UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey.
UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey.
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DOI：
10.1136/bmjopen-2017-018593
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发表时间：
2017-11-16
期刊：
影响因子：
2.9
通讯作者：
Guyatt GH
中科院分区：
文献类型：
--
作者：
Agoritsas T;Merglen A;Heen AF;Kristiansen A;Neumann I;Brito JP;Brignardello-Petersen R;Alexander PE;Rind DM;Vandvik PO;Guyatt GH
UpToDate被世界各地的临床医生广泛使用，包括9400多条建议，这些建议适用于建议评估、开发和评估（GRADE）框架。GRADE指南警告，当证据的确定性低或非常低时（不一致的建议），不要提出强烈的建议，但已经确定了五种范例情况，在这些情况下，不一致的建议可能是合理的。我们的目标是记录UpToDate中建议的强度，并评估不一致建议的频率和适当性。对UpToDate中的所有建议进行分析调查。我们确定了UpToDate中的所有GRADE建议，并检查了它们的强度（强或弱）和证据的确定性（高、中或低确定性）。截至2015年1月，我们确定了所有不一致的建议，并根据UpToDate中提供的证据，将其独立分类为五个适当范例之一或与GRADE指南不一致的三个类别之一。UpToDate包含9451条GRADE建议，其中6501条（68.8%）为弱建议，2950条（31.2%）为强建议。其中，844份（28.6%）基于效果估计的高度确定性，1740份（59.0%）基于中度确定性，366份（12.4%）基于低确定性。在349项不一致的建议中，204项（58.5%）被认为是适当的（与五种范式之一一致）;我们将47项（13.5%）归类为良好实践声明; 38项（10.9%）将证据错误归类为低确定性，当它至少是中等时，60项（17.2%）需要弱而不是强的建议。UpToDate中不一致建议的比例很小（占所有建议的3.7%），真正有问题的比例（最好是弱的强建议）非常小（0.6%）。然而，临床医生应该谨慎，并在UpToDate和其他地方寻找明确的解释，当指南基于低确定性证据提供强有力的建议时。
UpToDate is widely used by clinicians worldwide and includes more than 9400 recommendations that apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. GRADE guidance warns against strong recommendations when certainty of the evidence is low or very low (discordant recommendations) but has identified five paradigmatic situations in which discordant recommendations may be justified. Our objective was to document the strength of recommendations in UpToDate and assess the frequency and appropriateness of discordant recommendations. Analytical survey of all recommendations in UpToDate. We identified all GRADE recommendations in UpToDate and examined their strength (strong or weak) and certainty of the evidence (high, moderate or low certainty). We identified all discordant recommendations as of January 2015, and pairs of reviewers independently classified them either into one of the five appropriate paradigms or into one of three categories inconsistent with GRADE guidance, based on the evidence presented in UpToDate. UpToDate included 9451 GRADE recommendations, of which 6501 (68.8%) were formulated as weak recommendations and 2950 (31.2%) as strong. Among the strong, 844 (28.6%) were based on high certainty in effect estimates, 1740 (59.0%) on moderate certainty and 366 (12.4%) on low certainty. Of the 349 discordant recommendations 204 (58.5%) were judged appropriately (consistent with one of the five paradigms); we classified 47 (13.5%) as good practice statements; 38 (10.9%) misclassified the evidence as low certainty when it was at least moderate and 60 (17.2%) warranted a weak rather than a strong recommendation. The proportion of discordant recommendations in UpToDate is small (3.7% of all recommendations) and the proportion that is truly problematic (strong recommendations that would best have been weak) is very small (0.6%). Clinicians should nevertheless be cautious and look for clear explanations—in UpToDate and elsewhere—when guidelines offer strong recommendations based on low certainty evidence.
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影响因子：
7.2
作者：
Alexander, Paul E.;Li, Shelly-Anne;Guyatt, Gordon H.
通讯作者：
Guyatt, Gordon H.
影响因子：
1.9
作者：
LANDIS, JR;KOCH, GG
通讯作者：
KOCH, GG
DOI：
10.1186/1748-5908-8-6
发表时间：
2013-01-09
期刊：
Implementation science : IS
影响因子：
--
作者：
Treweek S;Oxman AD;Alderson P;Bossuyt PM;Brandt L;Brożek J;Davoli M;Flottorp S;Harbour R;Hill S;Liberati A;Liira H;Schünemann HJ;Rosenbaum S;Thornton J;Vandvik PO;Alonso-Coello P;DECIDE Consortium
通讯作者：
DECIDE Consortium
影响因子：
9.6
作者：
Guyatt, Gordon H.;Norris, Susan L.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.
影响因子：
7.2
作者：
Guyatt, Gordon H.;Oxman, Andrew D.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.