Improving GRADE evidence tables part 2: a systematic survey of explanatory notes shows more guidance is needed

Langendam, Miranda; Carrasco-Labra, Alonso; Mustafa, Reem A.; Brignardello‐Petersen, Romina; Ventresca, Matthew; Heus, Pauline; Lasserson, Toby J; Moustgaard, Rasmus; Brožek, Jan

doi:10.1016/j.jclinepi.2015.12.008

Cited by 19 publications

(8 citation statements)

References 20 publications

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“…The GRADE approach [58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] was used to assess the certainty of the evidence. The evidence from prospective cohort studies was classified initially as being of low certainty and that from RCTs was classified initially as being of high certainty, with the evidence downgraded or upgraded based on prespecified criteria.…”

Section: Grade Assessmentmentioning

confidence: 99%

Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials

et al. 2022

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Aims/hypothesis Nordic dietary patterns that are high in healthy traditional Nordic foods may have a role in the prevention and management of diabetes. To inform the update of the EASD clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes. Methods We searched MEDLINE, EMBASE and The Cochrane Library from inception to 9 March 2021. We included prospective cohort studies and RCTs with a follow-up of ≥1 year and ≥3 weeks, respectively. Two independent reviewers extracted relevant data and assessed the risk of bias (Newcastle–Ottawa Scale and Cochrane risk of bias tool). The primary outcome was total CVD incidence in the prospective cohort studies and LDL-cholesterol in the RCTs. Secondary outcomes in the prospective cohort studies were CVD mortality, CHD incidence and mortality, stroke incidence and mortality, and type 2 diabetes incidence; in the RCTs, secondary outcomes were other established lipid targets (non-HDL-cholesterol, apolipoprotein B, HDL-cholesterol, triglycerides), markers of glycaemic control (HbA1c, fasting glucose, fasting insulin), adiposity (body weight, BMI, waist circumference) and inflammation (C-reactive protein), and blood pressure (systolic and diastolic blood pressure). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. Results We included 15 unique prospective cohort studies (n=1,057,176, with 41,708 cardiovascular events and 13,121 diabetes cases) of people with diabetes for the assessment of cardiovascular outcomes or people without diabetes for the assessment of diabetes incidence, and six RCTs (n=717) in people with one or more risk factor for diabetes. In the prospective cohort studies, higher adherence to Nordic dietary patterns was associated with ‘small important’ reductions in the primary outcome, total CVD incidence (RR for highest vs lowest adherence: 0.93 [95% CI 0.88, 0.99], p=0.01; substantial heterogeneity: I2=88%, pQ<0.001), and similar or greater reductions in the secondary outcomes of CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). Inverse dose–response gradients were seen for total CVD incidence, CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). No studies assessed CHD or stroke mortality. In the RCTs, there were small important reductions in LDL-cholesterol (mean difference [MD] −0.26 mmol/l [95% CI −0.52, −0.00], pMD=0.05; substantial heterogeneity: I2=89%, pQ<0.01), and ‘small important’ or greater reductions in the secondary outcomes of non-HDL-cholesterol, apolipoprotein B, insulin, body weight, BMI and systolic blood pressure (p<0.05). For the other outcomes there were ‘trivial’ reductions or no effect. The certainty of the evidence was low for total CVD incidence and LDL-cholesterol; moderate to high for CVD mortality, established lipid targets, adiposity markers, glycaemic control, blood pressure and inflammation; and low for all other outcomes, with evidence being downgraded mainly because of imprecision and inconsistency. Conclusions/interpretation Adherence to Nordic dietary patterns is associated with generally small important reductions in the risk of major CVD outcomes and diabetes, which are supported by similar reductions in LDL-cholesterol and other intermediate cardiometabolic risk factors. The available evidence provides a generally good indication of the likely benefits of Nordic dietary patterns in people with or at risk for diabetes. Registration ClinicalTrials.gov NCT04094194. Funding Diabetes and Nutrition Study Group of the EASD Clinical Practice. Graphical abstract

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Section: Grade Assessmentmentioning

confidence: 99%

Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials

et al. 2022

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“…The effects of the intervention (pirfenidone, a drug that inhibits the production of growth factors and procollagens) are summarized both in relative terms and as absolute risk differences. The main reason for a quality assessment or other noteworthy points is documented in explanatory footnotes that constitute an essential part of GRADE tables . The Summary of Findings (SoF) table (Table ) includes an assessment of the quality of evidence for each outcome but not the detailed judgments on which that assessment is based.…”

Section: The Certainty Of the Evidence Quality Of The Evidence Or Smentioning

confidence: 99%

“…The main reason for a quality assessment or other noteworthy points is documented in explanatory footnotes that constitute an essential part of GRADE tables. 35,50 The Summary of Findings (SoF) table (Table 6) includes an assessment of the quality of evidence for each outcome but not the detailed judgments on which that assessment is based. Summary of Findings tables are intended for a broader audience, for example users of guidelines: They provide a concise summary of the key information underlying a recommendation.…”

Section: Grade Evidence Profiles and Summary Of Findings Tablesmentioning

confidence: 99%

Using systematic reviews in guideline development: The GRADE approach

Zhang

Akl

Schünemann

2018

Research Synthesis Methods

Self Cite

146

102

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Systematic reviews are essential to produce trustworthy guidelines. To assess the certainty of a body of evidence included in a systematic review the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group has developed an approach that is currently used by over 100 organisations, including the World Health Organization and the Cochrane Collaboration. GRADE provides operational definitions and instructions to rate the certainty of the evidence for each outcome in a review as high, moderate, low, or very low for the effects of interventions, prognostic estimates, values and preferences, test accuracy and resource utilization. The assessment includes assessing risk of bias, imprecision, inconsistency, indirectness, and publication bias, the magnitude of effects, dose-response relations and the impact of residual confounding and bias. Summary statistical information and assessments of certainty are presented in GRADE evidence summary tables, which can be produced using GRADE's official GRADEpro software tool (www.gradepro.org/). The evidence summary tables feed into the GRADE Evidence to Decision frameworks which guideline panels can use to produce recommendations.

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“…[29] Trotzdem werden die (oft sehr knappen) Erklärungen in der Tabelle (Darstellung als Evidenzprofile oder ,,Summary of Findings'' Tabellen) oder Fußnoten von KlinikerInnen als unzureichend angesehen. [30] Lösungsansätze für die Kommunikation von Ergebnissen der GRADE-Bewertungen sind einerseits intuitivere und damit leichter verständliche Darstellungsmöglichkeiten. An diesen arbeitet die GRADE Working Group im Rahmen des DECIDE-Projekts (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) bereits.…”

Section: Erstellung Der Empfehlungenunclassified

Leitlinienentwicklung: von der Evidenz zu Empfehlungen Möglichkeiten und Herausforderungen aus Sicht der MethodikerInnen

Mahlknecht

Glechner

Gartlehner

2015

Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheit

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The development of evidence-based guidelines is an interdisciplinary process in which methodologists play an important role. In addition to creating new or assessing existing systematic reviews as a basis for evidence-based decision making, methodologists can support the entire development process. Due to the increasing complexity of methods and the information overload of available publications, cooperation between the involved experts (especially clinicians and methodologists, but also patient representatives) is essential in order to develop reliable, acceptable and practical guidelines. This article looks at eight key points of the guideline development process (transparency, conflicts of interest, composition of guideline development group, establishing evidence foundation, development and formulation of recommendations, external review and updating) from the perspective of methodologists, and highlights problems, challenges and solution approaches. The earliest possible involvement of methodologists, a clear and a--for non-methodologists--understandable presentation of the best available evidence, the integration of methodologists in the creation and formulation of recommendations (systematic, evidence-based decision-making process) and cooperation between the participating experts are essential to improve the development process of evidence-based guidelines.

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Improving GRADE evidence tables part 2: a systematic survey of explanatory notes shows more guidance is needed

Cited by 19 publications

References 20 publications

Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials

Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials

Using systematic reviews in guideline development: The GRADE approach

Leitlinienentwicklung: von der Evidenz zu Empfehlungen Möglichkeiten und Herausforderungen aus Sicht der MethodikerInnen

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