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Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines

BACKGROUND: A standardized systematic approach to grade evidence and the strength of recommendations is important for guideline users to minimize bias and help interpret the most suitable decisions at the point of care. The study aims to identify and classify determinants used to make judgement for...

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Autores principales: Shin, Ein-Soon, Jang, Ji-Eun, Yeon, Ji-Yun, Kim, Da-sol, Chang, Sung-Goo, Lee, Yoon-Seong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Medical Sciences 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809756/
https://www.ncbi.nlm.nih.gov/pubmed/29441759
http://dx.doi.org/10.3346/jkms.2018.33.e79
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author Shin, Ein-Soon
Jang, Ji-Eun
Yeon, Ji-Yun
Kim, Da-sol
Chang, Sung-Goo
Lee, Yoon-Seong
author_facet Shin, Ein-Soon
Jang, Ji-Eun
Yeon, Ji-Yun
Kim, Da-sol
Chang, Sung-Goo
Lee, Yoon-Seong
author_sort Shin, Ein-Soon
collection PubMed
description BACKGROUND: A standardized systematic approach to grade evidence and the strength of recommendations is important for guideline users to minimize bias and help interpret the most suitable decisions at the point of care. The study aims to identify and classify determinants used to make judgement for the strength of recommendations among 56 Korean clinical practice guidelines (CPGs), and explore strong recommendations based on low quality of evidence. METHODS: Determinants used in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach among 34 CPGs which have reported both strength of recommendations and level of evidence were reviewed. RESULTS: Five of 34 CPGs (14.7%) considered quality of evidence, benefits and harms, patients' values and preferences, and costs. And 24 of 34 CPGs (70.6%) considered both magnitude of effect and feasibility as additional determinants. Judgement table was not widely provided for use to translate evidence into recommendations. Eighty-two of 121 recommendations (67.8%, ranged 20.0% to 100.0%) among 11 CPGs using the same judgement scheme showed ‘strong’ strength of recommendations based on low or very low quality of evidence. Among 5 paradigmatic situations that justify strong recommendations based on low or very low evidence, situation classified as ‘potential equivalence, one option clearly less risky or costly’ was 87.8% for 82 strong recommendations. Situation classified as ‘uncertain benefit, certain harm’ was 4.9%. CONCLUSION: There is a need to introduce and systematize an evidence-based grading system. Using judgement table to justify the strength of recommendations and applying the 5 paradigmatic situations mentioned above is also recommended in the near future.
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spelling pubmed-58097562018-02-19 Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines Shin, Ein-Soon Jang, Ji-Eun Yeon, Ji-Yun Kim, Da-sol Chang, Sung-Goo Lee, Yoon-Seong J Korean Med Sci Original Article BACKGROUND: A standardized systematic approach to grade evidence and the strength of recommendations is important for guideline users to minimize bias and help interpret the most suitable decisions at the point of care. The study aims to identify and classify determinants used to make judgement for the strength of recommendations among 56 Korean clinical practice guidelines (CPGs), and explore strong recommendations based on low quality of evidence. METHODS: Determinants used in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach among 34 CPGs which have reported both strength of recommendations and level of evidence were reviewed. RESULTS: Five of 34 CPGs (14.7%) considered quality of evidence, benefits and harms, patients' values and preferences, and costs. And 24 of 34 CPGs (70.6%) considered both magnitude of effect and feasibility as additional determinants. Judgement table was not widely provided for use to translate evidence into recommendations. Eighty-two of 121 recommendations (67.8%, ranged 20.0% to 100.0%) among 11 CPGs using the same judgement scheme showed ‘strong’ strength of recommendations based on low or very low quality of evidence. Among 5 paradigmatic situations that justify strong recommendations based on low or very low evidence, situation classified as ‘potential equivalence, one option clearly less risky or costly’ was 87.8% for 82 strong recommendations. Situation classified as ‘uncertain benefit, certain harm’ was 4.9%. CONCLUSION: There is a need to introduce and systematize an evidence-based grading system. Using judgement table to justify the strength of recommendations and applying the 5 paradigmatic situations mentioned above is also recommended in the near future. The Korean Academy of Medical Sciences 2018-01-30 /pmc/articles/PMC5809756/ /pubmed/29441759 http://dx.doi.org/10.3346/jkms.2018.33.e79 Text en © 2018 The Korean Academy of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Shin, Ein-Soon
Jang, Ji-Eun
Yeon, Ji-Yun
Kim, Da-sol
Chang, Sung-Goo
Lee, Yoon-Seong
Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines
title Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines
title_full Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines
title_fullStr Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines
title_full_unstemmed Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines
title_short Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines
title_sort determinants used to justify the strength of recommendations among korean clinical practice guidelines
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809756/
https://www.ncbi.nlm.nih.gov/pubmed/29441759
http://dx.doi.org/10.3346/jkms.2018.33.e79
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