核心级别7:从证据转向建议和决定的原则
Gordon Guyatt1,2,3, Per Olav Vandvik3,4, Alfonso Iorio1,2
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
概括
核心GRADE方法通过权衡益与危害,考虑患者价值,并评估证据确定性来指导基于证据的建议. 强有力的建议需要明确的益处危害平衡和中等到高确定性的证据.
科学领域:
- 临床实践指南 临床实践指南
- 卫生政策发展卫生政策发展
- 基于证据的医学是基于证据的医学.
背景情况:
- 建议评估,开发和评价 (GRADE) 框架的分级对于将研究成果转化为临床实践和政策至关重要.
- 需要一个系统的方法,从证据评估转向可行的建议,考虑各种因素.
研究的目的:
- 介绍基于综合证据的核心GRADE方法论,用于制定基于综合证据的建议.
- 概述使用GRADE方法制定强烈建议与有条件建议的标准.
主要方法:
- 核心等级包括评估干预措施的理想与不理想后果的平衡.
- 关键考虑因素包括证据的确定性,患者的价值观和偏好,成本,可行性,可接受性和公平性.
- 确定结果的最小重要差异对于制定建议至关重要.
主要成果:
- 当理想的后果明显超过不理想的后果,证据确定性中等至高时,强有力的建议是最受欢迎的.
- 当平衡不太清楚或证据确定性较低时,就会提出有条件的建议.
- 建议明确说明所考虑的基本价值和偏好.
结论:
- 核心GRADE方法为证据转化为建议提供了一个结构化的方法.
- 患者价值观,证据确定性和上下文因素是强有力的推开发的组成部分.
- 该框架支持医疗保健中的知情决策.
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