To talk about the one of the projects that we've been working together here during my sabbatical here,
which is we called it for maybe provisionally the OHA, which is the old Oral Health Foundation.
So we're working on school days and I slept through school, so this project would have favoured my sales for online.
Also, student loans, so painful for me.
Okay. Just briefly, I am also a professor at the Department of Epidemiology at the University of the State of Virginia,
and I am also a professor at the National School of Public Health.
So all the consultants. So it just struck me as you know, I come from my background.
I graduated younger than for a few years of practice, especially for the Vipers.
Then I migrated to public health and epidemiology, got my first lovin life in 93.
And I witnessed the birth of the Space Medicine Organ A.V. Club in collaboration.
I was actually at the University College London and at the London Hospital Medical College at that time.
Then I thought or thought evidence based data in 1993 and 1997.
Since 1997, I've been teaching epidemiology and public health to physicians, dentists, nutritionists, basically all.
Health health care workers. My main interest is on organisation goals and overachievement and I supervise my day to day work.
I supervise page the calculating.
So before I start sharing it with you, it is true that we are developing, that we are calling all Hi.
That stands for Oral Health Answers of this.
What motivated both to. So what motivated us to create this goal and what motivated those challenges is the practice of evidence based health care.
So some of the challenges were personal, but they are to cooperate.
And Cockrum suggested that the relationship between doctors and patients has
been established as a marriage of two strong desires the desire of the health,
the desire of the patient to be helped. And the with the advent of the National Health Service here,
that's novel such as have you had led to decrease ubereats financial barriers to access health services?
And that's led to a tremendous increase in the number of prescriptions and tests.
But always the patients wanted doctors to help and the doctor to think of something to do to help patients.
So that was a marriage of choice.
It's also important also noted that there was an exaggerated belief in doctors, which probably developed because doctors were able to alleviate pain.
Because of the general placebo effect. Because that's one part of many decisions.
All these things are improved over time.
So whatever you're doing with this process, it looks like something that was.
And also because of the higher social status of Google.
But what if he reversed the logic, his logic of providing whatever help you are able to provide and reverse in in that way?
He suggested that a doctor should always wear.
Provide treatment if there is an inconsistent policy position that statements are what?
That's the opposite of what was going on on the before the the movement of evidence based medicine.
All the challenge challenges to explain to us what you get is named the sick syndrome.
Well, sick stands for self-defence. Innumeracy and conflict of interest.
Just self defence. Defensive medicine is when doctors or dentists prescribe excessively for shoot.
Innumeracy is real. The.
Get used to. So this will.
They don't the the meaning of the of the estimates of effectiveness, of accuracy,
of diagnostic patterns of treatment or otherwise of diagnostic tests.
And this has been shown to happen mainly because they fail to neglect the base rate of the disease.
So it puts too much emphasis on the results to be passed without considering the prior probability of the disease.
And they also don't understand when they hear a 40% reduction, a 30% reduction, what that means and the conflict of interest is,
well, they refute books like luxury hotels and conferences and all the famous gifts.
So, for instance, they don't know. They're talking about factors, which is very common.
And also they are paid a fee for service, which means that the more they do with what they are.
So this challenging web based practice that we have highlighted.
Help them to survive if things are left naturally.
There will be an uncontrolled growth of health care and unsustainable health services.
And people will to to perpetual patience.
And this all drive us forth over your health.
Questions of overdiagnosed Overtreatment.
So here is a summary of the context that motivated those to create or.
So doctors desire to help and patients decide to be help exaggerated the doctor's
health proxy overseeing the work of insurance drivers over the treatment.
We believe that all her can help overcome this challenge.
Of course, also looking for someone to that can help to overcome this challenge.
So to illustrate, you simply demonstrate when we are talking about the diagnosis of administration.
So we basically painted over that, you know,
as this conference in Copenhagen thing where we presented a paper to David Stevens myself trying to publish.
I hope they addressed the issue of overdiagnosis by too much.
And it was interesting to notice that the audience was surprised because people hear a lot about complains of lots of deaths,
of lack of access to dentistry. And then we were talking about too much dentistry.
Especially those who are following the situation in the UK.
There is a lot of talk about the nature of the stream of fiscal benefits, not wanting to be involved.
So people are having problems of access. What people don't realise is that there is a lot of overdiagnosed,
a little bit treatment that may be contributing this under the rules of overtreatment,
because if you will get two thirds full of treatments that a lot of people don't have time to look out for, what is loss of life.
That's what we are suggesting is happening. So how exactly this over that was occurred.
So basically what the diagnosis is,
when you want to fire conditions that will blow up and the first vehicle into
patients unnecessarily would classify someone as having a foot of disease.
This person becomes a patient. And this normally happens by redefining disease and lowering thresholds for disease and risk factors.
So let me just go to sleep. So I suppose it's Aaron.
If, like you said, health is from both literally an example of health, which is of the most common dental problem.
So people use it for dental care when they feel the full of pain.
When you have the situation in at the stage level five or six famous people, this is all this conflict that requires fame.
Now. At the time.
That's that's the wrong time for cavities or dental care as the dentist talked about those at levels five and six.
The dentist at that time already took the opportunity to also fill this up.
So these cavities that are much smaller, he is four and at that time they used to fill this cavities, not only putting the tissue around the floor,
which is too small, it usually would expand the country or create a much larger effect even remotely to avoid future problem.
And that was the question. If that was a good practice,
then eventually it became clear that was not the practice and they changed and
they stopped having to do a surgical procedure in order to do those large.
So now you have a minimal intervention approach where they try to keep from this feeling to the small lesion, small to medium level.
It get confused with level two, for instance. And what else?
Well, happens is that nowadays they're just trying to identify reason where there is no cavity with all white spot lesions.
So the threshold, a lot has changed.
And of course, almost everybody had this kind of news.
But that's the crucial. They didn't penetrate in with the.
And you can say, well, but if the lesions is identified earlier, that's the problem.
What we have, which is central to problems work, is that most of the institutions that are defined value, they don't develop.
And so they are unnecessarily. Well, simply.
Well, it's no difference in terms of prognosis when you have treatments.
It's usually is for application professional for the patient and sometimes with the raising issue traditionally.
So you have interventions, preventive interventions, or you don't have the proposals.
We don't know what's what's that? So basically what we have now moved from an operating cycle of restoration,
new restorations in level five and six and three and 4 to 8, repetitive cycle prevention.
And to do that, dentists suggest, recommends people to use the dentist every six months so they can be.
Followed and assessed every year twice clean and in order to to avoid a new Newcastle.
So of course the problem is huge. But in practice, there is a lot of evidence that prevent a visit to the dentist will be beneficial to oral health.
So the six months we built a check up, which is probably one of the most lively.
Abandoned Delta Public health measures is also one of the newest evidence based.
And back more than 40 years now of asylum with this paper the less.
I bring something simple if you travel because there is this recent progression of.
Thanks, Wolf. KLEIN The failed license, a small development to a dental practice takes more than two years.
You should. Why would you need to in six months?
It's largely similar to periodontal disease.
And the. Falcon review on the subject of the paper we plan to call to.
The complication of the interval trial, which was a UK multicenter,
pragmatic randomised control trial in primary care setting, included only two trials.
And I'm not going to carry on talking about this now because one of the dental
fact boxes that I'm going to present to you at the end of the talk about.
So one school set. Well, there are other initiatives like the dental health, the trip,
the database as they go through June of at the local practice that were initially
intended to go to deal with the overwhelming amount of information available.
So they tried to solve this problem of overload, but they also grew very, very large.
And so finding answers for sources requires time and expertise.
And it's challenging to get information from this.
But. So the overload problem remains unresolved.
So there was a far more selective repository.
And here's an example of a search elf looking for a root canal.
And I found 383 results here.
So you have to go through all these 383 hits to select what you want.
So to answer your question. The same search in the evidence based dentistry.
Now we had 105 hints.
And these are the jewels of Apple's late dental practice.
106 point. So.
So it's really easy to get around and get to answer quickly.
So all have distinctions. Self control main ways that look divorce is published appraised studies and review.
So what we do is publish the critically acclaimed work and publish their analysis and the summary of that review.
The thing with blogs Google Maps, Fortune 500, that's all.
In all, you look at all the reviews, all the synthesis, and we create one box, one summary of all of this.
They place all of these benefits. So the use of what is the information is not just one.
Another difference that all this other sources, they grow each time more because they encompass more and more things and still.
And important part was looking for less is more. So we restrict our fat boxes.
So the most commonly dealt with. We'll give you just the bill for three vote, but that's not a lot.
But as far as we know, the first Fox box was a drugs Fox box, which was developed by Schwartz and Wallace 3013.
And the other one more recent boxes from the housing support boxes and developed like you get in here in your house were inspired by this little one.
So here's the deal. Just to show you what it was possible.
The Drug FAQ talks about a drug to treat Alzheimer's disease.
And you have to. So we want coming.
You have the evidence about this drug and the benefits.
They divide the thought, the box lines, and the red line starts the benefits and then the harms.
The both. They will be both. Then you see basically they say they show here they just showed these two trials that they selected.
They give the up and they have one column for the treatment room column for the placebo.
So one outcome is three and five scale of coils that at all time will give you a lot of scale.
So that's welcome. And they give the results separately for one.
So it's not one single people.
And he has a small summary, but he's also one of the following smoke from the outcome.
So they interpret very deeply what result means, and they give me the source of information with a reference that requires approval.
So if you think about this drug on the back of this drug benefits and heart, and here is another quote from the original sample of this war was about.
In which the test of the they wanted to be effective mammography screening and they I have
the first column but also hope that no screening and the second fold don't have a screening.
So have all civil incidents of the the outcome both separate.
And also you have benefits involved and a small very about.
So this is the fact that these expire lands.
So it's all has to go. So basically what we want is a concise start on all sides.
Summaries of the best available evidence format that promotes clear thinking.
So I think if I can summarise in this purpose, we hope to identify and communicate the truth that has been hidden behind an excess of information.
That's what we'll. Got to make a point about more studies in there.
Unfortunately, there are surf outcomes of more than a third for patients.
So what that means is that it comes with a lot of patients and also lack prognostic when.
So for me, the principle of hope that less is more or had select studies that assessed tangible outcomes.
So the company prioritised a lot of things like SlutWalk Youth A.
17, the dancing witches will stage Ragu with over 3.5 losers of active oral function and wellbeing, including chewing ability viewing of.
Alam importantly, avoids key tangible outcomes like wide squat lesions or gingivitis,
which is just the redness of the girl or small bleeding that is questionable.
Important for oral health. Now we also have of interest the general use the vehicle.
So we expect that we will.
Several dentists administered the treatment being tested and launched from a highly specialised
clinic where you only have one or two very skilful dentists by the nature of what we do.
We also favour, of course, of all the studies that the syncopations opening in day to day vertical.
So what's the structure of. So each day out of the block, Fox blocks these three names of information.
So the work is comprehensive but takes longer to consult because it's very expensive school.
It has everything down, all the things, everything. You create that first books, all thinking, process, smoothing.
On the other hand, the last three is superficial.
Lightweight provides a quick and musical solution.
It was also immediately mentioned, which includes some good things, like, for instance, the precision of the estimates and the deep assault.
But it's more convinced than you want the basement, which is very easy to.
So depending on the interest of the user, you find that what is that specific moment?
They can choose to consult one or another. Quick and superficial information or marketing.
Okay, so how do we find out what I'm going to show you?
Well, the template that we put a fat portfolio of the most detailed layer of the.
That simply functions as a guide to us authors of the.
When we act, we are creating a specific force in order.
So I want to show you just a little more or less some of the postings.
And then I'm going to go to the examples, because I think if you look at the examples, you will just know how.
In any case. So the creator did not have to write down all these questions.
So what's the question? The main source of information, main outcomes that are going to be reported in that box and etc.
I'd like to just talk a little bit about the question so we have to write down.
So since the beginning, the treatment, specify the treatment, specify the outcomes.
The population should be left open as well as any company of interest.
But what? And it is at this stage that maybe we have to reframe the question.
We have to live with thinking of oppression. What may be the results of the question?
For example, the dental check up the fact books.
We had to reframe the question to consider interactive because we were interested initially to check up with multiple.
But there is no study of check ups and check with the medical school because that is never agreed.
So I'll look for patients to to check Check-up.
The maximum we managed to get was given the interval time between check-ups ups.
We found evidence of studies, basically one study that compared a six month check up with a 24 month check.
So we came because of that. That's a different question, wasn't it?
But that's the best we could get. Also, we were interested in outcomes such as truth, loss to faith.
If you go to the next six months, you will have lost some of these outcomes.
They didn't. So we have to accept.
Only then can cavity also scale of oral functioning like wellbeing and gingivitis.
Just as we are. Back in the early 1990, I was planning to do a trial of multiple up.
That was after one year.
From our calculations, sample size. I needed nearly 40 general practice equipment at the end of one year.
I bought less than seven, but people were not willing to follow.
The goal was not feasible. And that was the only life in my life.
Have you tried each new trial that they would launch?
They are looking to try 24 months off. Six months into that, the benefits would be closer.
It was three months and eight months.
And well, the thing is to be allocated to 24 months, only 30% of the participants, because the date is only with all of you for four months.
Those who they believed were at most developing care and don't want things.
But don't ask me to give you all the gift that patient will never be subjected to.
So only 30%, 70% of the patients in this trial.
People ought to be able to get. So basically we have that's the best weapon.
That's the real life. Then not for fact books that have people that don't exist.
So there is also the practical layer, while both about clinical considerations of showing your gets up is easier instead of breathing here.
Also the perspective to putting the visual aspect of this to perspective.
It is truly remarkable that we will have this while I was showing one example.
A source of information about their main character. So we have to write down everything that was done or just find the source of information before
selecting the reference for the systematic review of the primary studies that were selected.
Study a number of participants, details about intervention, length of follow up.
All of it is reported. Then there is a search strategy and strategy in four steps.
So we have to stay the date of the search, find the most recent systematic review.
And if you look at this database here, if no appropriate review is the most relevant, credible primary studies.
Then you look at the two or three citations of systematic reviews and citations.
The most recent review. Finally, finally among the press.
And if you don't find or if you find the an all the more results of systematic review and the third step that is the step one.
Now Table of contents of Summary of evidence as a single core samples to represent the present efficacy.
So we always look at all the cons for each group.
We have the for Muslims outcomes. So let's use it.
So long. So now, with the treatment. All without.
Without. So sometimes these incidents are reported involving numbers, sometimes in percentages.
The absolute numbers. But when we report that some bourbons, we keep the the denominator constant.
So we hope everything's fine.
We want to change of.
We will say so in pale versus five.
It makes a really.
And I should mention that David and I and other colleagues of vaping are review to find out the best format of whole patient.
So depending on the results of these. We may change the presentation of results in.
Okay. Well, to the event in the examples.
So we have now I showed you the box in draft form, so I won't pay attention to the layout of what we want for you.
So if we manage to get funding, we have people, professionals to work on the layout.
Which are very important.
So one example that I will give you is the benefit of local check-up for health Audience The success rate of root canal treatment.
So there's a full profit doubles because of some interesting examples of how be.
So one of them has to update up to date.
Systematic review, which is the dental Check-up example.
And then all the ones. You don't affect the box on root canal treatment in Philadelphia since 2010.
After that, many private citizens will come as consumers.
All of this glamorous third party. And also the question about the different treatment.
So if you want to check all kinds of technological treatments,
we have to also take all the questions from our fashion forward cohorts or other experimental activities.
We have indirect data, indirect evidence from the dental check-up.
We have direct evidence that walking on the canal treatment.
So. Is this true?
Examples. I like the fact that in real life.
Scenarios. We never have a perfect scenario.
So health professionals and patients frequently find themselves making decisions based on less than perfect evidence.
We believe this will help them think new challenging scenarios.
So the political order is six months to 24 months.
You have the. Which is the most superficial, quick, so patient we have.
If you ever leave the nose with for what the comparison is about, it's adults aged 18 years or older, followed by four years.
You look like one of.
So we each each line here is more logical.
She might not want the benefits of the five year cost in the postcard and you have the six month info on.
And we have a number of them and this is what we.
And so you don't see any indication of seizure of people, really.
You clear? For instance, if you look at the 31 patients we've had,
the presence of 50 with the formation of all three procedure was the result of the
patient say that there was no statistically significant difference in the benefits.
So even without that engineer you.
That's five conferences ago. And in the case of when you travel with the.
Well. If you look at the.
Moving it to the intermediate layer to.
Uh, what do you see here that you're not feeling of three other sources of information for your life?
FOLKENFLIK So here we have the source of information, which is this fact.
But and you help me think about.
But that's true. And then you have to move on.
We could move to the things Player one, which is the most detailed.
The world is setting the table here that we did not see the letter to is the
interpretation of each outcome result in relation to the estimate and precision.
For example, if you look at the percentage of patients with cavities, we write, the interpretation of all the interpretations was new,
and the imprecision of these estimates indicates that there is no evidence that there was a difference between six and 24 month intervals.
So that's what this one word interpretation for you ultimately on each one of them, these labels.
And then you have all things being equal sort consideration.
So let's play what the advantages and disadvantages of a potential.
Well, we've see what's the information that is lacking.
Explain everything in this. Books.
And then the perspective for the vision of the population.
So I just think it's interesting.
And so to read what we said to the perspective of the interview,
it is not possible to know whether I will benefit from the six month or the 24 month interval between the two check ups.
If I am over 18 years of age and my dentist will see this, that I am more high risk of developing cancer periodontitis.
Visiting the dentist for a check-up That is,
even when I feel that there is nothing wrong with my teeth and gums once every six months or once every two years,
you probably have the same effect on my old son.
So we need to look.
And although the text for those who are interested in football once we st was the aspect of the population.
We give all good sources of informations here, all the publications consulted.
The result of the scaffold will be followed in each step.
How we calculated the person closely when they were.
It was it's not properly really not available until it's been outlawed.
And finally, the example of Scott. The question was how many patients complete root canal treatment but extract the gift within five or ten.
On the telephone. There is no information about the procedure.
Just say the. Data fall within 5 minutes.
Thousands of patients with strolling barefoot folk will have this exciting five year plan.
Nearly 20%, 70%. So that's all possible.
But then in the second layer, we have.
What we think of our view of public health is not only will the position of possession and have discussions of income,
which is what we would develop with the sausage population, plenty, because we both want to do well as all this public studies.
We had to look at. And if you go to the label once we have the same information on the table that we're having, these two would be the same tables.
And then. We have all the clinical considerations.
For instance. Well, let me to you the clinical considerations for this five.
The extraction of the tooth is a definite and effective way of treating root canal infection or toothache.
And the dog treatment is an alternative intervention that is performed to eradicate or prevent infection in the root canal,
toothache and the extraction of tooth.
Therefore it is of interest for the and for some patients to know the effectiveness of the novel as its function for.
Sometimes there's a lot of people's initiative but must be discontinued and the tooth extracted within one year due to,
for example, perforation of the technology and location instrument structure.
Don't, you know, crack and people die. The reasons for starting but not successfully copying can be good growth,
lagging on that selection of cases and technical or biological difficulties related the tooth and the dentist.
And here comes the important information. This fox box does not include and the daunting treatment that started.
But the have not been this have not been sorry but had to be discontinued.
It provides information, all of the devoted treatment that was completed.
There is a lot of box. That provides information about the equipment that was started so that when it was open, so they'll be usable.
Here is the data.
If you completed successfully the treatment that 15% and then treatment signalling both the frequency of the stop voice and the final treatment.
And there is the possibility that it's not important.
And there's another factor for that to show that 30% of the stuff a one of the most significant.
So that's what's going on. Another perspective too.
Individual the perspective to the population. And we'll see what the source of information was.
The it is the search strategy. So when it came to the relevance to this, among those citations of the review, of course,
was 2005, you identified all those studies have got to think about these things,
which are the population to a nationwide population study in South Korea, a nationwide population study, the United States.
So there was a couple of things. Other nationwide studies we do.
So there are so many studies that help us.
Straight out to all of you. I'm doing fine.
So we felt like verify that there is a need for systematic review of the there was a protocol.
But what I noticed with you and with all of Drupal, also of developing protocol.
So the point is for the board. And so we had to do all this together.
We cannot ignore this just because there is room for systematic review.
So we have had some of. To gather all this data together.
Let me explain here the calculations that we do that.
How we calculated the imprecision precision of the estimates.
That's all we talked about.
And with all this explanation, how we managed to get through this.
And no information should succeed.
Okay open that to by now all of.
Waiting for the order to be available. So.