Grading quality of evidence and strength of recommendations in clinical practice guidelines Part 3 of 3. The GRADE approach to developing recommendations

被引：207

作者：

Brozek, J. L. ^{[2
]}

Akl, E. A. ^{[2
,3
,4
]}

Compalati, E. ^{[5
]}

Kreis, J. ^{[6
]}

Terracciano, L. ^{[7
]}

Fiocchi, A. ^{[7
]}

Ueffing, E. ^{[8
]}

Andrews, J. ^{[9
,10
]}

Alonso-Coello, P. ^{[11
]}

Meerpohl, J. J. ^{[12
,13
]}

Lang, D. M. ^{[14
]}

Jaeschke, R. ^{[2
]}

Williams, J. W., Jr. ^{[15
,16
]}

Phillips, B. ^{[17
]}

Lethaby, A. ^{[18
]}

Bossuyt, P. ^{[19
]}

Glasziou, P. ^{[20
]}

Helfand, M. ^{[21
]}

Watine, J. ^{[22
]}

Afilalo, M. ^{[23
]}

Welch, V. ^{[8
]}

Montedori, A. ^{[24
]}

Abraha, I. ^{[24
]}

Horvath, A. R. ^{[25
,26
]}

Bousquet, J. ^{[27
,28
]}

Guyatt, G. H. ^{[2
]}

Schuenemann, H. J. ^{[1
,2
]}

机构：

[1] McMaster Univ, Dept Clin Epidemiol & Biostat, Fac Hlth Sci, Hamilton, ON, Canada

[2] McMaster Univ, Dept Med, Hamilton, ON, Canada

[3] SUNY Buffalo, Dept Med, Sch Med & Biomed Sci, Buffalo, NY 14260 USA

[4] SUNY Buffalo, Dept Family Med, Sch Med & Biomed Sci, Buffalo, NY 14260 USA

[5] Univ Genoa, Dept Internal Med, Allergy & Resp Dis Clin, I-16126 Genoa, Italy

[6] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[7] Univ Milan, Sch Med, Melloni Hosp, Pediat Div,Dept Child & Maternal Med, Milan, Italy

[8] Univ Ottawa, Ctr Global Hlth, Inst Populat Hlth, Ottawa, ON, Canada

[9] Vanderbilt Univ, Dept Obstet & Gynecol, Nashville, TN USA

[10] Vanderbilt Univ, Evidence Based Practice Ctr, Nashville, TN USA

[11] Inst Biomed Res CIBER Epidemiol & Publ Hlth CIBER, Clin Epidemiol & Publ Hlth Dept, Iberoamer Cochrane Ctr, Barcelona, Spain

[12] Univ Med Ctr Freiburg, Inst Med Biometry & Med Informat, German Cochrane Ctr, Freiburg, Germany

[13] Univ Med Ctr Freiburg, Ctr Pediat & Adolescent Med, Freiburg, Germany

[14] Cleveland Clin, Resp Inst, Allergy Immunol Sect, Cleveland, OH 44106 USA

[15] Duke Univ, Dept Internal Med & Psychiat, Durham, NC USA

[16] Durham VA Med Ctr, Durham, NC USA

[17] Univ York, Ctr Reviews & Disseminat, York YO10 5DD, N Yorkshire, England

[18] Univ Auckland, Fac Med & Hlth Sci, Sch Populat Hlth, Auckland 1, New Zealand

[19] Univ Amsterdam, Acad Med Ctr, Dept Clin Epidemiol Biostat & Bioinformat, NL-1105 AZ Amsterdam, Netherlands

[20] Univ Oxford, Dept Primary Hlth Care, Ctr Evidence Based Med, Oxford, England

[21] Oregon Hlth & Sci Univ, Portland Vet Adm Med Ctr, Portland, OR 97201 USA

[22] Hop Rodez, Lab Biol Polyvalente, Rodez, France

[23] McGill Univ, Jewish Gen Hosp, Montreal, PQ H3T 1E2, Canada

[24] Reg Hlth Author Umbria, Off Reg Hlth Planning, Perugia, Italy

[25] Univ Sydney, Sch Publ Hlth, Screening & Test Evaluat Program, Sydney, NSW 2006, Australia

[26] Prince Wales Hosp, SEALS Dept Clin Chem, Sydney, NSW, Australia

[27] Hop Arnaud de Villeneuve, Serv Malad Resp, Montpellier, France

[28] INSERM, U1018, Villejuif, France

来源：

ALLERGY | 2011年 / 66卷 / 05期

关键词：

clinical practice guidelines; evidence-based medicine; GRADE;

D O I：

10.1111/j.1398-9995.2010.02530.x

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

P>This is the third and last article in the series about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We describe the factors that influence the strength of recommendations about the use of diagnostic, preventive and therapeutic interventions: the balance of desirable and undesirable consequences, the quality of a body of evidence related to a decision, patients' values and preferences, and considerations of resource use. We provide examples from two recently developed guidelines in the field of allergy that applied the GRADE approach. The main advantages of this approach are the focus on patient important outcomes, explicit consideration of patients' values and preferences, the systematic approach to collecting the evidence, the clear separation of the concepts of quality of evidence and strength of recommendations, and transparent reporting of the decision process. The focus on transparency facilitates understanding and implementation and should empower patients, clinicians and other health care professionals to make informed choices.

引用

页码：588 / 595

页数：8

共 12 条

[1]

[Anonymous], 2009, PRINCIPLES BIOMEDICA

[2] Systems for grading the quality of evidence and the strength of recommendations -: I:: Critical appraisal of existing approaches The GRADE Working Group -: art. no. 38 [J].

Atkins, D ;

Eccles, M ;

Flottorp, S ;

Guyatt, GH ;

Henry, D ;

Hill, S ;

Liberati, A ;

O'Connell, D ;

Oxman, AD ;

Phillips, B ;

Schünemann, H ;

Edejer, TTT ;

Vist, GE ;

Williams, JW .

BMC HEALTH SERVICES RESEARCH, 2004, 4 (1)

[3] Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies [J].

Brozek, J. L. ;

Akl, E. A. ;

Jaeschke, R. ;

Lang, D. M. ;

Bossuyt, P. ;

Glasziou, P. ;

Helfand, M. ;

Ueffing, E. ;

Alonso-Coello, P. ;

Meerpohl, J. ;

Phillips, B. ;

Horvath, A. R. ;

Bousquet, J. ;

Guyatt, G. H. ;

Schuenemann, H. J. .

ALLERGY, 2009, 64 (08) :1109-1116

[4] Grading quality of evidence and strength of recommendations in clinical practice guidelines [J].

Brozek, J. L. ;

Akl, E. A. ;

Alonso-Coello, P. ;

Lang, D. ;

Jaeschke, R. ;

Williams, J. W. ;

Phillips, B. ;

Lelgemann, M. ;

Lethaby, A. ;

Bousquet, J. ;

Guyatt, G. H. ;

Schuenemann, H. J. .

ALLERGY, 2009, 64 (05) :669-677

[5] Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 Revision [J].

Brozek, Jan L. ;

Bousquet, Jean ;

Baena-Cagnani, Carlos E. ;

Bonini, Sergio ;

Canonica, G. Walter ;

Casale, Thomas B. ;

van Wijk, Roy Gerth ;

Ohta, Ken ;

Zuberbier, Torsten ;

Schuenemann, Holger J. .

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2010, 126 (03) :466-476

[6]

Fiocchi A, 2010, PEDIAT ALLERG IMM-UK, V21, P1, DOI [10.1111/j.1399-3038.2010.01068.x, 10.1097/WOX.0b013e3181defeb9]

[7]

Guyatt GH, 2008, USERS GUIDES MED LIT, P597

[8] GRADE:: Incorporating considerations of resources use into grading recommendations [J].

Guyatt, Gordon H. ;

Oxman, Andrew D. ;

Kunz, Regina ;

Jaeschke, Roman ;

Helfand, Mark ;

Liberati, Alessandro ;

Vist, Gunn E. ;

Schunemann, Holger J. .

BRITISH MEDICAL JOURNAL, 2008, 336 (7654) :1170-1173

[9] GRADE:: going from evidence to recommendations [J].

Guyatt, Gordon H. ;

Oxman, Andrew D. ;

Kunz, Regina ;

Falck-Ytter, Yngve ;

Vist, Gunn E. ;

Liberati, Alessandro ;

Schunemann, Holger J. .

BMJ-BRITISH MEDICAL JOURNAL, 2008, 336 (7652) :1049-1051

[10] The Yale Guideline Recommendation Corpus: A representative sample of the knowledge content of guidelines [J].

Hussain, Tamseela ;

Michel, George ;

Shiffman, Richard N. .

INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS, 2009, 78 (05) :354-363

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