{"id":418,"date":"2013-04-03T20:00:13","date_gmt":"2013-04-03T19:00:13","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/adc-archimedes\/?p=418"},"modified":"2013-03-30T20:03:43","modified_gmt":"2013-03-30T19:03:43","slug":"grade-it","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/adc\/2013\/04\/03\/grade-it\/","title":{"rendered":"GRADE it."},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" alt=\"\" src=\"http:\/\/www.gradeworkinggroup.org\/graphs\/logo.gif\" width=\"168\" height=\"120\" \/>As mentioned quite some time ago, there are a number of ways of approaching the ideas of indicating the strength of evidence behind recommendations. Archi has stuck with a rather old, but easy-to-follow version from the Centre for Evidence Based Medicine in Oxford. During the decade of Archi&#8217;s existence there&#8217;s been the steady development of a tool handily called <a href=\"http:\/\/www.gradeworkinggroup.org\/\">GRADE<\/a>. This produces high to very-low strengths of evidence, which translate into strong or weak recommendations. Explaining this seemed to be complicated, but Jeremy Howick has cracked a <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jebm.12018\/abstract\">straightforward approach.<\/a><br \/>\n<!--more--><\/p>\n<p>GRADE recommendations for interventions can be achieved by following a five-step process:<\/p>\n<ol>\n<li><span style=\"line-height: 13px\">Rank on the basis of randomised (high) or observational (low) study design<\/span><\/li>\n<li>Upgrade or downgrade on specific features of study results or conduct<br \/>\nUp for Consistent effects, Dose response or Confounders plausibly reducing effects seen<br \/>\nDown for High risk of bias in individual studies, publication or small study bias, Inconsistent, Indirect or Imprecise results<\/li>\n<li>Use this to assign an evidence level (High, Moderate, Low or Very Low)<\/li>\n<li>Consider other factors affecting a recommendation &#8211; like balances of harms and benefits, patient preferences and cost effectiveness<\/li>\n<li>Develop the strength of the recommendation (strong or weak)<\/li>\n<\/ol>\n<p>Such decisions can be supported with standardised templates for the evidence, and <a title=\"\u201cIt ain\u2019t what you say but the way that you say it\u201d\" href=\"https:\/\/stg-blogs.bmj.com\/adc-archimedes\/2010\/06\/26\/it-aint-what-you-say-but-the-way-that-you-say-it\/\">as mentioned previously\u00a0<\/a>putting your recommendations in this frame can be very helpful to everyone.<\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>As mentioned quite some time ago, there are a number of ways of approaching the ideas of indicating the strength of evidence behind recommendations. Archi has stuck with a rather old, but easy-to-follow version from the Centre for Evidence Based Medicine in Oxford. During the decade of Archi&#8217;s existence there&#8217;s been the steady development of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2013\/04\/03\/grade-it\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[79],"tags":[],"class_list":["post-418","post","type-post","status-publish","format-standard","hentry","category-archimedes"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/418","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/comments?post=418"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/418\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/media?parent=418"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/categories?post=418"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/tags?post=418"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}