scholarly journals The GRADE approach, Part 2: Evidence to decision frameworks—outlining decision-making in health

Medwave ◽  
2021 ◽  
Vol 21 (04) ◽  
pp. e8182-e8182
Author(s):  
Carlos Quilodrán ◽  
Matías Kirmayr ◽  
Bárbara Valente ◽  
Javier Pérez-Bracchiglione ◽  
Luis Garegnani ◽  
...  
Keyword(s):  
Decision Making ◽  
Resource Use ◽  
Evaluation Methodology ◽  
Adoption Process ◽  
Trade Off ◽  
Assessment Development ◽  
Extensive Information ◽  
Structured System ◽  
Grade Methodology ◽  
Grade Approach

The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology provides a framework for assessing the certainty of the evidence and making recommendations. The Evidence to Decision Framework (EtD) is a transparent and structured system for formulating health recommendations. Once the problem is identified and the certainty of the evidence is assessed, EtD provides several criteria for formulating a recommendation. These criteria include the trade-off between benefits and harms, patients’ values and preferences, acceptability, feasibility, resource use, and impact on equity. The resulting recommendations may differ in strength (strong or weak) and direction (for or against). The process is transparent, allowing other users to adjust the framework of recommendations by modifying the criteria to fit the desired context through an adaptation-adoption process. Given the extensive information available on EtD and the GRADE methodology in general, this narrative review seeks to explain the main concepts involved in decision-making in health by using simplified and friendly descriptions, accompanied by practical examples, thus facilitating its understanding by inexperienced readers.

scholarly journals Addressing Challenges When Applying GRADE to Public Health Guidelines: A Scoping Review Protocol and Pilot Analysis

2022 ◽  
Vol 19 (2) ◽  
pp. 992
Author(s):  
Lucia Kantorová ◽  
Tereza Friessová ◽  
Simona Slezáková ◽  
Alena Langaufová ◽  
Jiří Kantor ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Scoping Review ◽  
Descriptive Statistics ◽  
Graphical Form ◽  
Assessment Development ◽  
Directed Content Analysis ◽  
Scoping Reviews ◽  
Review Protocol ◽  
Grade Approach

This is a protocol for a scoping review that aims to determine how guideline authors using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach have addressed previously identified challenges related to public health. The Joanna Briggs Institute (JBI) methodology for scoping reviews will be followed. We will search and screen titles of guidelines for all languages published in 2013–2021 in: the GIN library, BIGG database, Epistemonikos GRADE guidelines repository, GRADEpro Database, MAGICapp, NICE and WHO websites. Two reviewers will independently screen full texts of the documents identified. The following information will be extracted: methods used for identifying different stakeholders and incorporating their perspectives; methods for identification and prioritization of non-health outcomes; methods for determining thresholds for decision-making; methods for incorporating and grading evidence from non-randomized studies; methods for addressing concerns with conditional recommendations in public health; methods for reaching consensus; additional methodological concerns; and any modifications made to GRADE. A combination of directed content analysis and descriptive statistics will be used for data analysis, and the findings presented narratively in a tabular and graphical form. In this protocol, we present the pilot results from 13 identified eligible guidelines issued between January and August 2021. We will publish the full review results when they become available.

Making the most of individual differences in joint decisions

2018 ◽  
Author(s):  
Bahador Bahrami
Keyword(s):  
Decision Making ◽  
Direct Evidence ◽  
Cross Cultural ◽  
Collective Decision Making ◽  
Wisdom Of Crowds ◽  
Trade Off ◽  
Adaptive Value ◽  
Joint Decisions ◽  
Cultural Data ◽  
Better Than

Evidence for and against the idea that “two heads are better than one” is abundant. This chapter considers the contextual conditions and social norms that predict madness or wisdom of crowds to identify the adaptive value of collective decision-making beyond increased accuracy. Similarity of competence among members of a collective impacts collective accuracy, but interacting individuals often seem to operate under the assumption that they are equally competent even when direct evidence suggest the opposite and dyadic performance suffers. Cross-cultural data from Iran, China, and Denmark support this assumption of similarity (i.e., equality bias) as a sensible heuristic that works most of the time and simplifies social interaction. Crowds often trade off accuracy for other collective benefits such as diffusion of responsibility and reduction of regret. Consequently, two heads are sometimes better than one, but no-one holds the collective accountable, not even for the most disastrous of outcomes.

scholarly journals Comparative Efficacy of Antifungal Agents Used in the Treatment of Oropharyngeal Candidiasis among HIV-Infected Adults: A Systematic Review and Network Meta-Analysis

2021 ◽  
Vol 7 (8) ◽  
pp. 637
Author(s):  
Shamala Gopal Rajadurai ◽  
Mari Kannan Maharajan ◽  
Sajesh K. Veettil ◽  
Divya Gopinath
Keyword(s):  
Antifungal Agents ◽  
Meta Analysis ◽  
Oropharyngeal Candidiasis ◽  
Mycological Cure ◽  
Comparative Efficacy ◽  
Assessment Development ◽  
Randomized Controlled ◽  
Favorable Safety ◽  
Grade Approach

The objective of this study was to assess the comparative efficacy and safety of different antifungal agents used for the treatment of oropharyngeal candidiasis (OPC) in adult patients with HIV. A systematic search was performed on the four major databases (Medline, Embase, CENTRAL and Scopus) to identify randomized controlled trials (RCTs) that evaluated the efficacy of antifungal agents in HIV patients with OPC. A network meta-analysis was performed from the data extracted from the selected studies. The agents were ranked according using surface under the cumulative ranking (SUCRA). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of evidence. A total of 15 trials were included in the quantitative analysis involving the data from a total of 2883 participants. Fluconazole was ranked as the most effective antifungal agent to achieve clinical cure (SUCRA = 0.87) in OPC followed by posaconazole and itraconazole. Posaconazole was ranked the most efficacious agent in achieving mycological cure (SUCRA = 0.81), followed by fluconazole. While nystatin was ranked the safest, the effect estimates of none of the other systemic antifungal agents were significantly higher than fluconazole. Based on the available evidence, fluconazole can be considered as the most effective drug in the treatment of OPC among HIV-infected adults and has a favorable safety profile, followed by posaconazole.

Novel Multi-objective Decision-Making and Trade-Off Approach for Selecting Optimal Machining Parameters of Inconel-800 Superalloy

2020 ◽  
Vol 45 (7) ◽  
pp. 5833-5847 ◽  
Author(s):  
Syed Abou Iltaf Hussain ◽  
Binayak Sen ◽  
Archisman Das Gupta ◽  
Uttam Kumar Mandal
Keyword(s):  
Decision Making ◽  
Machining Parameters ◽  
Trade Off ◽  
Multi Objective ◽  
Inconel 800

Burst Suppression for ICP Control

2016 ◽  
Vol 32 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Frederick A. Zeiler ◽  
Eva Akoth ◽  
Lawrence M. Gillman ◽  
Michael West
Keyword(s):  
Reference Lists ◽  
Burst Suppression ◽  
Suppressive Therapy ◽  
Cochrane Library ◽  
Infection Rates ◽  
Assessment Development ◽  
Severe Hypotension ◽  
Grade Methodology ◽  
Clinical Trials Registry ◽  
The Impact

Background: The goal of our study was to perform a systematic review of the literature to determine the effect that burst suppression has on intracranial pressure (ICP) control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to January 2015), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and the Grading of Recommendation Assessment Development and Education (GRADE) methodology. Results: Seven articles were considered for review. A total of 108 patients were studied, all receiving burst suppression therapy. Two studies failed to document a decrease in ICP with burst suppression therapy. There were reports of severe hypotension and increased infection rates with barbiturate-based therapy. Etomidate-based suppressive therapy was linked to severe renal dysfunction. Conclusions: There currently exists both Oxford level 2b and GRADE C evidence to support that achieving burst suppression reduces ICP, and also has no effect on ICP, in severe traumatic brain injury. The literature suggests burst suppression therapy may be useful for ICP reduction in certain cases, although these situations are currently unclear. In addition, the impact on patient functional outcome is unclear. Further prospective study is warranted.

scholarly journals Ebola Hemorrhagic Fever: Recent Update On Disease Status, Current Therapies And Advances In Treatment

2017 ◽  
Vol 5 (2) ◽  
pp. 217-234
Author(s):  
Jaskaran Singh ◽  
Thapa Komal ◽  
Sandeep Arora ◽  
Amarjot Kaur ◽  
Thakur Gurjeet Singh
Keyword(s):  
Ebola Virus ◽  
Hemorrhagic Fever ◽  
Disease Status ◽  
Clinical Test ◽  
Assessment Development ◽  
Hiv Virus ◽  
The World ◽  
New Guidelines ◽  
Virus Zika ◽  
Grade Methodology

Swiftly growing viruses are a major intimidation to human health. Such viruses are extremely pathogenic like Ebola virus, influenza virus, HIV virus, Zika virus etc . Ebola virus, a type of Filovirus, is an extremely infectious, single-stranded ribonucleic acid virus that infects both humans and apes, prompting acute fever with hemorrhagic syndrome. The high infectivity, severity and mortality of Ebola has plagued the world for the past fifty years with its first outbreak in 1976 in Marburg, Germany, and Frankfurt along with Belgrade and Serbia. The world has perceived about 28,000 cases and over 11,000 losses. The high lethality of Ebola makes it a candidate for use in bioterrorism thereby arising more concern. New guidelines have been framed for providing best possible care to the patients suffering from Ebola virus i.e Grading of Recommendation Assessment, Development And Evaluation (GRADE) methodology to develop evidence-based strategy for the treatment in future outbreak of Ebola virus. No drugs have been approved, while many potent drugs like rVSV-EBOV, Favipiravir, ZMapp are on clinical test for human safety. In this review we will discover and discuss perspective aspects that lead to the evolution of different Ebola variants as well as advances in various drugs and vaccines for treatment of the disease.

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