Expanding the Grading of Recommendations Assessment, Development, and Evaluation (Ex-GRADE) for Evidence-Based Clinical Recommendations: Validation Study.

Clinicians use general practice guidelines as a source of support for their intervention, but how much confidence should they place on these recommendations? How much confidence should patients place on these recommendations? Various instruments are available to assess the quality of evidence of research, such as the revised Wong scale (R-Wong) which examines the quality of research design, methodology and data analysis, and the revision of the assessment of multiple systematic reviews (R-AMSTAR), which examines the quality of systematic reviews.The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) Working Group developed an instrument called the GRADE system in order to grade the quality of the evidence in studies and to evaluate the strength of recommendation of the intervention that is proposed in the published article. The GRADE looks at four factors to determine the quality of the evidence: study design, study quality, consistency, and directness. After combining the four components and assessing the grade of the evidence, the strength of recommendation of the intervention is established. The GRADE, however, only makes a qualitative assessment of the evidence and does not generate quantifiable data.In this study, we have quantified both the grading of the quality of evidence and also the strength of recommendation of the original GRADE, hence expanding the GRADE. This expansion of the GRADE (Ex-GRADE) permits the creation of a new instrument that can produce tangible data and possibly bridge the gap between evidence-based research and evidence-based clinical practice.

Evidence-Based Research in Complementary and Alternative Medicine III: Treatment of Patients with Alzheimer's Disease.

This paper presents the novel domain of evidence-based research (EBR) in the treatment of patients with Alzheimer's disease (AD) from the perspective of traditional medicine and of complementary and alternative medicine. In earlier lectures we have described the process of evidence-based medicine as a methodological approach to clinical practice that is directed to aid clinical decision-making. Here, we present a practical example of this approach with respect to traditional pharmacological interventions and to complementary and alternative treatments for patients with AD.

Evidence-based research in alternative protocols to dental implantology: a closer look at publication bias.

Several techniques exist for the surgical placement of dental implants. The aim of this study was to assess systematically, the efficacy of these protocols by the evidence-based perspective. Five best-case studies involving 607 early/immediately loaded implants and 300 conventionally loaded implants were identified by examining the available literature and rigorous inclusion/exclusion criteria. Overall analyses demonstrated a 98.4 percent success rate for the early/immediate procedure and a 95.3 percent for the conventional protocol. Success rates in the articles reviewed were based on implant survival over a follow-up period of between one to two years. A meta-analysis was generated to evaluate the presented evidence and to aid in decision-making. Despite its common implementation, this technique presents many caveats, among which publication bias is one of the most common. To investigate the possible presence of publication bias, a funnel plot analysis complemented several statistical tests. By means of the systematic investigation of dental implants, the authors' results confirm the presence of publication bias in implant dentistry literature, which strongly suggests that clinicians ought not base their decisions solely on the results presented by a few published studies. Rather, it is recommended that clinicians cautiously draw conclusions and seek studies that present accountable and clinically relevant results. Furthermore, it is suggested that clinicians attend seminars to learn of the effective advances in evidence-based dentistry, so as to develop the ability to easily detect inadequate literature due to attempted correlation with the most current research. It is also recommended that additional research is necessary to analyze which fields of research are more prone to bias, thus forewarning clinicians before formulating clinical conclusions.