GRADE System: Classification of Quality of Evidence and Strength of Recommendation

Effects of midodrine in patients with ascites due to cirrhosis: Systematic review and meta‐analysis

“…Clinical and methodological heterogeneities were identified across the included trials, including unclear randomization, inadequate allocation concealment and lack of blinding, which contributed to the moderate quality of evidence for either primary or secondary end-points, as assessed by the approach proposed by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group. 32 In conclusion, this meta-analysis is the first to focus on the effectiveness of midodrine in patients with cirrhotic ascites. The strengths of the current metaanalysis are its efforts to identify and systematically review all relevant RCTs.…”

“…Additionally, it was difficult to correlate surrogate marker PRA with meaningful clinical outcomes. Clinical and methodological heterogeneities were identified across the included trials, including unclear randomization, inadequate allocation concealment and lack of blinding, which contributed to the moderate quality of evidence for either primary or secondary end‐points, as assessed by the approach proposed by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group …”

Obesity and Depression: Its Prevalence and Influence as a Prognostic Factor: A Systematic Review

“…7 The following inclusion criteria was applied: available abstract, English written articles, already established diagnostic criteria for both conditions (obesity according to body mass index (BMI) and depression according to major depression criteria in the DSM IV or ICD-10, studies of prevalence in both pathologies and finally, the evaluation of the possible prognostic association between these conditions when they affect the same person simultaneously. The exclusion criteria where the following: no available abstract, articles written in a non-English language, articles of very low quality according to the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation), 8,9 and the failure to fulfil the objectives of the study.…”

“…The GRADE system initially classifies the evidence into high or low, coming from experimental or observational studies; subsequently and following a series of considerations (risk/ benefit balance, values and preferences of the patients and professionals, and the use of resources or costs), the evidence is classified into high, moderate, low or very low. 9 In comparison with other systems, the advantages of GRADE classification includes a clear separation between quality of evidence and strength of recommendations, provide comprehensive criteria and acknowledgment of values and preferences and explicit evaluation of the importance of outcomes of alternative management strategies. 8 Finally studies which main objective was the evaluation of interventions aimed at reducing the frequency of these conditions were also excluded.…”

Post-Traumatic Stress Disorder Psychological Interventions in Sub-Saharan Africa: Protocol for a Systematic Review of Literature

“…If ndings remain consistent, then robustness of the ndings will be assured, if ndings change with exclusion of certain studies, then risk of reporting bias will be considered. Overall, the level of evidence for this review will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) [36]. The a priori level of evidence is high as the review will include only randomised controlled trials, but the ultimate quality will depend on other ndings such as effect size and risk of bias assessment.…”