• GRADE guidelines – best practices using the GRADE framework

    by Alan Batt. Last modified: 22/11/14

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    The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) Working Group began in the year 2000 as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health care. The working group has developed a common, sensible and transparent approach to grading quality of evidence and strength of recommendations.

    The 2011 JCE series provides a 20-part guide for systematic review and health technology assessment authors, guideline panelists and methodologists on how to apply the GRADE methodology framework in more detail. Clinicians and policy-making users and anyone new to GRADE may want to consider first reading the 6-part BMJ series from 2008.

    The links have been updated to provide free access to the full text and pdf through the JCE home page.

    JCE Series 2011

    1. Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knotterus A.
      GRADE guidelines: A new series of articles in the Journal of Clinical Epidemiology.
      J Clin Epidemiol. 2010 Dec 27
    2. Guyatt G, Oxman AD, Akl E, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, Debeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schünemann HJ.
      GRADE guidelines 1. Introduction-GRADE evidence profiles and summary of findings tables.
      J Clin Epidemiol. 2011 Jan 3
    3. Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G, Alderson P, Glasziou P, Falck-Ytter Y, Schunemann HJ.
      GRADE guidelines 2. Framing the question and deciding on important outcomes.
      J Clin Epidemiol. 2011 Jan 3
    4. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH.
      GRADE guidelines 3: rating the quality of evidence – introduction.
      J Clin Epidemiol. 2011 Jan 6
    5. Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, Montori V, Akl EA, Djulbegovic B, Falck-Ytter Y, Norris SL, Williams JW Jr, Atkins D, Meerpohl J, Schünemann HJ..
      GRADE guidelines 4: rating the quality of evidence – risk of bias.
      J Clin Epidemiol. 2011 Jan 20
    6. Guyatt GH, Oxman AD, Montori V, Vist G, Kunz R, Brozek J, Alonso-Coello P, Djulbegovic B, Atkins D, Falck-Ytter Y, Williams JW Jr, Meerpohl J, Norris SL, Akl EA, Schünemann HJ.
      GRADE guidelines 5: rating the quality of evidence – publication bias.
      J Clin Epidemiol. 2011 Aug 1
    7. Guyatt G, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, Devereaux P, Montori VM, Freyschuss B, Vist G, Jaeschke R, Williams JW Jr, Murad MH, Sinclair D, Falck-Ytter Y, Meerpohl J, Whittington C, Thorlund K, Andrews J, Schünemann HJ.
      GRADE guidelines 6. Rating the quality of evidence – imprecision. 
      J Clin Epidemiol. 2011 Aug 12
    8. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, Alonso-Coello P, Glasziou P, Jaeschke R, Akl EA, Norris S, Vist G, Dahm P, Shukla VK, Higgins J, Falck-Ytter Y, Schünemann HJ; The GRADE Working Group.
      GRADE guidelines: 7. Rating the quality of evidence – inconsistency.
      J Clin Epidemiol. 2011 Aug 2
    9. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, Alonso-Coello P, Falck-Ytter Y, Jaeschke R, Vist G, Akl EA, Post PN, Norris S, Meerpohl J, Shukla VK, Nasser M, Schünemann HJ; The GRADE Working Group.
      GRADE guidelines: 8. Rating the quality of evidence – indirectness.
      J Clin Epidemiol. 2011 Aug 1
    10. Guyatt GH, Oxman AD, Sultan S, Glasziou P, Akl EA, Alonso-Coello P, Atkins D, Kunz R, Brozek J, Montori V, Jaeschke R, Rind D, Dahm P, Meerpohl J, Vist G, Berliner E, Norris S, Falck-Ytter Y, Murad MH, Schünemann HJ; The GRADE Working Group.
      GRADE guidelines: 9. Rating up the quality of evidence.
      J Clin Epidemiol. 2011 Aug 1
    11. Brunetti M, Shemilt I, et al.; The GRADE Working.
      GRADE guidelines: 10. Rating the quality of evidence for resource use.
      J Clin Epidemiology [publication – upcoming]
    12. Guyatt G, Oxman AD, Sultan S, Brozek J, Glasziou P, Alonso-Coello P, Atkins D, Kunz R, Montori V, Jaeschke R, Rind D, Dahm P, Akl EA, Meerpohl J, Vist G, Berliner E, Norris S, Falck-Ytter Y, Schünemann HJ.
      GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes.
      J Clin Epidemiol. 2012 Apr 30.
    13. Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, Brozek J, Norris S, Meerpohl J, Djulbecovic B, Alonso-Coello P, Post PN, Busse JW, Glasziou P, Christensen R, Schünemann HJ.
      GRADE guidelines 12. Preparing Summary of Findings tables-binary outcomes.
      J Clin Epidemiol. 2012 May 18.
    14. Thorlund K, Oxman AD, Walter SD, Patrick D, Furukawa TA, Johnston BC, Karanicolas P, Akl EA, Vist G, Kunz R, Brozek J, Kupper LL, Martin SL, Meerpohl JJ, Alonso-Coello P, Christensen R, Schunemann HJ.
      GRADE guidelines 13. Preparing Summary of Findings tables-continuous outcomes.
      J Clin Epidemiology 2013 Feb;66(2):173-83
    15. [to follow]
    16. Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y, Nasser M, Meerpohl J, Post PN, Kunz R, Brozek J, Vist G, Rind D, Akl EA, Schünemann HJ.
      GRADE guidelines: 15. Going from evidence to recommendations: the significance and presentation of recommendations.
      J Clin Epidemiol. 2013 Jan 9 

     

    BMJ Series

    1. Guyatt GH, Oxman AD, Vist G, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, for the GRADE Working Group.
      Rating quality of evidence and strength of recommendations GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
      BMJ 2008;336:924-926 or [pdf]
    2. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ; GRADE Working Group.
      Rating quality of evidence and strength of recommendations: What is “quality of evidence” and why is it important to clinicians?
      BMJ. 2008 May 3;336(7651):995-8
    3. Schünemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, Williams JW Jr, Kunz R, Craig J, Montori VM, Bossuyt P, Guyatt GH; GRADE Working Group.
      Grading quality of evidence and strength of recommendations for diagnostic tests and strategies.
      BMJ. 2008 May 17;336(7653):1106-10
    4. Guyatt GH, Oxman AD, Kunz R, Jaeschke R, Helfand M, Liberati A, Vist GE, Schünemann HJ; GRADE working group.
      Rating quality of evidence and strength of recommendations: Incorporating considerations of resources use into grading recommendations.
      BMJ. 2008 May 24;336(7654):1170-3
    5. Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schünemann HJ; GRADE Working Group.
      Rating quality of evidence and strength of recommendations: Going from evidence to recommendations.
      BMJ. 2008 May 10;336(7652):1049-51
    6. Jaeschke R, Guyatt GH, Dellinger P, Schünemann H, Levy MM, Kunz R, Norris S, Bion J; GRADE working group.
      Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive.
      BMJ. 2008 Jul 31;337:a744

    Links from the GRADE Working Group website – http://www.gradeworkinggroup.org/

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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