Research Techniques Made Simple: Evaluating the Strength of Clinical Recommendations in the Medical Literature: GRADE, SORT, and AGREE Mayra Buainain de.

Slides:

Advertisements

Similar presentations

Evidence-based Dental Practice Developing guidelines or clinical recommendations Slide #1 This lecture follows the previous online lecture on evidence.

Advertisements

Katrina Abuabara, MD, MA1 Esther E Freeman MD, PhD2;

What is a review? An article which looks at a question or subject and seeks to summarise and bring together evidence on a health topic.

Grading the Strength of a Body of Evidence on Diagnostic Tests Prepared for: The Agency for Healthcare Research and Quality (AHRQ) Training Modules for.

Methods Chapter 2 Gillian Booth, Alice YY Cheng Canadian Diabetes Association 2013 Clinical Practice Guidelines.

Critical Appraisal of the Biomedical Literature Welcome June 2012 Peggy Edwards, AMLS TTUHSC - Preston Smith Library Lubbock, Texas

Critically Evaluating the Evidence: Tools for Appraisal Elizabeth A. Crabtree, MPH, PhD (c) Director of Evidence-Based Practice, Quality Management Assistant.

Grading of Recommendations Assessment, Development and Evaluation (GRADE) Methodology.

Clinical Policy / Practice Guideline Development Andy Jagoda, MD, FACEP Professor of Emergency Medicine Mount Sinai School of Medicine New York, New York.

Health care decision making Dr. Giampiero Favato presented at the University Program in Health Economics Ragusa, June 2008.

Module 6 Making a Case. Review Linde, 2005 Moderate improvements for mild or temp depression ONLY Table of Evidence # studies/part Study types Valid?

Chapter 7. Getting Closer: Grading the Literature and Evaluating the Strength of the Evidence.

Clinical Policy / Practice Guideline Development Andy Jagoda, MD, FACEP Professor of Emergency Medicine Mount Sinai School of Medicine New York, New York.

By Dr. Ahmed Mostafa Assist. Prof. of anesthesia & I.C.U. Evidence-based medicine.

Clinical Practice Guidelines

From Evidence to EMS Practice: Building the National Model Eddy Lang, MD, CFPC (EM), CSPQ SMBD-Jewish General Hospital, McGill University Montreal, Canada.

Critical Appraisal of Clinical Practice Guidelines

Illustrating the GRADE Methodology: The Cather Associated-UTI Case Study TEACH Level II Workshop 5 NYAM August 9 th, 2013 Craig A Umscheid, MD, MSCE, FACP.

Dr.F Eslamipour DDS.MS Orthodontist Associated professor Department of Oral Public Health Isfahan University of Medical Science.

U.S. Department of Agriculture Center for Nutrition Policy and Promotion Slides provided by the USDA Center for Nutrition Policy and Promotion.

COMPREHENSIVE SEARCH Literature searched: List of established guideline websites, list of specialty websites related to the topic, Google, Ovid MEDLINE,

Applicability of the AGREE II Instrument in Evaluating the Development Process and Quality of Current National Academy of Clinical Biochemistry Guidelines.

Brief summary of the GRADE framework Holger Schünemann, MD, PhD Chair and Professor, Department of Clinical Epidemiology & Biostatistics Professor of Medicine.

Best Practices: Standing on the Shoulders of Giants? Ronnie Detrich Wing Institute.

Evidence-Based Public Health Nancy Allee, MLS, MPH University of Michigan November 6, 2004.

Introduction To Evidence Based Nursing By Dr. Hanan Said Ali.

TIGER Standards & Interoperability Collaborative

This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator.

Plymouth Health Community NICE Guidance Implementation Group Workshop Two: Debriding agents and specialist wound care clinics. Pressure ulcer risk assessment.

TEACH LEVEL II: CLINICAL POLICIES AND GUIDELINES STREAM Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiology Director, Center.

Systematic Review Module 11: Grading Strength of Evidence Interactive Quiz Kathleen N. Lohr, PhD Distinguished Fellow RTI International.

September 16, 2010 Larissa J. Lucas, MD Senior Deputy Editor, DynaMed.

BMH CLINICAL GUIDELINES IN EUROPE. OUTLINE Background to the project Objectives The AGREE Instrument: validation process and results Outcomes.

Evidence Based Practice RCS /9/05. Definitions  Rosenthal and Donald (1996) defined evidence-based medicine as a process of turning clinical problems.

Appraisal of Guidelines for Research & Evaluation Using the AGREE¹ Instrument CAN-IMPLEMENT Toolkit Version 1.0 April 2010 Modified from:

Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b This material (Comp1_Unit9b) was developed.

Research Techniques Made Simple: Validation of Outcome Measures in Dermatology Kate V. Viola, MD, MHS 1 Tamar Nijsten, MD, PhD 2 Karthik Krishnamurthy,

WHO GUIDANCE FOR THE DEVELOPMENT OF EVIDENCE-BASED VACCINE RELATED RECOMMENDATIONS August 2011.

Adapting Guidelines for Local Implementation: Fusion Cuisine or Fast Food Leftovers Eddy Lang MDCM CCFP(EM) Head Department of Emergency Medicine Senior.

Implementing a new drug or technique (APA Cambridge 21. June 2013) Tom G. Hansen, MD, PhD, Department of Anaesthesia & Intensive Care Odense University.

RARE BEST PRACTICES COURSE ROMA (Feb ) Euro-HSP Madrid 2015 May 30 Jean Bénard May 31, GA 2015 Madrid.

Is the conscientious explicit and judicious use of current best evidence in making decision about the care of the individual patient (Dr. David Sackett)

Welcome to Inspire! Michael Fleming, MD, FAAFP Senior Medical Editor Antidote Education Company.

Developing evidence-based guidelines at WHO. Evidence-based guidelines at WHO | January 17, |2 |

Guidelines Recommandations. Role Ideal mediator for bridging between research findings and actual clinical practice Ideal tool for professionals, managers,

EBM --- Journal Reading Presenter ：葉麗雯 Date ： 2005/10/27.

Research Design Evidence Based Medicine Concepts and Glossary.

GDG Meeting Wednesday November 9, :30 – 11:30 am.

GRADE Grading of Recommendations Assessment, Development and Evaluation British Association of Dermatologists April 2014.

Evidence-Based Medicine: A Basic Primer Kevin Bradford, M.L.S. Clinical Information Librarian Instructor Medical College of Georgia April 2007.

The Use of the Canadian C-Spine Rule to Reduce the Rates of Unnecessary Radiography in Alert Stable Patients With Trauma Shannon Goddard Pacific University.

Clinical Practice Guidelines: Can we fix Babel? Eddy Lang Department Chair, Emergency Alberta Health Services Associate Professor University of Calgary.

Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 10 Evidence-Based Practice Sharon E. Lock.

Standards for Developing Trustworthy Clinical Practice Guidelines Standards for Developing Trustworthy Clinical Practice Guidelines Institute of Medicine.

“Look-up Conference” A Learner-driven Resident Conference Format Timothy N. Stephens, MD Allen F. Shaughnessy, PharmD Tufts University Family Medicine.

Approach to guideline development

Building an Evidence-Based Nursing Practice

HelpDesk Answers Evaluating the Evidence (Strength of Recommendations)

Critically Appraising a Medical Journal Article

ACOEM Council on Education and Academic Affairs

Conflicts of interest Major role in development of GRADE

Evidence-Based Practice I: Definition – What is it?

Overview of the GRADE approach – selected slides

Clinical Study Results Publication

Box 3. Steps in the development of the revised 2010 Kenyan pediatric treatment guidelines 1. Establishment of guideline development group / evidence summary.

Adapted from a presentation at the Rwanda First National Workshop on

What is a review? An article which looks at a question or subject and seeks to summarise and bring together evidence on a health topic. Ask What is a review?

Evaluating the Strength of Clinical Recommendations in the Medical Literature: GRADE, SORT, and AGREE Mayra Buainain de Castro Maymone, Stephanie D.

Evidence-Based Public Health

Integrating evidence quality appraisal with an assessment of the anticipated balance between benefits and harms leads to designation of a policy as a strong.

Presentation transcript:

Research Techniques Made Simple: Evaluating the Strength of Clinical Recommendations in the Medical Literature: GRADE, SORT, and AGREE Mayra Buainain de Castro Maymone1, Stephanie D. Gan1, Michael Bigby2 1Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts, USA 2Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Adopted by more than 65 organizations worldwide as an international standard for guideline development Explicitly evaluates relevant outcomes and considers risks, benefits, patient expectations, and resource utilization in reaching recommendations

4. Trade-off between benefits and risks The GRADE Process 1. Framing the questions Using PICO (patient/intervention/comparator/outcome) 2. Treatment effects Summary of best available evidence, focusing on critical outcomes 3. Quality of evidence Assessment of confidence in the estimate of treatment effect 4. Trade-off between benefits and risks (values and preferences) 5. Recommendation (estimate of effect, confidence estimate, and patient perspective) Adapted with permission from Journal of Thrombosis and Haemostasis (Guyatt et al., 2013)

Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Quality of the evidence Strength of Recommendation Strong: benefits outweigh risks of the intervention Weak: most informed people would choose this recommendation, but a substantial number would not High Moderate Low Very Low

Strength of Recommendation Taxonomy (SORT) Simple and easily applied by authors and physicians Advocates the use of patient-oriented over disease-oriented outcomes Adopted by the American Academy of Dermatology

Strength of Recommendation Taxonomy (SORT) Quality of the Evidence A= Based on consistent and good-quality patient- oriented evidence B= Based on inconsistent or limited-quality patient-oriented evidence C= Based on consensus, usual practice, opinion, disease-oriented evidence or case series Level 1: good quality Level 2: limited quality Level 3: others

AGREE Validated instrument that assesses the quality of guidelines development Assesses 6 domains in guideline development: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence Uses a 4-point numerical scoring system, ranging from 1 (strongly disagree) to 4 (strongly agree). Scores reflecting inadequate quality are assigned a score ≤2.

GRADE, SORT, and AGREE GRADE and SORT are two methods of evaluating a body of evidence and the quality of studies to create a comprehensive recommendation The AGREE instrument is a validated quantitative scoring method created to systematically assess the quality of practice guidelines

Limitations of GRADE, SORT, and AGREE GRADE is complicated and requires an expertise in statistics SORT is an overly simplified instrument that is not applied internationally AGREE has no set minimum domain scores to differentiate high- versus poor-quality guidelines