Expanding the Grading of Recommendations Assessment, Development, and Evaluation (Ex-GRADE) for Evidence-Based Clinical Recommendations: Validation Study

Clinicians use general practice guidelines as a source of support for their intervention, but how much confidence should they place on these recommendations? How much confidence should patients place on these recommendations? Various instruments are available to assess the quality of evidence of research, such as the revised Wong scale (R-Wong) which examines the quality of research design, methodology and data analysis, and the revision of the assessment of multiple systematic reviews (R-AMSTAR), which examines the quality of systematic reviews

Breast and Cervical Cancer Screening among US and non US Born African American Muslim Women in New York City

Health disparities related to breast and cervical cancer among African American and African-born Muslim women in the United States have been identified in previous literature. Our study aimed at exploring the breast and cervical screening rates and factors that influence this population’s disposition to adhere to cancer screening exams. Methods: Mixed methods were used to collect data with African American and African-born Muslim women in New York City. Data were collected from a total of 140 women; among them, 40 participated in four focus groups. Findings: Focus groups revealed nine themes: healthcare practices; lack of knowledge/misconceptions; negative perceptions and fear; time; modesty; role of religion; role of men; role of community; stigma and shame. Among 130 women who reported their cancer screening status, 72.3% of those age 21 and over were adherent to cervical cancer screening; 20.0% never had a Pap test. Among women age 40 and over, 80.2% reported adherence to recommended mammogram; 12.8% never had one. Among women under age 40, 52.2% had their last clinical breast exam (CBE) less than three years ago. Among women age 40 and over, 75.0% were adherent to yearly CBE. Conclusions: While rates of screenings were above the national average and higher than expected, specific barriers and facilitators related to religious and health beliefs and attitudes that influence the decision to adhere to screening were revealed. These factors should be further explored and addressed to inform future research and strategies for promoting regular breast and cervical cancer screenings

Expanding the Grading of Recommendations Assessment, Development, and Evaluation (Ex-GRADE) for Evidence-Based Clinical Recommendations: Validation Study.

Clinicians use general practice guidelines as a source of support for their intervention, but how much confidence should they place on these recommendations? How much confidence should patients place on these recommendations? Various instruments are available to assess the quality of evidence of research, such as the revised Wong scale (R-Wong) which examines the quality of research design, methodology and data analysis, and the revision of the assessment of multiple systematic reviews (R-AMSTAR), which examines the quality of systematic reviews.The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) Working Group developed an instrument called the GRADE system in order to grade the quality of the evidence in studies and to evaluate the strength of recommendation of the intervention that is proposed in the published article. The GRADE looks at four factors to determine the quality of the evidence: study design, study quality, consistency, and directness. After combining the four components and assessing the grade of the evidence, the strength of recommendation of the intervention is established. The GRADE, however, only makes a qualitative assessment of the evidence and does not generate quantifiable data.In this study, we have quantified both the grading of the quality of evidence and also the strength of recommendation of the original GRADE, hence expanding the GRADE. This expansion of the GRADE (Ex-GRADE) permits the creation of a new instrument that can produce tangible data and possibly bridge the gap between evidence-based research and evidence-based clinical practice