GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength
Humans; United States; Canada; Practice Guidelines as Topic; Treatment Outcome; Research Design; Risk Assessment; Evidence-Based Medicine; Treatment Failure; Germany; Pulmonary Disease; Health Care; Quality Assurance; Chronic Obstructive
In the GRADE approach, the strength of a recommendation reflects the extent to which we can be confident that the composite desirable effects of a management strategy outweigh the composite undesirable effects. This article addresses GRADE's approach to determining the direction and strength of a recommendation. The GRADE describes the balance of desirable and undesirable outcomes of interest among alternative management strategies depending on four domains, namely estimates of effect for desirable and undesirable outcomes of interest, confidence in the estimates of effect, estimates of values and preferences, and resource use. Ultimately, guideline panels must use judgment in integrating these factors to make a strong or weak recommendation for or against an intervention.
2013-07
Andrews JC; Schunemann HJ; Oxman A; Pottie K; Meerpohl Joerg J; Coello PA; Rind D; Montori VM; Brito JP; Norris S; Elbarbary M; Post P; Nasser M; Shukla V; Jaeschke R; Brozek J; Djulbegovic B; Guyatt G
Journal Of Clinical Epidemiology
2013
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.jclinepi.2013.02.003" target="_blank" rel="noreferrer">10.1016/j.jclinepi.2013.02.003</a>
The n-of-1 randomized controlled trial: clinical usefulness. Our three-year experience
Female; Humans; Adult; Physician's Role; Research Design; Double-Blind Method; Patient Compliance; Clodronate; Randomized Controlled Trials/methods; Amitriptyline/therapeutic use; Propranolol/therapeutic use; Syncope/drug therapy
OBJECTIVE: To review the feasibility and effectiveness of n-of-1 randomized controlled trials (n-of-1 trials) in clinical practice. DESIGN: Individual trials were double-blind, randomized, multiple crossover trials. The impact of n-of-1 trials was determined by eliciting physicians' plans of management and confidence in those plans before and after each trial. SETTING: Referral service doing n-of-1 trials at the requests of community and academic physicians. OBJECT of ANALYSIS: All trials were planned, started, and completed by the n-of-1 service. MEASURES of OUTCOME: The proportion of planned n-of-1 trials that were completed and the proportion that provided a definite clinical or statistical answer. A definite clinical answer was achieved if an n-of-1 trial resulted in a high level of physician's confidence in the management plan. Specific criteria were developed for classifying an n-of-1 trial as providing a definite statistical answer. MAIN RESULTS: Seventy-three n-of-1 trials were planned in various clinical situations. Of 70 n-of-1 trials begun, 57 were completed. The reasons for not completing n-of-1 trials were patients' or physicians' noncompliance or patients' concurrent illness. Of 57 n-of-1 trials completed, 50 provided a definite clinical or statistical answer. In 15 trials (39% of trials in which appropriate data were available), the results prompted physicians to change their "prior to the trial" plan of management (in 11 trials, the physicians stopped the drug therapy that they had planned to continue indefinitely). CONCLUSION: We interpret the results as supporting the feasibility and usefulness of n-of-1 trials in clinical practice.
1990
Guyatt GH; Keller JL; Jaeschke R; Rosenbloom D; Adachi JD; Newhouse MT
Annals Of Internal Medicine
1990
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.7326/0003-4819-112-4-293" target="_blank" rel="noreferrer">10.7326/0003-4819-112-4-293</a>