GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables

Guyatt, Gordon; Oxman, Andrew D; Akl, Elie A.; Kunz, Regina; Vist, Gunn Elisabeth; Brožek, Jan; Norris, Susan L.; Falck‐Ytter, Yngve; Glasziou, Paul; deBeer, Hans

doi:10.1016/j.jclinepi.2010.04.026

Cited by 7,665 publications

(5,689 citation statements)

References 15 publications

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“…Values in parentheses are 95 per cent c.i.*The risk in the intervention group (incisional negative‐pressure wound therapy, iNPWT) is based on the assumed risk in the comparison group (standard dressing) and the relative risk of the intervention.†Evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system30 (see text for full details);‡moderate risk of bias in study;§inconsistency of direction of effect;¶imprecision owing to small sample size. NNT, number needed to treat; RCT, randomized clinical trial.…”

Section: Resultsmentioning

confidence: 99%

“…Evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system30 (see text for full details);…”

Section: Resultsmentioning

confidence: 99%

“…Its strength is that, individually, the two largest published studies35, 37 showed significant results favouring iNPWT. Overall, iNPWT appeared to reduce the risk of wound infection, even though the quality of evidence was downgraded to moderate; this means that the true effect is likely to be close to the estimate of the effect, although there is a probability of a substantial difference30. The study by Stannard and co‐workers37 included 249 patients with 263 fractures, indicating that some patients had more than one fracture.…”

Section: Discussionmentioning

confidence: 99%

“…The quality of evidence for each outcome was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system30. The evidence was classified as: high quality (the authors are very confident that the true effect lies close to that of the estimate of the effect); moderate quality (the authors are moderately confident in the effect estimate); low quality (the authors' confidence in the effect estimate is limited); or very low quality (the authors have very little confidence in the effect estimate)30, 31.…”

Section: Methodsmentioning

confidence: 99%

“…The evidence was classified as: high quality (the authors are very confident that the true effect lies close to that of the estimate of the effect); moderate quality (the authors are moderately confident in the effect estimate); low quality (the authors' confidence in the effect estimate is limited); or very low quality (the authors have very little confidence in the effect estimate)30, 31. The small study bias was assessed visually by examining the symmetry of funnel plots, and statistically as described by Egger et al 32…”

Section: Methodsmentioning

confidence: 99%

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Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

199

175

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BackgroundPostoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions.MethodsThis was a systematic review and meta‐analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions.ResultsTen studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence.ConclusionCompared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet.

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Section: Resultsmentioning

confidence: 99%

“…Evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system30 (see text for full details);…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

199

175

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Breast Cancer Screening for Women at Average Risk

Oeffinger

Fontham

Etzioni

et al. 2015

JAMA

1,439

906

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Importance Breast cancer is a leading cause of premature mortality among U.S. women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. This report updates the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer. Process The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update, and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. Evidence Synthesis Mammography screening in women aged 40–69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening in women who are age 70 years and older and are in good health. Estimates of the cumulative lifetime risk of false positive exams are greater if screening begins at younger ages due to the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs. biennially. Evidence does not support routine clinical breast examination as a screening method for average risk women. Recommendations The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women who are ages 45 to 54 years should be screened annually (qualified recommendation). Women who are age 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

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Association Between Perioperative Low-Molecular-Weight Heparin vs Unfractionated Heparin and Clinical Outcomes in Patients With Cancer Undergoing Surgery

Akl

Kahale

2015

JAMA

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GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables

Cited by 7,665 publications

References 15 publications

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Breast Cancer Screening for Women at Average Risk

Association Between Perioperative Low-Molecular-Weight Heparin vs Unfractionated Heparin and Clinical Outcomes in Patients With Cancer Undergoing Surgery

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