Do Kyung Kim; Eu Chang Hwang; Ho Won Kang; Ja Yoon Ku; Hyun Jin Jung; Hong Wook Kim; Jae Hung Jung

doi:10.14777/uti.2019.14.1.28

Journal List > Urogenit Tract Infect > v.14(1) > 1124663

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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 Jung^6,^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

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.

Go to :

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.

2. Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S, et al. GRADE Working Group. 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; 4:38.

3. Lacchetti C, Guyatt G. Therapy and validity: surprising results of randomized controlled trials. Guyatt G, Rennie D, editors. editors.Users' guides to the medical literature: a manual for evidencebased clinical practice. Chicago: American Medical Association;2002.

4. American College of Physicians. Guidelines for counseling postmenopausal women about preventive hormone therapy. Ann Intern Med. 1992; 117:1038–41.

5. Humphrey LL, Chan BK, Sox HC. Postmenopausal hormone replacement therapy and the primary prevention of cardiovascular disease. Ann Intern Med. 2002; 137:273–84.

6. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998; 280:605–13.

7. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002; 288:321–33.

8. Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991; 324:781–8.

9. Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of metaanalyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA. 1992; 268:240–8.

Go to :

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).

TOOLS

Similar articles