photic zone taken from the deepest point; (ii) a surface dip sample taken at the deepest point; (iii) a surface dip sample taken by wading into the water's edge; (iv) a dip sample taken slightly further off shore by suspending a bottle below a buoy thrown out about 30 m from the shore; and (v) a sample taken along a short transect out from the shore using a model boat to transport the sample bottle. In shallower lakes the integrating tube sampler gave significantly higher estimates of mean concentrations than other methods due to the increase in volume of the unmixed hypolimnion which reduced the depth of the well mixed epilimnion to less than the tube length. For national survey purposes samples taken from the edge of the lake are the most cost effective.