Assessment of the Quality of Current American Dental Association Clinical Practice Guidelines.

INTRODUCTION: The American Dental Association (ADA) defines evidence-based dentistry (EBD) as "an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences." Clinical practice guidelines (CPGs) are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Therefore, ADA CPGs are the most rigorous examples of EBD to inform clinical practice. CPGs should be of the highest level of quality to ensure the appropriateness and timeliness of clinical recommendations. OBJECTIVES: The aim of this study was to measure the methodological rigor and transparency of the ADA CPGs. METHODS: Each ADA CPG was appraised by 4 independent assessors using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Quantitative quality scores were obtained for 6 domains and overall quality. In addition, assessors provided a qualitative analysis by providing comments for each item and an appraisal of the full recommendation. RESULTS: A quality score of 75% was used as the threshold for high-quality guidelines. Using this metric, 6 of the current 10 current ADA CPGs were considered to be of high quality, 1 was slightly below the quality threshold, and 3 were considered marginal. Even among those evaluated to be high quality in overall assessment, certain domains did not reach the quality threshold of 75%. CONCLUSION: Overall, the ADA CPGs collectively provide high-quality guidance for the clinician. While the AGREE appraisal guidelines have been used in CPG development since 2016, there is still room for improvement in certain domains (i.e., stakeholder involvement, rigor of development, applicability, and editorial independence). KNOWLEDGE TRANSFER STATEMENT: The results of this study summarize the methodological rigor and transparency of the 10 current ADA clinical practice guidelines. Since adoption of AGREE standards (2016), CPGs have been uniformly of high quality. The quality of older CPGs was somewhat lower but overall deemed acceptable. Thus, ADA CPGs may be used with confidence to inform practitioners of treatment options supported by rigorous evidence-based dentistry standards. However, there is still room for improvement in methodological quality.

Osmetrichia in the grey brocket deer (Mazama gouazoubira)

Osmetrichia have been defined as hairs specialized in the storage of secretions used in olfactory communication between conspecifics (M³ller-Schwarze, et al. 1977). These authors found highly specialized osmetrichia in the tarsal gland tufts of black-tailed but not white-tailed deer. Chemical communication appears to be well developed in grey brocket deer: the bucks scent mark by rubbing their foreheads on bushes, and all deer urinate and defecate almost exclusively on dung heaps. Brocket deer also possess tarsal tufts. The purpose of this study was to examine hairs from several glandular areas in this species. Osmetrichia, similar to those found in black tailed deer, were found in tarsal tufts and in interdigital gland hairs; these hairs possessed open scales with deep pockets suitable for holding secretions, in comparison to the flat scales seen on control hairs. Hairs with different morphological characteristics (slightly open scales) were found over the frontal gland. Specialized hairs were not found in the tarsal tufts of one specimen of a related species, the red brocket deer (Mazama americana). The similarities in the hairs of grey brocket and black-tailed deer are remarkable in light of the ecological and behavioral differences between these two species

Osmetrichia in the grey brocket deer (Mazama gouazoubira)

Osmetrichia have been defined as hairs specialized in the storage of secretions used in olfactory communication between conspecifics (Müller-Schwarze, et al. 1977). These authors found highly specialized osmetrichia in the tarsal gland tufts of black-tailed but not white-tailed deer. Chemical communication appears to be well developed in grey brocket deer: the bucks scent mark by rubbing their foreheads on bushes, and all deer urinate and defecate almost exclusively on dung heaps. Brocket deer also possess tarsal tufts. The purpose of this study was to examine hairs from several glandular areas in this species. Osmetrichia, similar to those found in black tailed deer, were found in tarsal tufts and in interdigital gland hairs; these hairs possessed open scales with deep pockets suitable for holding secretions, in comparison to the flat scales seen on control hairs. Hairs with different morphological characteristics (slightly open scales) were found over the frontal gland. Specialized hairs were not found in the tarsal tufts of one specimen of a related species, the red brocket deer (Mazama americana). The similarities in the hairs of grey brocket and black-tailed deer are remarkable in light of the ecological and behavioral differences between these two species

"Osmetrichia" in the grey brocket deer (Mazama gouazoubira).

Osmetrichia have been defined as hairs specialized in the storage of secretions used in olfactory communication between conspecifics (Müller-Schwarze, et al. 1977). These authors found highly specialized osmetrichia in the tarsal gland tufts of black-tailed but not white-tailed deer. Chemical communication appears to be well developed in grey brocket deer: the bucks scent mark by rubbing their foreheads on bushes, and all deer urinate and defecate almost exclusively on dung heaps. Brocket deer also possess tarsal tufts. The purpose of this study was to examine hairs from several glandular areas in this species. Osmetrichia, similar to those found in black tailed deer, were found in tarsal tufts and in interdigital gland hairs; these hairs possessed open scales with deep pockets suitable for holding secretions, in comparison to the flat scales seen on control hairs. Hairs with different morphological characteristics (slightly open scales) were found over the frontal gland. Specialized hairs were not found in the tarsal tufts of one specimen of a related species, the red brocket deer (Mazama americana). The similarities in the hairs of grey brocket and black-tailed deer are remarkable in light of the ecological and behavioral differences between these two species.

[quot ]Osmetrichia[quot ] in the grey brocket deer (Mazama gouazoubira).

Osmetrichia have been defined as hairs specialized in the storage of secretions used in olfactory communication between conspecifics (M³ller-Schwarze, et al. 1977). These authors found highly specialized osmetrichia in the tarsal gland tufts of black-tailed but not white-tailed deer. Chemical communication appears to be well developed in grey brocket deer: the bucks scent mark by rubbing their foreheads on bushes, and all deer urinate and defecate almost exclusively on dung heaps. Brocket deer also possess tarsal tufts. The purpose of this study was to examine hairs from several glandular areas in this species. Osmetrichia, similar to those found in black tailed deer, were found in tarsal tufts and in interdigital gland hairs; these hairs possessed open scales with deep pockets suitable for holding secretions, in comparison to the flat scales seen on control hairs. Hairs with different morphological characteristics (slightly open scales) were found over the frontal gland. Specialized hairs were not found in the tarsal tufts of one specimen of a related species, the red brocket deer (Mazama americana). The similarities in the hairs of grey brocket and black-tailed deer are remarkable in light of the ecological and behavioral differences between these two species.