The system of grading the quality of medical evidence and the strength of recommendations: development and present situation_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Wei , XU Ji ,  DENG Hongyong

TCM Health Service Collaborative Innovation Center, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R.China;

Corresponding author：

DENG Hongyong, Email: denghy@shutcm.edu.cn

Keywords：

Evidence; Quality; Grading; Evidence-based medicine

DOI：

10.7507/1672-2531.201907049

Video：

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Obtaining the best evidence is an important part of practicing evidence-based medicine. Evidence grading is an indispensable tool and process in helping decision makers obtain the best evidence. However, the current research evidence is numerous, the quality of evidence is uneven, the evidence classification system is diverse and the standards are different. By reviewing the development history and process of evidence grading and recommendation system, this paper analyzed representative grading recommendation systems with representative and international influence, and expounded the status quo, characteristics and development trend of evidence grading development, so as to provide a reference for the grading recommendation system exploration in contemporary medical field.

Citation： ZHANG Wei, XU Ji, DENG Hongyong. The system of grading the quality of medical evidence and the strength of recommendations: development and present situation. Chinese Journal of Evidence-Based Medicine, 2019, 19(11): 1373-1378. doi: 10.7507/1672-2531.201907049 Copy

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2.	陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
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18.	AAN. Clinical practice guideline process manual (2011 edition). MN: The American Academy of Neurology, 2011. Available at: http://tools.aan.com/globals/axon/assets/9023.pdf.
19.	Murad MH, Montori VM, Sidawy AN, et al. Guideline methodology of the Society for Vascular Surgery including the experience with the GRADE framework. J Vasc Surg, 2011, 53(5): 1375-1380.
20.	陈耀龙, 杨克虎, 姚亮, 等. GRADE 系统方法学进展. 中国循证儿科杂志, 2013, 8(1): 64-65.
21.	陈薇, 方赛男, 刘建平, 等. 国际循证医学证据分级体系的发展与现状. 中国中西医结合杂志, 2017, (12): 1413-1419.
22.	Lewin S, Glenton C, Munthe-Kaas H, et al. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med, 2015, 12(10): 1-18.
23.	陈昊, 曾宪涛, 谷万杰, 等. 更新版 Guideline Development Tool(GRADE pro GDT)在干预性临床实践指南制定中的应用. 中国循证医学杂志, 2018, (10): 1135-1142.
24.	肖淑君, 刘练, 柯立鑫, 等. GRADE 新版结果总结表简介及实例解读. 药品评价, 2018, 15(14): 3-7.
25.	World Health Organization. Increasing access to health workers in remote and rural areas through improved retention: Global policy recommendations. Geneva: World Health Organization, 2010.
26.	李伦, 孙甜甜, 田金徽, 等. GRADE 方法是否可以应用到病因学的系统评价中? 第七届亚太地区循证医学研讨会, 2012.
27.	陈昊, 王艳, 陈耀龙, 等. 从 GRADE 系统方法学看中医药临床证据体系的构建. 中华中医药杂志, 2017, 32(1): 25-28.
28.	Spencer FA, Iorio A, You J, et al. Uncertainties in baseline risk estimates and confidence in treatment effects. BMJ, 2012, 345(7885): e7401.
29.	陈薇, 方赛男, 刘建平. 基于证据体的中医药临床证据分级标准建议. 中国中西医结合杂志, 2019, 39(3): 358-364.

1. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011, 64(4): 383-394.
2. 陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
3. Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res, 2004, 4(1): 38.
4. Guyatt G, Gutterman D, Baumann MH, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American college of chest physicians task force. Chest, 2006, 129(1): 174-181.
5. Moran K. Acute pain management: operative or medical procedures and trauma. J Neurosci Nurs, 1993, 25(2): 130.
6. Berkman ND, Lohr KN, Ansari MT, et al. Grading the strength of a body of evidence when assessing health care interventions: an EPC update. J Clin Epidemiol, 2015, 68(11): 1312-1324.
7. Eccles M, Clapp Z, Grimshaw J, et al. North of England evidence based guidelines development project: methods of guideline development. BMJ, 1996, 312(7033): 760-762.
8. USPSTF. U. S. preventive services task force procedure manual. 2018. Available at: https://www.uspreventiveservicestaskforce.org/Page/Name/procedure-manual.
9. Glasziou PP, Irwig L, Bain CJ, et al. How to use the evidence: assessment and application of scientific evidence. Canberra: National Health & Medical Research Council, 2000.
10. SIGN 50: a guideline developer's handbook. Available at: https://www.sign.ac.uk/sign-50.html.
11. CEBM. Explanation of the 2011 OCEBM Levels of Evidence. Available at: https://www.cebm.net/2011/06/explanation-2011-ocebm-levels-evidence/.
12. SUNY downstate EBM Tutorial. Guide to research methods: the evidence pyramid. Available at: http://library.downstate.edu/EBM2/2100.htm.
13. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
14. Balshem H, Helfand M, SchBalshem HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol, 2011, 64(4): 401-406.
15. GRADEpro[computer program]. Version 3. 2 for Windows. 2008. Available at: https://gradepro.org/.
16. GRADE working group. GRADE home. Available at: http://www.gradeworkinggroup.org.
17. Harris JS, Weiss MS, Haas NS, et al. Methodology for ACOEM's Occupational Medicine Practice Guidelines-2017 Revision. J Occup Environ Med, 2017, 59(9): 913-919.
18. AAN. Clinical practice guideline process manual (2011 edition). MN: The American Academy of Neurology, 2011. Available at: http://tools.aan.com/globals/axon/assets/9023.pdf.
19. Murad MH, Montori VM, Sidawy AN, et al. Guideline methodology of the Society for Vascular Surgery including the experience with the GRADE framework. J Vasc Surg, 2011, 53(5): 1375-1380.
20. 陈耀龙, 杨克虎, 姚亮, 等. GRADE 系统方法学进展. 中国循证儿科杂志, 2013, 8(1): 64-65.
21. 陈薇, 方赛男, 刘建平, 等. 国际循证医学证据分级体系的发展与现状. 中国中西医结合杂志, 2017, (12): 1413-1419.
22. Lewin S, Glenton C, Munthe-Kaas H, et al. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med, 2015, 12(10): 1-18.
23. 陈昊, 曾宪涛, 谷万杰, 等. 更新版 Guideline Development Tool(GRADE pro GDT)在干预性临床实践指南制定中的应用. 中国循证医学杂志, 2018, (10): 1135-1142.
24. 肖淑君, 刘练, 柯立鑫, 等. GRADE 新版结果总结表简介及实例解读. 药品评价, 2018, 15(14): 3-7.
25. World Health Organization. Increasing access to health workers in remote and rural areas through improved retention: Global policy recommendations. Geneva: World Health Organization, 2010.
26. 李伦, 孙甜甜, 田金徽, 等. GRADE 方法是否可以应用到病因学的系统评价中? 第七届亚太地区循证医学研讨会, 2012.
27. 陈昊, 王艳, 陈耀龙, 等. 从 GRADE 系统方法学看中医药临床证据体系的构建. 中华中医药杂志, 2017, 32(1): 25-28.
28. Spencer FA, Iorio A, You J, et al. Uncertainties in baseline risk estimates and confidence in treatment effects. BMJ, 2012, 345(7885): e7401.
29. 陈薇, 方赛男, 刘建平. 基于证据体的中医药临床证据分级标准建议. 中国中西医结合杂志, 2019, 39(3): 358-364.

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