Artikel
New developments in GRADE
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Veröffentlicht: | 10. Juli 2012 |
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Gliederung
Text
12 years ago a group of guideline developers, public health officers, clinicians, epidemiologists, policy makers and other scientists reacted to the confusion caused by the existence of multiple systems to evaluate the quality of evidence (aka levels of evidence or strength of evidence) and to develop recommendations by deciding to develop, test and implement a new and potentially universal one. The defining features of the resulting GRADE approach were a’priori specification of outcomes critical for a given recommendation, judging the quality of evidence (QoE) on an individual outcome level, separating QoE from the strength of recommendation and consideration of all criteria that are relevant for making recommendations [1]. Much work has taken place...
The new development and innovations in GRADE are illustrated by number of processes which took place during recent CPG work. Those included:
- 1.
- changes in the process (attention to the intellectual or financial conflict of interest; leading roles for unconflicted methodologist from outside of professional societies
- 2.
- explicit distinction between patient-important and surrogate outcomes
- 3.
- specification of values and preferences
- 4.
- changes in the scope (increasing attention to diagnostic issues)
- 5.
- changes in the presentation of evidence: preparation of evidence profiles
- 6.
- ongoing close ‘as you go’ collaboration of interested methodologists and clinicians;
- 7.
- exclusion of conflicting experts, explicit presentation of evidence and recognition of variability in values and preferences led to frequent weak rather than strong recommendation;
Future challenges:
- 1.
- training of sufficient number of individuals serving as GRADE resource person; planning for the future updates and reiterations (succession plans);
- 2.
- training of sufficient number of content area experts in GRADE methodology (rise and usefulness of webinars);
- 3.
- continuous struggle to link the recommendations to evidence.
References
- 1.
- Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schünemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW Jr, Zaza S. Grading quality of evidence and strength of recommendations. BMJ. 2004 Jun;328(7454):1490. DOI: 10.1136/bmj.328.7454.1490