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Hwang, Kim, 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: Going from Evidence to Recommendations' (A Secondary Publication)
Editorial

Urogenit Tract Infect 2019;14(3):99-103.

Published online: 20 January 2019

DOI: https://doi.org/10.14777/uti.2019.14.3.99

Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: Going from Evidence to Recommendations' (A Secondary Publication)

Eu Chang Hwang, Do Kyung Kim1, 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, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea

1Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

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

3Department of Urology, Pusan National University Hospital, Busan, Korea

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

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

6Department of Urology, Yonsei University Wonju College of Medicine, 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 18 September 2019       Revised 18 September 2019       Accepted 18 September 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

This article is the third translation of a GRADE series published in the BMJ for developing and presenting recommendations for managing patients. The strength of a recommendation reflects the extent to which we can be confident that desirable effects of an intervention outweigh any undesirable effects. GRADE classifies the strength of recommendations as strong or weak. The strength of recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, quality of the evidence, variability in values and preferences, and the appropriate usage of resources.

References

1. Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, et al. GRADE Working Group. Going from evidence to recommendations. BMJ. 2008; 336:1049–51.
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2. Fleisher LA, Bass EB, McKeown P. American College of Chest Physicians. Methodological approach: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005; 128(2 Suppl):17–23S.
3. O'Connor AM, Stacey D, Entwistle V, Llewellyn-Thomas H, Rovner D, Holmes-Rovner M, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2003; 2:CD001431.
4. Geerts W, Ray JG, Colwell CW, Bergqvist D, Pineo GF, Lassen MR, et al. Prevention of venous thromboembolism. Chest. 2005; 128:3775–6.
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5. Devereaux PJ, Anderson DR, Gardner MJ, Putnam W, Flowerdew GJ, Brownell BF, et al. Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study. BMJ. 323:1218–22.
6. Schunemann HJ, Best D, Vist G, Oxman AD. GRADE Working Group. Letters, numbers, symbols and words: how to communicate grades of evidence and recommendations. CMAJ. 2003; 169:677–80.

Table 1.
Determinants of the strength of recommendation
Factor Comment
Balance between desirable and undesirable effects The larger the difference between the desirable and undesirable effects, the higher the likelihood that a strong recommendation is warranted. The narrower the gradient, the higher the likelihood that a weak recommendation is warranted.
Quality of evidence The higher the quality of evidence, the higher the likelihood that a strong recommendation is warranted.
Values and preferences The more values and preferences vary, or the greater the uncertainty in values and preferences, the higher the likelihood that a weak recommendation is warranted.
Costs (resource allocation) The higher the costs of an intervention, that is, the greater the resources consumed. then the lower the likelihood that a strong recommendation is warranted.

Adapted from the article of Guyatt et al. BMJ 2008;336:1049–51 [1].

Table 2.
Representations of quality of evidence and the strength of recommendations
Quality of evidence
High quality ⊕⊕⊕⊕ or A
Moderate quality ⊕⊕⊕○ or B
Low quality ⊕⊕○○ or C
Very low quality ⊕○○○ or D
Strength of recommendation
Strong recommendation for using an intervention ↑↑ or 1
Weak recommendation for using an intervention ↑ ? or 2
Weak recommendation against using an intervention ↓ ? or 2
Strong recommendation against using an intervention ↓↓ or 1

Adapted from the article of Guyatt et al. BMJ 2008;336::1049–51 [1].

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