Table 5.

Summary of issues identified by authors of systematic reviews of RCTs

1. Inconsistency in defining or even including mention of periodontal disease status of study participants 2. Inconsistent definitions of VAP, HAP, and NHAP 3. Gold standard for diagnosing VAP not always used 4. Inconsistency in the type(s) of treatment(s) provided, i.e., timing, concentration of antimicrobial agents, frequency, clinician, use of antibiotics, mixing various interventions 5. Different settings and population groups 6. No mention of nursing or caregiver staff training re: providing oral care 7. Variation in outcomes measured and measurement technique used 8. No uniform methods for adjustment of confounders such as comorbidities and hospital treatment bundles for prevention of VAP 9. Comparison group in most studies was "usual care"--anything from toothbrushing to mouthrinsing--which could confound results. Only a few included studies used a placebo 10. Quality of studies (methodological shortcomings) and reporting 11. Publication bias: so few studies involved in some SRs that publication bias was not assessed 12. Lack of power calculations in studies 13. More consistent use of CONSORT in the RCTs would improve the quality of the studies