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Kim, Hwang, Kang, Ku, Jung, Kim, Jung, and Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation: Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations' (A Secondary Publication)
Editorial

Urogenit Tract Infect 2019;14(1):28-32.

Published online: 20 April 2019

DOI: https://doi.org/10.14777/uti.2019.14.1.28

Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations' (A Secondary Publication)

Do Kyung Kim, Eu Chang Hwang1, Ho Won Kang2, Ja Yoon Ku3, Hyun Jin Jung4, Hong Wook Kim5, Jae Hung Jung6, 7, ; Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation

Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

1Department of Urology, Chonnam National University Medical School, Gwangju, Korea

2Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea

3Department of Urology, Pusan National University Hospital, Busan

4Department of Urology, Daegu Catholic University School of Medicine, Daegu, Korea

5Department of Urology, College of Medicine, Konyang University, Daejeon, Korea

6Department of Urology, Wonju, Korea

7Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to: Jae Hung Jung https://orcid.org/0000-0002-4990-7098 Department of Urology, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea Tel: +82-33-741-0652, Fax: +82-33-741-1930 E-mail: geneuro95@yonsei.ac.kr

Received 1 April 2019       Revised 9 April 2019       Accepted 9 April 2019

Copyright © 2019 Korean Association of Urogenital Tract Infection and Inflammation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Clinical practice guidelines are statements that include recommendations intended to optimize patient care based on a systematic review of the evidence assessing the benefits and harm of alternative care options. Guideline developers should use an explicit, judicious, and transparent methodology to make trustworthy guidelines. Although there are a variety of frameworks that can help translate enormous medical knowledge into recommendations, the most widely adopted tool for grading the quality of evidence and making recommendations is GRADE (Grading of Recommendations, Assessment, Development and Evaluations). This article is the first translation of a series published in the BMJ with regard to the GRADE Approach for Evidence Based Clinical Practice Guideline Development to provide informative knowledge for moving from evidence to recommendations to Korean guideline developers.

References

1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336:924–6.
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Table 1.
Advantages of GRADE over other systems
ㆍDeveloped by a widely representative group of international guideline developers
ㆍClear separation between the quality of evidence and strength of recommendations
ㆍExplicit evaluation of the importance of outcomes of alternative management strategies
ㆍExplicit, comprehensive criteria for downgrading and upgrading the quality of evidence ratings
ㆍTransparent process of moving from evidence to recommendations
ㆍExplicit acknowledgment of values and preferences
ㆍClear, pragmatic interpretation of strong versus weak recommendations for clinicians, patients, and policy makers
ㆍUseful for systematic reviews and health technology assessments, as well as guidelines

Adapted from the article of Guyatt et al. BMJ 2008;336:924–6 [1].

See also Appendix 1 (complete translate in Korean).

Table 2.
Quality of evidence and definitions
ㆍHigh quality—Further research is unlikely to change our confidence in the estimate of effect
ㆍModerate quality—Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
ㆍLow quality—Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
ㆍVery low quality—Any estimate of effect is very uncertain

Adapted from the article of Guyatt et al. BMJ 2008;336:924–6 [1].

See also Appendix 2 (complete translate in Korean).

Table 3.
Factors that affect the strength of a recommendation
Factor Examples of strong recommendations Examples of weak recommendations
Quality of evidence Many high quality randomized trials have shown the benefit of inhaled steroids in asthma Only case series have examined the utility of pleurodesis in pneumothorax
Uncertainty about the balance between desirable and undesirable effects Aspirin in myocardial infarction reduces mortality with minimal toxicity, inconvenience, and cost Warfarin in low risk patients with atrial fibrillation results in small stroke reduction but increases the bleeding risk and causes substantial inconvenience
Uncertainty or variability in values and preferences Young patients with lymphoma will invariably place a higher value on the life prolonging effects of chemotherapy than on the treatment toxicity Older patients with lymphoma may not place a higher value on the life prolonging effects of chemotherapy than on the treatment toxicity
Uncertainty about whether the intervention represents a wise use of resources The low cost of aspirin as a prophylaxis against stroke in patients with transient ischemic attacks The high cost of clopidogrel and of combination dipyridamole and aspirin as prophylaxis against stroke in patients with transient ischemic attacks

Adapted from the article of Guyatt et al. BMJ 2008;336:924–6 [1].

See also Appendix 3 (complete translate in Korean).

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