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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.

Infection with the human immunodeficiency virus-1 (HIV) and the resulting acquired immune deficiency syndrome (AIDS) alter not only cellular immune regulation but also the bone metabolism. Since cellular immunity and bone metabolism are intimately intertwined in the osteoimmune network, it is to be expected that bone metabolism is also affected in patients with HIV/AIDS. The concerted evidence points convincingly toward impaired activity of osteoblasts and increased activity of osteoclasts in patients with HIV/AIDS, leading to a significant increase in the prevalence of osteoporosis. Research attributes these outcomes in part at least to the ART, PI, and HAART therapies endured by these patients. We review and discuss these lines of evidence from the perspective of translational clinically relevant complex systematic reviews for comparative effectiveness analysis and evidence-based intervention on a global scale.

Objective: The objective of the study is to investigate the effect of infection control barrier (ICB) and curing time on irradiance of light cure units (LCUs). Methods: Irradiance (mW/cm2) of the LCUs at a government dental school were recorded with and without ICB at 0 (T0), 10 (T10), and 20 (T20) seconds using a digital radiometer. Data were analyzed using IBM® SPSS® Statistics Version 17 for Windows software for the analysis of variance and Bonferroni methods at 0.05 significance level. Results: Using ICB resulted in a statistically significant effect on the irradiance mean (P < 0.01). A significant difference existed between the four different brands of LCUs at different time intervals, irrespective of the use of ICB. At T0 and T10, the mean output of Acteon mini-light-emitting diode (LED) was significantly higher than that of either the Kerr Demi Ultra or the Kavo Polylux II. At T20, E-Morlit's mean irradiance was significantly higher than that of Kerr Demi Ultra, which in turn was significantly higher than that of the Kavo PolyLux II. The mean irradiance of the LEDs was significantly higher than that of the halogens irrespective of barrier placement and at all-time points. Conclusion: The ICB used in this study resulted in a statistically significant reduction in the irradiance output. No significant difference in the irradiance was found at different curing time intervals for the tested units regardless of ICB usage. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to evaluate the effects of different curing units and modes on the degree of conversion (DC) and microhardness (MH) of two different resin composites [ESTELITE Σ QUICK (EQ), and Z350 XT (Z3)]. Materials and Methods: One hundred (100) discs of each tested material were made and divided into two subgroups (n = 50) according to the discs' dimensions: 5 mm diameter × 2 mm thickness, and 2 mm diameter × 2 mm thickness. Each subgroup was further subdivided into the following five classes (n = 10): I) cured with halogen light curing-unit; II) cured with light-emitting diode (LED) unit; III) cured with argon laser; IV) cured with halogen light-curing unit for 5 s, 10 s rest followed by 20 s curing; and V) cured with halogen light-curing unit for 10 s, then 10 s rest, followed by 10 s curing. The first subgroup was tested for MH using the Vickers Microhardness tester and the second subgroup was tested for DC using Fourier transform infrared spectroscopy (FTIR). Data were statistically analyzed using two-way analysis of variance (ANOVA) and Tukey's post hoc test P < 0.05. Results: Specimens in class IV showed the highest mean DC and MH, followed by class III, then class II. Class I showed significantly lower mean values for both DC and MH. On the other hand, Z3 showed statistically significantly higher mean DC and MH than EQ. Conclusion: Although the two tested composites did not perform similarly under the test conditions, curing with halogen unit for 5 s, then 10 s rest, followed by 10 s curing improved the DC and the MH of both the tested materials. [ABSTRACT FROM AUTHOR]

Many in-office bleaching techniques use the light/laser in conjunction with the bleaching agent claiming more favorable bleaching results. Controversy still exists in the literature as to the role of a light/laser in bleaching results. The goal of this study is to determine, through Comparative Effectiveness-Efficacy Research and Analysis for Practice (CEERAP), if the co-use of light/laser activation with the chemical bleaching agent has improved teeth whitening compared to using the chemical bleaching agent alone. Systematic reviews and randomized clinical trials on the research question were obtained using multiple search engines. Assessment of the level and quality of evidence and acceptable sample analysis were performed for the Randomized Clinical Trials (RCTs). Due to heterogeneity of the acceptable studies, meta-analysis was performed only on the two most homogenous studies. Qualitative assessment of the acceptable studies was performed. The strength of clinical recommendation was assessed. Only one qualitative systematic review was found. Eight articles were accepted as high quality RCTs. The meta-analysis shows preferable outcome when using the light activation with the bleaching material than when using the bleaching material alone. Qualitative assessment of the acceptable studies shows conflicting results. Most studies agreed that the use of light is proven to increase the whitening effect of the bleaching agent, especially for a short term after treatment. Additional studies with greater consistency in methodology and outcomes are needed to be able to reach a definite consensus regarding the effectiveness of using light during bleaching through an overarching meta-analysis for more powerful statistical results. [ABSTRACT FROM AUTHOR]