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Rating the quality of evidence and the strength of recommendations using GRADE

World Journal of Urology volume 29, pages 311–317 (2011)Cite this article

Abstract

Objectives

Urologists can benefit from a standardized system for guideline development and presentation. This article introduces the GRADE system and explains how it may be useful for Urologic physicians, in their practice and in their healthcare systems.

Methods

The GRADE system is reviewed. Specific aspects of how GRADE rates the quality of the evidence and the strength of recommendations are explored.

Results

GRADE can provide explicit and structured guidance, which separates the quality of evidence from the strength of recommendations. This information can be used by consumers of guidelines, including patients, physicians, and policy makers.

Conclusions

Urologists can benefit from a more transparent and rigorous framework when formulating recommendations. GRADE is an emergent proposal with broader implications for healthcare policy as well.

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Fig. 1

References

  1. Scottish Intercollegiate Guidelines Network (2008) SIGN 50: a guideline developer’s handbook. Scottish Intercollegiate Guidelines Network, Guideline no. 50

  2. Scottish Intercollegiate Guidelines Network (2004) Management of urinary incontinence in primary care. Scottish Intercollegiate Guidelines Network, Guideline no. 79

  3. Winn RJ, McClure JS (2003) The NCCN clinical practice guidelines in oncology (NCCN Guidelines™) NCCN Senior Vice President, Clinical Information & Publications

  4. NCCN Guidelines Prostate Cancer (2010) National comprehensive cancer network, Version 1.2011

  5. Heidenreich A, Aus G, Bolla M et al (2008) EAU guidelines on prostate cancer. Eur Urol 53:68

    Article  PubMed  Google Scholar 

  6. Thuroff JW, Abrams P, Andersson KE et al (2011) EAU guidelines on urinary incontinence. European urol 59(3):387–400

    Google Scholar 

  7. Guyatt GH, Oxman AD, Vist G et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Bmj 336:924

    Article  PubMed  Google Scholar 

  8. Schunemann HJ, Oxman AD, Brozek J et al (2008) Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. Bmj 336:1106

    Article  PubMed  Google Scholar 

  9. Guyatt GH, Oxman AD, Kunz R et al (2008) What is “quality of evidence” and why is it important to clinicians? Bmj 336:995

    Article  PubMed  Google Scholar 

  10. Guyatt GH, Oxman AD, Kunz R et al (2008) Incorporating considerations of resources use into grading recommendations. Bmj 336:1170

    Article  PubMed  Google Scholar 

  11. Guyatt GH, Oxman AD, Kunz R et al (2008) Going from evidence to recommendations. Bmj 336:1049

    Article  PubMed  Google Scholar 

  12. http://www.gradeworkinggroup.org

  13. Oxman AD, Guyatt GH (1988) Guidelines for reading literature reviews. CMAJ 138:697

    PubMed  CAS  Google Scholar 

  14. Seitz C, Liatsikos E, Porpiglia F et al (2009) Medical therapy to facilitate the passage of stones: what is the evidence? Eur Urol 56:455

    Article  PubMed  Google Scholar 

  15. Hollingsworth JM, Zhang Y, Krein SL et al (2010) Understanding the variation in treatment intensity among patients with early stage bladder cancer. Cancer 116:3587

    Article  PubMed  Google Scholar 

  16. Wolf JS Jr, Bennett CJ, Dmochowski RR et al (2008) Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol 179:1379

    Article  PubMed  Google Scholar 

  17. Feldman DR, Bosl GJ, Sheinfeld J et al (2008) Medical treatment of advanced testicular cancer. JAMA 299:672

    Article  PubMed  CAS  Google Scholar 

  18. Meek PD, Evang SD, Tadrous M et al (2011) Overactive bladder drugs and constipation: a meta-analysis of randomized, placebo-controlled trials. Dig Dis Sci 56(1):7–18

    Google Scholar 

  19. Canfield SE, Dahm P (2010) Evidence-based urology in practice: incorporating patient values in evidence-based clinical decision making. BJU Int 105:4

    Article  PubMed  Google Scholar 

  20. Herrmann TR, Merseburger AS, Burchardt M (2009) Considerations on prostate cancer: diagnosis and treatment decisions. World J Urol 27:579

    Article  PubMed  Google Scholar 

  21. Hunter KF, Glazener CM, Moore KN (2007) Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev (2):CD001843

  22. Kantoff PW, Higano CS, Shore ND et al (2010) Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med 363:411

    Article  PubMed  CAS  Google Scholar 

  23. Preminger GM, Tiselius HG, Assimos DG et al (2007) Guideline for the management of ureteral calculi. J Urol 178:2418

    Article  PubMed  Google Scholar 

  24. Emanuel EJ (1996) Cost savings at the end of life. What do the data show? JAMA 275:1907

    Article  PubMed  CAS  Google Scholar 

  25. Seitz C, Liatsikos E, Porpiglia F et al (2009) Medical therapy to facilitate the passage of stones: what is the evidence? Eur Urol 56:455

    Article  PubMed  Google Scholar 

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Acknowledgments

This article relies heavily on the landmark series published in the British Medical Journal by the GRADE working group.

Conflict of interest

Dr. Dahm is a member of the GRADE working group.

Author information

Authors and Affiliations

  1. Division of Urology, UT Medical School at Houston, 6431 Fannin St. MSB 6.018, Houston, TX, 77030, USA

    Steven E. Canfield

  2. Department of Urology, College of Medicine, University of Florida, Gainesville, FL, USA

    Philipp Dahm

Authors
  1. Steven E. Canfield
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  2. Philipp Dahm
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Corresponding author

Correspondence to Steven E. Canfield.

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Canfield, S.E., Dahm, P. Rating the quality of evidence and the strength of recommendations using GRADE. World J Urol 29, 311–317 (2011). https://doi.org/10.1007/s00345-011-0667-2

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  • DOI: https://doi.org/10.1007/s00345-011-0667-2

Keywords

  • Guidelines
  • Levels of evidence
  • Urology