My area of interest is Evidence-based Research and Practice (EBRP), specifically using research to provide improved health care outcomes in the service or practice of dentistry. People need choices to determine optimum treatments, materials, devices, and therapies that meet their personal preferences and values. Not having choices when uncertainties arise in healthcare leads to less than optimum outcomes whether it is demonstrated as dissatisfaction in physical, mental, social and spiritual well-being.
My vision began when the discipline of EBRP began. I was associated with two fine individuals, Drs. Francesco Chiappelli and Mike Newman. Since then, Dr. Chiappelli has produced many of the critical assessment tools used in EBR such as R-Wong assessment instrument for primary source systematic reviews and R-Amstar assessment instrument for clinically relevant, complex systematic reviews, as well as Ex-GRADE in assessing the strength of the recommendation. Dr. Newman initiated the Journal of Evidence-based Dental Practice. I turned my research efforts towards software development and how practitioners could use the principles of EBR in creating EBRP. My vision in this area is to facilitate a compact between researcher, clinician, and patient in advancing optimum clinical decision-making when uncertainties arise in oral health care. To achieve this vision, I have four areas of development. One vision, software in education and training in EBRP, Abstract Systematic Review (ASR), has been developed. I have used the Institute of Medicine’s criteria for making quantifiable, qualifiable, and usable CPGs. ASR accomplishes one of these criteria in education and training. I continue to work on an application that I call Facilitated Systematic Review (FSR) to facilitate the creation of new best evidence to be incorporated into a registry of “Big Data.” Thus, my third area of interest is in developing graph databases, algorithms, and incorporating combined medical and dental electronic health records to manage best evidence. Additionally, I am studying developing and quantifying the best estimate from various levels: Subject Matter Experts, systematic review, existing databases, and streaming data from private practice that utilizes analytics attributed to "Big Data."My last application that has been configured into a prototype is to facilitate practitioners in EBRP. The practitioner and patient engage in constructing a clinical practice guideline based on a clinical question. After input of the question into the application, a clinical practice guideline is developed (CPG) within normal practice flow, specifically the initial or periodic dental assessment, evaluation, and treatment planning encounter. After development, the patient and practitioner engage in a discussion as to the usefulness of the CPG to the patient, or review the resultant CPG. This CPG is representative of best “average” evidence from which the patient may game to convert “average” into “individual” best evidence. All three software applications have been copyrighted and/or patent pending. Dissemination of the CPGs firstly is to patients and practitioners engaged in clinical decision-making and secondarily, to researcher, policy makers, agencies, and the public through mechanisms that support written and verbal communication and social media.
I have been engaged in private dental practice for the last 35 years, only retiring from that service recently. My practice developed from a general dentistry practice to one that treated older adults. As early as 1980, I became apprised of the direction of growth within the world’s population of older adults. Thus, I took two pathways to expand my learning in healthcare service to older adults. As a Robert Wood Johnson Scholar and Scholar in Geriatric Medicine and Dentistry through the Department of Human Health Services, I became a dental geriatrician. Since older adults are at most risk for changes in all aspects of well-being, I continue to focus my efforts on older adults and the complex decision-making that is needed to service them. Thus, the discipline of EBRP is most appropriate in my quest for further knowledge and service.