Date: January 30,
Associate Director (Training)
UK Cochrane Centre, Summertown Pavilion,
Middle Way, Oxford OX2 7LG, UK
for The Cochrane Collaboration Sheiham Public Health and Primary Care
am very keen to learn the skills required to do a Cochrane Systematic
Review. Since there is no such training available in India, the Sheiham
Scholarship would enable me to get it right where it is all happening-
the Mecca of EBD, Oxford. Hence I would like to submit my candidature
for this scholarship. I have enclosed all the required documents and information
as mentioned in the scholarship leaflet. These include:
1. Full curriculum vitae.
2. Full names and addresses (including e-mail address)
of three referees.
3. A detailed outline of work already done on systematic
reviews or clinical trials, including an outline of experience with quantitative
4. The suggested topic for review, with a write-up explaining
the relevance to public health and primary care.
5. Confirmation from Cochrane Oral Health CRG that the
topic has been agreed.
While assessing my
eligibility for the scholarship, I request consideration of the following:
Ø The concept of a Cochrane review is almost unheard of in India,
at least in the field of oral health care. In the field of general health
care, only 13 reviews have been done or are under different stages of
completion (by an Indian reviewer). None exists, however, in the field
of oral health care. The patients needing oral health care stand to benefit
greatly from such reviews. A beginning has to be made to make these skills
available in India.
Ø Even though I lack previous experience in doing a systematic
review or dealing with quantitative data (which I suppose is a pre-requisite
for gaining the scholarship), my conviction and enthusiasm to do one should
make me eligible for gaining the scholarship. Further, the Oral Health
Group at Oxford has been very supportive in my attempt to get involved
in the process of doing a Cochrane Systematic Review. In fact, the words
of Emma Tavender, the Group Co-ordinator, go much more beyond that. To
quote her "Whilst you are based here in the UK we would be happy to
support you through the review process and maybe you would like to work
here in Manchester for a period of time?" She adds, "…you have
the support of the Cochrane Oral Health Group editorial team who have
offered their assistance in the completion of a systematic review and
Ø Moreover, I am actively involved (as one of the founding directors)
in the activities of our Centre for Evidence-Based Dentistry and Informatics
(more information at http://www.cods.net/cebd/). We shall be conducting
the first ever workshop on EBD on the 10th & 11th of March 2001 (details
Dr. Derek Richards (Director, CEBD, Oxford, UK) and Dr. Osbjorn Jokstad
(Assoc. Editor, EBD Journal, Norway) shall be conducting this workshop
for our centre. Prior to the workshop, they shall conduct an instructional
course for some of us at the centre. This course shall cover systematic
reviews as well as other evidence-based dentistry topics.
Ø About 100 senior teachers are expected to attend the workshop.
The Vice-Chancellor of our state's health university and his senior staff,
and the President of the central regulatory authority 'Dental Council
of India' will also be attending. Their presence is an acknowledgement
that EBD has arrived in India and that the activity generated by us shall
be sustained on a wider scale. This is surely going to create a lot of
interest in things like systematic review. If I get trained in the skills
required to do systematic reviews, the same can be imparted to others
locally. The Oxford team can even come here to do the good deed themselves.
Sir, I hope this information
gives a better perspective when looking at my application.
Although it may seem
a little premature to mention, I must make it known that the period between
June to September is the most suitable for me to avail the scholarship
(at least as far as the year 2001 is concerned). The full set of application
documents is also being faxed to you. I shall be eager to provide any
more information with regard to this application.
I await your decision.
Dr. Shailesh Lele
(Total number of pages
faxed including this application= 9)
Senior Professor & Head, Department of Oral Medicine & Radiology, College
of Dental Sciences, Davangere-577004
Tel. No.: 91-8192-31285 Fax: 91-8192-51070
A-5, Indragiri, BEA Staff Quarters, Anjaneya Layout, Davangere-577004
Tel. No.: 91-8192-20023 e-mail: email@example.com
B.D.S.: University of Bombay, June 1983 *1st Rank in two subjects:
Oral Medicine & Radiology, Pedodontia
M.D.S.: University of Bombay, June 1986
Certificate Course in Computer Fundamentals: 1991
Ø Sufficient knowledge and experience of computer applications
such as word processor (MS Word), presentations (PowerPoint, Macromedia
Director), graphics (CorelDraw, PhotoImapct, Photo Editor), spreadsheet
(Excel), HTML (Macromedia Dreamweaver, FrontPage), WS_FTP, Sound Forge.
Ø Created about 60 presentations for undergraduate curriculum.
Ø Created (using Macromedia Dreamweaver) a web site for the department
with about 26 web pages and 90 images (and still growing) depicting the
faculty, facilities and activities of the department. The archive on the
site hosts interesting case studies with clinical, laboratory, radiographic
and histological records, and articles of interest (http://omr-cods.tripod.com/).
Ø Created (using Macromedia Dreamweaver) a web site for the Centre
for Evidence-Based Dentistry & Informatics with about 40 web pages and
several graphical images (self-created) depicting the Centre- and EBD-related
The site is still under development.
Ø Clinical photography
11 years teaching experience at
1. Bapuji Dental College & Hospital, Davangere
2. Government Dental College & Hospital, Bombay
3. Bharati Vidyapeeth's Dental College & Hospital, Pune
4. College of Dental Sciences, Davangere since 23rd August 1997 to-date.
Published 4 scientific papers
1. "Goals for oral health by 2000 AD- A review", Dental Dialogue, 14:1,
2. "Resorption of permanent teeth- An overview", Journal of Indian Dental
Association, 62:7, 1991
3. "Whose radiograph is it anyway" (editorial), Dental Dialogue, 16:1
& 2, 1991
4. "Gestant odontome- A case report", Dental Dialogue, 20:3, 1995
Attended 5 continuing education programs
Conducted a state level 'Hands-on' Course on Oral Digital Radiography
& Photography, College of Dental Sciences, Davangere, September 1998
Guest Speaker presentations
1. 'Computers in Public Health Dentistry' at the 4th National Conference
of Indian Association of Public Health Dentistry, November 1998
2. 'Digital Imaging in Dentistry' at
Ø The 2nd Continuing Education Programme of Bapuji Dental Colleges
Alumni Association, June 1999 and
Ø The Continuing Education Programme of Krupa Continuing Dental
Education Wing, Bangalore, September 1999 3. 'Digital Imaging in Endodontics'
at the National Endodontic Workshop at College of Dental Sciences, Davangere,
Best Paper Presentation Award for the presentation on 'Computer-Aided-Education'
at the X National Conference of Indian Academy of Oral Medicine & Radiology,
Mangalore, December 1998
presentation on 'X-ray Tube Head- The Inside Out story' at the XI
National Conference of Indian Academy of Oral Medicine & Radiology, Navi
Mumbai, December 1999 (also available in the archive at http://omr-cods.tripod.com/)
'Dissertation Writing' and 'Computers in Research' for postgraduate students
of College of Dental Sciences, Davangere
~ Science of higher education
~ Evidence-based dentistry
~ Computer and Internet applications in dental education
names and addresses (e-mail address if possible) of three referees:
1. Dr. Anmol S. Kalha,
Sr. Professor & Head, Department of Orthodontics, College of Dental Sciences,
Pavilion Road, Davangere-577004, Karnataka, India
e-mail address: firstname.lastname@example.org
2. Dr. Ravindranath
Sable, Professor & Head, Department of Orthodontics, B. V. Deemed University
Dental College & Hospital, Dhanakawadi, Pune-411043, Maharashtra, India
e-mail address: email@example.com
3. Dr. S. Madhava
Murthy, Manager- Dental Division, Technical Department, Birla 3M Limited,
Plot No. 48-51, Electronics City Hosur Road, Bangalore-561229, Karnataka,
India e-mail: firstname.lastname@example.org
outline of work already done on systematic reviews or clinical trials,
including an outline of experience with quantitative data
Ø As part of my dissertation work (in 1985-86, see below),
I was required to do a review of literature relevant to the hypothesis
of the study. All the studies cited in the bibliographies of textbook
chapters, journal articles were hand-searched. The Index Medicus (Medline
was unheard of in those days) and dental index were similarly hand-searched.
Wherever full articles could be accessed, the contents were analyzed (not
statistically, though) for their relevance to my study. The results of
these relevant studies were summarized and included in the 'Review of
Literature' section of the dissertation.
Ø I did a similar exercise prior to publication of an article titled
"Resorption of permanent teeth- An overview" (in Journal of Indian Dental
Association, 62:7, 1991).
Ø I have done similar reviews on digital imaging prior to conducting
a 'Hands-on course of oral digital radiography & photography' and giving
lectures on the same topic for various audiences.
and experience with quantitative data:
Ø "A comparative study of automatic processing versus manual"
was the title of the dissertation that I submitted to University of Bombay
in partial fulfillment of the requirements of the postgraduate course
(Master of Dental Surgery).
periapical exposures of a site were made in 100 patients (after obtaining
an informed consent). One film was processed in automatic processor, the
other processed by the standard manual method. The radiographs so obtained
were shown in a random order to three observers (who were blinded as to
the method of processing) for critical evaluation along certain criteria.
Their valuations were tabulated and analyzed statistically. The image
quality was concluded to be equal in radiographs processed by the two
methods (non-parametric test of significance was employed). A cost-benefit
evaluation was also made.
Ø As a university examiner for the Master of Dental Surgery examinations,
I am required to critically evaluate the submitted dissertations for methodology
and statistical handling of data.
Knowledge: Some! I
have read the following resources on systematic reviews, clinical trials
and quantitative data:
Reviewers' Handbook 4.1 including the Appendices and Glossary
2. Style Guidelines for Cochrane Reviews
3. Randomized Controlled Trials: A User's Guide by Alejandro Jadad,
BMJ Books, 1998.
4. Evidence-based practice Handbook, Dr. Anthony Staines, Department
of Public Health Medicine and Epidemiology, University College Dublin.
5. Critical appraisal and using the literature, From the resources
of School of Health and Related Research, The University of Sheffield
6. Systematic reviews: what are they and why are they useful?
From the resources of School of Health and Related Research, The University
Reviews: Rationale for systematic reviews, C D Mulrow, BMJ 1994;309:597-599
2. Systematic Reviews: Reporting, updating, and correcting systematic
reviews of the effects of health care, I Chalmers, B Haynes, BMJ 1994;309:862-865
3. Anticonvulsant drugs for management of pain: a systematic review,
Henry McQuay, Dawn Carroll, Alejandro R Jadad, Philip Wiffen, Andrew Moore,
BMJ 1995;311:1047-1052 (21 October) 4. Analgesic efficacy and safety
of paracetamol-codeine combinations versus paracetamol alone: a systematic
review, Anton J M de Craen, Giuseppe Di Giulio, Angela J E M Lampe-Schoenmaeckers,
Alphons G H Kessels, Jos Kleijnen, Angela J E M Lampe-Schoenmaeckers,
BMJ 1996;313:321-325 (10 August)
5. Letters to the editor: Systematic reviews provide information
not contained in traditional narrative reviews, David Henry, BMJ 1997;314:1832
6. How to read a paper: Papers that report drug trials, Trisha
Greenhalgh, BMJ 1997;315:480-483 (23 August)
7. How to read a paper: Papers that report diagnostic or screening
tests, Trisha Greenhalgh, BMJ 1997;315:540-543 (30 August)
8. How to read a paper: Papers that summarise other papers (systematic
reviews and meta-analyses), Trisha Greenhalgh, BMJ 1997;315:672-675 (13
9. How to read a paper: Papers that go beyond numbers (qualitative
research), Trisha Greenhalgh, Rod Taylor, BMJ 1997;315:740-743 (20 September)
10. Systematic review of randomised controlled trials of interventions
for painful shoulder: selection criteria, outcome assessment, and efficacy,
Sally Green, Rachelle Buchbinder, Richard Glazier, Andrew Forbes, BMJ
1998;316:354-360 (31 January)
11. Letters to the editor: Medline and Embase complement each
other in literature searches, David Woods, Kate Trewheellar, BMJ 1998;316:1166
( 11 April )
12. Letters to the editor: Research questions for systematic reviews
must be unambiguous from protocol stage, Gunther Eysenbach, BMJ 1999;319:1265
( 6 November )
These and some other
readings have convinced me that preparing systematic reviews is the need
of the times. The patients stand to benefit greatly from them. So I am
very keen to obtain training and experience in preparing systematic reviews.
And what better place than Oxford to get that!
agreed topic for review: Pharmacological interventions for pain
in patients with temporomandibular disorders (TMD)
Relevance of the
review to public health and primary care
A sizeable number
of patients in a hospital setting such as ours (a teaching institute with
hospital services in dentistry) comprise TMD patients. The complex, multi-factorial
and poorly understood pathogenesis and clinical course of TMD has led
to appearance of a variety of management methods. Most of these methods
are picked up from the senior teachers, from narrated experiences of colleagues
or from a stray article in a journal. Little thought is given to validity
and applicability of these methods in one's own patients. Mostly the outcome
of such arbitrary management is unsatisfactory and patients suffer from
the psychosocial and economic impact of the maltreated disorder.
One of the mainstays
of management of TMD patients is prescribing a pharmacological agent either
singly, but mostly in combination with another. Relief from or reduction
in pain intensity is usually the aim of this pharmacotherapy. These agents
can be broadly grouped under: nonopioid analgesics, opioids, corticosteroids,
antidepressants, benzodiazepines and muscle relaxants. How far are the
benefits, if any, real and how far by chance or other factors is not well
The data supporting
the effectiveness of these, either singly or in combination, is said to
be limited. Apparently, so also is the data supporting their utility when
used in combination with other management methods such as physical therapy.
The ease with which a prescription can be filled out may be causing unnecessary
use or overuse (on account of chronicity of pain) of these agents. Drug
toxicity that may result from this action needs to be seriously taken
into consideration. On the other hand, there is a possibility that some
agents such as opioids may be underutilized, thus depriving the patient
of their benefits.
Lack of a clear-cut
picture as to the utility, or otherwise, of the pharmacological interventions
in TMD is to the detriment of public health. Whether drugs such as of
the types mentioned above have a role in the primary care of TMD needs
to be ascertained. If they do, their benefits need to be balanced with
the costs and toxicity. If they don't, the resources being expended on
them can be better utilized on other methods of management. A systematic
review is most likely to provide an answer to this area of concern in
the management of TMD. The statement made above about the limited data
can also be validated as true or false. If true, the systematic review
shall throw up pointers for further clinical research that needs to be
carried out. If false, it is likely we shall know the answers to many
a question in the management of TMD.
Either way a problem
area in public health and primary care shall get suitably addressed. Individual
patient, and the society at large stand to gain.