The author presents a case study for the development of an evidence synthesis service serving researchers outside of the health sciences at a large academic library. The purpose of this project was to highlight the importance of integrating existing core services and workflows that create seamless delivery of evidence synthesis support and yield quality service. The paper provides decisions that university libraries must consider as they are planning the implementation of these services. The research-intensive nature of evidence synthesis projects provides liaison librarians with a perfect entry to deliver high-quality and relevant services, especially to graduate students and researchers. Through this work, libraries will demonstrate strong evidence for their engagement and contributions to research on campus. Librarians interested in supporting this latest type of research can use this study to gain a sense of where their own professional strengths fit within this new functional area and plan how to enter this developing research space. This study may be of interest to administrators, reference and instruction librarians, and librarians serving graduate students. Issues are presented in a way that surfaces difficult topics, which will help guide planning conversations between supervisors and librarians regarding workload assignments.

<b>Introduction</b>: Today one of the primary goals of any kind of dental treatment is the achievement of balanced smile aesthetics, as patients increasingly attend dental clinics to improve their appearance. The main aim of the present study was to assess and compare the smile aesthetics created by the use of two orthodontic bracket systems (self-ligating vs. conventional ligating) as a part of analysing secondary outcomes of two randomised clinical trials comparing between these two systems. <b>Methodology</b>: The assessment of smile aesthetics was done by analysing and scoring post-orthodontic treatment 125 frontal smile photographs subjectively and objectively. The subjective evaluation was performed by 20 dental professionals and 20 laypeople, while the objective assessment was done by one principal examiner using a group of smile aesthetics parameters. <b>Statistical analysis</b>: Multiple regression statistical analyses were performed to test the association between subjective and objective assessment of smile aesthetics in order to find the significant smile aesthetics predictors and assess the effect of the bracket type (self-ligating vs conventional) on the resulting smile aesthetics. <b>Results</b>: The finding from this research shows that the bracket type was not an important smile aesthetics factor in all the statistical models, although there are other important smile aesthetics factors as there was a significant correlation between the subjective and objective assessment of smile aesthetics parameters (Pearson’s correlation coefficients “r” > 0.50). <b>Conclusion</b>: There is insufficient evidence to reject the null hypotheses of no significant difference in the smile aesthetics created by the two orthodontic bracket systems. An Orthodontic Smile Aesthetics Rating (OSAR) tool has been developed.

Project (B.S.)--James Madison University, 2009. / Includes bibliographical references.

This thesis examines philosophical controversies surrounding the evaluation of medical treatments, with a focus on the evidential roles of randomised trials and mechanisms in Evidence-Based Medicine. Current 'best practice' usually involves excluding non-randomised trial evidence from systematic reviews in cases where randomised trials are available for inclusion in the reviews. The first paper challenges this practice and evaluates whether adding of evidence from non-randomised trials might improve the quality and precision of some systematic reviews. The second paper compares the alleged methodological benefits of randomised trials over observational studies for investigating treatment benefits. It suggests that claims about the superiority of well-conducted randomised controlled trials over well-conducted observational studies are justified, especially when results from the two methods are contradictory. The third paper argues that postulating the unpredictability paradox in systematic reviews when no detectable empirical differences can be found requires further justification. The fourth paper examines the problem of absence causation in the context of explaining causal mechanisms and argues that a recent solution (Barros 2013) is incomplete and requires further justification. Solving the problem by describing absences as causes of 'mechanism failure' fails to take into account the effects of absences that lead to vacillating levels of mechanism functionality (i.e. differences in effectiveness or efficiency). The fifth paper criticises literature that has emphasised functioning versus 'broken' or 'non-functioning' mechanisms emphasising that many diseases result from increased or decreased mechanism function, rather than complete loss of function. Mechanistic explanations must account for differences in the effectiveness of performed functions, yet current philosophical mechanistic explanations do not achieve this. The last paper argues that the standard of evidence embodied in the ICE theory of technological function (i.e. testimonial evidence and evidence of mechanisms) is too permissive for evaluating whether the proposed functions of medical technologies have been adequately assessed and correctly ascribed. It argues that high-quality evidence from clinical studies is necessary to justify functional ascriptions to health care technologies. / <p>QC 20150312</p>

Made available in DSpace on 2015-07-22T20:50:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-01-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Contexto: consideramos as revisões sistemáticas como melhor nível de evidência para a tomada de decisão nos cuidados com a saúde, cujo rigor metodológico oferece uma diversidade de implicações para a prática clínica e para a pesquisa científica. Objetivo: avaliar a proporção de revisões sistemáticas completas da Colaboração Cochrane que permitem a aplicação prática dos resultados e implicações para a pesquisa científica. Tipo de Estudo: estudo transversal de revisões sistemáticas da Cochrane Library issue 4, 2004. Método: Análise da amostra aleatória de revisões sistemáticas dos 50 grupos colaborativos especializados da Cochrane. A extração de dados foi baseada nas conclusões dos autores, interpretações de metanálises e no contexto de cada revisão sistemática. As implicações para a prática foram classificadas em três categorias: A) “evidências que apóiam a utilização da intervenção testada”; B) ”evidências que contra-indicam a utilização da intervenção”; C) “ausência de evidências para recomendar ou desestimular a intervenção”. As implicações para a pesquisa científica foram categorizadas em: 1) “recomendação para mais pesquisas” e 2) “sem necessidade para recomendar novos estudos”. Número de estudos incluídos e metanálises foram também quantificados. Resultados: 1016 revisões sistemáticas foram analisadas, o que correspondeu a 46,60% da totalidade disponível na Cochrane Library, issue 4, 2004. As proporções e intervalo de confiança (IC) de 95% das implicações para a prática clínica foram: A) 44,39 (95% IC, 42,16 – 46,62) %; B) 6,79 (95% IC, 5,66 – 7,92)%; C) 48,81 (95% IC, 46,57 – 51,07)%. O total de revisões sistemáticas que recomendam a realização de mais estudos foi de 95,96% (95% IC, 95,08 – 97,04). O número de estudos incluídos foi de 13.830 (mediana 8 e moda 2) e o total de metanálises incluídas nas revisões sistemáticas avaliadas, de 6.461 (mediana 2 e moda 0). Conclusão: A grande maioria das revisões sistemáticas não traz orientações específicas com relação ao benefício ou malefício de uma intervenção, comparativamente ao grupo controle para determinada situação clínica. Há uma proporção significativa de revisões sistemáticas que sugerem recomendações de novos estudos para responderem à questão clínica da revisão. Há poucos estudos primários que respondem ao critério de inclusão da revisão sistemática, sugerindo uma qualidade metodológica pobre. Há pouca quantidade de metanálise por revisão sistemática para os desfechos clínicos de interesse. / Context: we consider systematic reviews the best level of evidence for the decision making in the health care, which methodological severity offers a diversity of implications to clinical practice and to scientific research. Objective: to assess the proportion of the complete systematic reviews of Cochrane Colaboration that allow practice application of results and implication to scientific research. Design and Setting: Cross-sectional study of systematic reviews of Cochrane Library issue 4, 2004. Main Outcomes Measures: 1016 systematic reviews published throughout 50 Cochrane Collaborative Review Groups were analysed randomly. Data extraction was based on the authors’ conclusions, meta-analysis interpretations and on the context of each systematic review. The implications to practice had been classified in three categories: A) evidences that support the use of the tested intervention. B) evidences that contraindicate the intervention use. C) absence of evidences to recommend or discourage the intervention. The implications to scientific research had been categorized in: 1) recommendation to further research and 2) no necessity to recommend new studies. Number of included studies and meta-analysis were also quantified. Results: 1016 systematic reviews were analyzed, which corresponded to 46,60% of the available totality in the Cochrane Library, issue 4, 2004. The proportions and confidence interval (CI) of 95% of the implications to clinical practice were: A) 44,39 (95% IC, 42,16 – 46,62) %; B) 6,79 (95% IC, 5,66 – 7,92)%; C) 48,81 (95% IC, 46,57 – 51,07)%. The totality of systematic reviews that recommend the accomplishment of further studies was 13.830 (medium 8 and mode 2) and the totality of included meta-analysis of the evaluated systematic reviews, 6.641 (medium 2 and mode 0). Conclusion: the great majority of systematic reviews do not bring specific orientations with relations to the benefit or curse of an intervention, comparatively to control group for certain clinical situation. There are a significant proportion of systematic reviews that suggest recommendations of new studies to answer to the clinical question of the review. There are few primary studies that answer the inclusion criterion of the systematic review and suggest a poor methodological quality. There is a little amount of meta-analysis by systematic review for the clinical outcomes of interest. / TEDE / BV UNIFESP: Teses e dissertações