1. American College of Chest Physicians (ACCP) Health and Science Policy Committee Orientation Program Part #4 Grading and Wording of Recommendations

2. Development of an Evidence-Based Guideline Formatting Recommendations Phrase it as a firm recommendation not a factual statement about the service and not a matrix or table Factual statements and supporting arguments belong in the textual discussion that precedes the recommendation Grading and writing recommendations

3. Development of an Evidence-Based Guideline The grading of the recommendation should appear at the end of the recommendation and should not appear bolded Grading and writing recommendations Always begin with the appropriate patient population, inclusive of any limiting factors Formatting Recommendations Propose the suggested service, test, therapy, procedure, etc Recommendations should be in bold print Patients with pulmonary arterial hypertension in functional class IV who are not candidates for, or who have failed, calcium channel blocker therapy, are candidates for long-term therapy with intravenous epoprostenol (treatment of choice). Grade of recommendation: 1A

4. Quality In keeping with the precepts of using evidence-based medicine in clinical decision making, the following grades are currently used by the HSP Committee when evaluating the evidence Development of an Evidence-Based Guideline Grading and writing recommendations HighRCTs without important limitations or overwhelming evidence from observational studies ModerateRCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies Low or Very LowObservational studies or case series

5. Net Benefit Benefit is assessed as follows: Development of an Evidence-Based Guideline Grading and writing recommendations

6. Strength of Recommendation Development of an Evidence-Based Guideline Grading and writing recommendations

7. The strength of the recommendation is composed of quality and net benefit Development of an Evidence-Based Guideline Grading and writing recommendations