Systematic reviews - avenues to improved quality in oral health care and research

Introduction Systematic reviews comprise a synthesis of scientific evidence that is a key in three approaches to improve the quality of care - evidence-based medicine, health technology assessment, and clinical guidelines. Analysis of the scientific literature also reveals issues that require further research as knowledge gaps will be identified. These can be used to improve the research agenda in health care. Objectives To analyse evidence from systematic reviews on imaging methods in oral health care. Materials and methods Common features of five systematic reviews, which we performed, were analysed. The reviews elucidated methods used to diagnose chronic periodontitis (one review), jaw bone tissue in dental implant planning (two reviews), and temporomandibular joint disorders (two reviews). Our analysis of original studies included and excluded in the reviews focussed on the study design and outcomes using the Thornbury's ladder (1). Results Overall there is room for improvement. There was a wide heterogeneity in study design and reported outcome variables. Most studies reported outcomes on the level of diagnostic ability. No study presented how any diagnostic method influenced patient care in terms of changed treatment and change in patient outcome. Evidence was limited also on outcomes of combinations of imaging methods with other diagnostic methods as used in clinical care. Conclusions and discussion To improve the accuracy and completeness of studies on diagnostic methods, the Standards for Reporting of Diagnostic Accuracy (STARD) statement should be applied. Evidence to support clinical effectiveness of imaging methods is required to improve oral health care. (1) Fryback DG, Thornbury JR. The efficacy of diagnostic imaging. Med Decis Making 1991;11:88-94. Rohlin M1, Knutsson K1, Lindh C1, Petersson A1 1 Malmö University, Malmö, Sweden Introduction Systematic reviews comprise a synthesis of scientific evidence that is a key in three approaches to improve the quality of care - evidence-based medicine, health technology assessment, and clinical guidelines. Analysis of the scientific literature also reveals issues that require further research as knowledge gaps will be identified. These can be used to improve the research agenda in health care. Objectives To analyse evidence from systematic reviews on imaging methods in oral health care. Materials and methods Common features of five systematic reviews, which we performed, were analysed. The reviews elucidated methods used to diagnose chronic periodontitis (one review), jaw bone tissue in dental implant planning (two reviews), and temporomandibular joint disorders (two reviews). Our analysis of original studies included and excluded in the reviews focussed on the study design and outcomes using the Thornbury's ladder (1). Results Overall there is room for improvement. There was a wide heterogeneity in study design and reported outcome variables. Most studies reported outcomes on the level of diagnostic ability. No study presented how any diagnostic method influenced patient care in terms of changed treatment and change in patient outcome. Evidence was limited also on outcomes of combinations of imaging methods with other diagnostic methods as used in clinical care. Conclusions and discussion To improve the accuracy and completeness of studies on diagnostic methods, the Standards for Reporting of Diagnostic Accuracy (STARD) statement should be applied. Evidence to support clinical effectiveness of imaging methods is required to improve oral health care. (1) Fryback DG, Thornbury JR. The efficacy of diagnostic imaging. Med Decis Making 1991;11:88-94