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Grade San Sebastian 2008 05 12hjs
1. Grading the quality of evidence and the strength of recommendations San Sebastián 12 - 14 May 2008 Pablo Alonso, Victor Montori, Andy Oxman, Holger Schünemann
24. Determinants of strength of recommendation Factors Impact on the strength of a recommendation Balance between desirable and undesirable effects Larger the difference between the desirable and undesirable effects, more likely a strong recommendation warranted. Narrower the gradient, more likely weak recommendation warranted. Quality of the evidence Higher the quality of evidence, more likely a strong recommendation warranted. Values and preferences More variability in values and preferences, or more uncertainty in values and preferences, more likely weak recommendation warranted. Costs (resource use) Higher the costs of an intervention – that is, the more resources consumed – less likely a strong recommendation warranted.
31. Hierarchy of outcomes according to their importance to assess the effect of phosphate lowering drugs in patients with renal failure and hyperphosphatemia Flatulence 2 Importance of endpoints 5 Pain due to soft tissue 6 calcification / function Fractures 7 Myocardial infarction 8 Mortality 9 3 4 1 Critical for decision making Important, but not critical for decision making Of low importance
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36. 2 Importance of endpoints 5 6 7 8 9 3 4 1 Critical for decision making Important, but not critical for decision making Of low importance
42. Assessment of the risk of bias Cochrane Handbook for Systematic Reviews of Interventions, Draft chapter of version 5 - Assessing risk of bias in included studies http://www.cochrane.org/resources/handbook/handbook5drafts.htm
43. Should patients with cancer receive parenteral anticoagulation (heparin) to prolong survival. Outcomes: Survival, bleeding
58. Akl E, Barba M, Rohilla S, Terrenato I, Sperati F, Schünemann HJ. “ Anticoagulation for the long term treatment of venous thromboembolism in patients with cancer ”. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD006650. Heparin or vitamin K antagonists for survival in patients with cancer
59. Non-steroidal drug use and risk of pancreatic cancer Capurso G, Sch ünemann HJ, Terrenato I, Moretti A, Koch M, Muti P, Capurso L, Delle Fave G. Meta-analysis: the use of non-steroidal anti-inflammatory drugs and pancreatic cancer risk for different exposure categories. Aliment Pharmacol Ther. 2007 Oct 15;26(8):1089-99.
98. What are examples of interventions you can think of for which you might upgrade the quality of evidence because of a large magnitude of effect? Why would you or would you not upgrade the quality of evidence?
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102. What are examples of interventions you can think of for which you might upgrade the quality of evidence because of a dose response relationship?
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105. What are examples of interventions you can think of for which you might upgrade the quality of evidence when an effect (association) was found - because all plausible confounders would result in an underestimate of effect or when an effect (association) was not found - because all plausible biases would result in an overestimate of effect?
124. Grading the quality of evidence and the strength of recommendations San Sebastián 13 May 2008 Pablo Alonso, Victor Montori, Andy Oxman, Holger Schünemann
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126. Any questions from yesterday about quality of evidence or about the agenda for today?
132. Determinants of strength of recommendation Factors Impact on the strength of a recommendation Balance between desirable and undesirable effects Larger the difference between the desirable and undesirable effects, more likely a strong recommendation warranted. Narrower the gradient, more likely weak recommendation warranted. Quality of the evidence Higher the quality of evidence, more likely a strong recommendation warranted. Values and preferences More variability in values and preferences, or more uncertainty in values and preferences, more likely weak recommendation warranted. Costs (resource use) Higher the costs of an intervention – that is, the more resources consumed – less likely a strong recommendation warranted.
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138. Should oseltamivir be used for treatment of patients hospitalised with avian influenza (H5N1)? Summary of findings Transmission : No human to human transmission Patient or population: Hospitalised, clinical and serologically confirmed cases of avian influenza
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140. Judgments about the strength of a recommendation - oseltamivir for treatment of patients hospitalised with avian influenza (H5N1) Factors Comments Balance between desirable and undesirable effects The benefits are uncertain. Quality of the evidence The quality of the evidence is very low. Values and preferences All patients and care providers would accept treatment for H5N1 disease. Costs (resource use) The cost is not high for treatment of sporadic cases.