Das GRADE-System: Ein internationaler Ansatz zur Vereinheitlichung der Graduierung von Evidenz und Empfehlungen in Leitlinien

Zusammenfassung: Leitlinien haben sich für Ärzte und Patienten zu einer wichtigen Stütze bei diagnostischen und therapeutischen Entscheidungen entwickelt. Um die aktuell verfügbaren methodischen Konzepte der Leitlinienentwicklung zu harmonisieren und die große Heterogenität und oft mangelnde Transparenz existierender Systeme zu überwinden, hat die GRADE (Grading of Recommendations, Assessment, Development and Evaluation) Working Group, eine internationale Kollaboration von Leitlinienentwicklern, Klinikern und Methodikern, die vorhandenen Konzepte weiterentwickelt. Zentrale Bestandteile des GRADE-Systems sind die Unterscheidung zwischen der Qualität der Evidenz und der Stärke einer Empfehlung, die gleichzeitige Betrachtung von Nutzen und Schaden einer Intervention, die Fokussierung auf patientenrelevante Endpunkte, die Abbildung von inhärenten Wertvorstellungen einer Empfehlung und die Integration von Überlegungen zum Ressourcenverbrauch. Unter Berücksichtigung dieser Kriterien werden mit dem GRADE-System starke und abgeschwächte Empfehlungen abgegeben. International befürworten zahlreiche Leitlinienorganisationen und medizinische Fachgesellschaften das System und haben es für die Erstellung der eigenen Leitlinien übernomme

From evidence to action. Understanding clinical practice guidelines.

Good guidelines will help us to take evidence into practice. In a survey among Dutch orthopedic surgeons, development and use of evidence-based guidelines was perceived as one of the best ways of moving from opinion-based to evidence-based orthopedic practice. The increasing number of guidelines means that knowing how to make a critical appraisal of guidelines is now a key part of every surgeon's life. This is particularly true because guidelines use varying systems to judge the quality of evidence and the strength of recommendations. In this manuscript we discuss what a guideline is, where we can find guidelines, how to evaluate the quality of guidelines, and finally provide an example on the different steps of guideline development. Thus, we show that good guidelines are a summary of the best available evidence and that they provide a graded recommendation to help surgeons in evidence-based practic

The Pandora's Box of Evidence Synthesis and the case for a living Evidence Synthesis Taxonomy.

Have we, as an evidence-based health community, opened the Pandora's box of evidence synthesis? There now exists a plethora of overlapping evidence synthesis approaches and duplicate, redundant and poor-quality reviews.1-4 After years of advocating for the need for systematic reviews of the evidence, there is a risk that this message been disseminated too widely and has been misinterpreted in this process. We have reached a point where in some fields more reviews exist than clinical trials, where same topic reviews are being conducted in parallel, and evidence syntheses possess limited utility for decision-making because of their poor quality or poor reporting.To paraphrase the late Douglas Altman,5 it is possible we are now at a stage where we need less reviews, better reviews and reviews done for the right reason - as opposed to the current state of mass production (approximately 80 reviews per day)6.Zachary Munn, Danielle Pollock, Timothy Hugh Barker, Jennifer Stone, Cindy Stern, Edoardo Aromataris, Holger J Schünemann, Barbara Clyne, Hanan Khalil, Reem A Mustafa, Christina Godfrey, Andrew Booth, Andrea C Tricco, Alan Pearso

ARIA-Versorgungspfade für die Allergenimmuntherapie 2019 = 2019 ARIA Care pathways for allergen immunotherapy

Allergen immunotherapy (MT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence- based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including health professionals. The decision to prescribe MT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as on the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomaikers that can predict MT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate phannacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow up of patients

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma a

Bringing two worlds closer together: a critical analysis of an integrated approach to guideline development and quality assurance schemes

Contains fulltext : 231643.pdf (publisher's version ) (Open Access

Guidelines rarely used GRADE and applied methods inconsistently: a methodological study of Australian guidelines

Objectives: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is accepted methodology to assess the certainty of the evidence included in systematic reviews and clinical practice guidelines. The GRADE approach is endorsed globally, in Australia, the National Health and Medical Research Council advocated for the use of the GRADE approach in 2011. The purpose of this methodological review was to assess how GRADE has been adopted for Australian practice guidelines. Study Design and Setting: This methodological review searched of the National Health and Medical Research Council Clinical Practice Guidelines Portal from 2011 to 2018, in an effort to retrieve all practice guidelines available via this medium. Results: 240 guidelines were retrieved authored by 51 different organizations. 15 guidelines followed GRADE methodology. Application of GRADE methods varied between guidelines, some misreported and altered aspects of the GRADE process. Guidelines that closely adhered to the guidance from the GRADE Working Group scored higher in domain 3 (rigor of development) of the Appraisal of Guidelines for Research and Evaluation II tool, indicating a positive linear relationship between GRADE adherence and rigor of development scores. Conclusion: The results of our project suggest that the use of GRADE in Australian guidelines is increasing, however, strategies to increase uptake and reporting within the guideline community need to be explored.Timothy Hugh Barker, Mafalda Dias, Cindy Stern, Kylie Porritt, Rick Wiechula, Edoardo Aromataris ... et al