Evolution of evidence grading and recommendation system for evidence-based guidelines_West China Medical Journal

Authors：

ZHANG Dingding ,  ZHU Yicheng

Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, P. R. China;

Corresponding?author：

ZHU Yicheng, Email: zhuych910@163.com

Keywords：

Evidence-based guidelines; evidence grading; recommendation strength

DOI：

10.7507/1002-0179.202405140

Video：

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Evidence grading and recommendation strength assessment are key steps in the development of evidence-based guidelines, and have made significant progress in recent years. This article systematically reviews the development and evolution of evidence grading and recommendation strength in the past 30 years, and introduces the main representative standards. At the same time, a brief introduction is given to the guidelines and consensus evaluation results published in the field of neurological diseases in China, and future improvements are proposed. This article aims to help readers understand the development patterns of evidence grading and recommendation strength, in order to better understand the guidelines, and to develop more standardized guidelines.

Citation： ZHANG Dingding, ZHU Yicheng. Evolution of evidence grading and recommendation system for evidence-based guidelines. West China Medical Journal, 2024, 39(5): 677-680. doi: 10.7507/1002-0179.202405140 Copy

1.	蔣朱明, 詹思延, 賈曉巍, 等. 制訂/修訂《臨床診療指南》的基本方法及程序. 中華醫學雜志, 2016, 96(4): 250-253.
2.	陳耀龍, 楊克虎, 王小欽, 等. 中國制訂/修訂臨床診療指南的指導原則(2022 版). 中華醫學雜志, 2022, 102(10): 697-703.
3.	Glasziou P, Vandenbroucke JP, Chalmers I. Assessing the quality of research. BMJ, 2004, 328(7430): 39-41.
4.	陳耀龍, 李幼平, 杜亮, 等. 醫學研究中證據分級和推薦強度的演進. 中國循證醫學雜志, 2008, 8(2): 127-133.
5.	Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J, 1979, 121(9): 1193-1254.
6.	Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest, 1986, 89(2 Suppl): 2S-3S.
7.	Agency for Health Care Policy and Research. Clinical Practice Guideline No. 1: acute pain management: operative or medical procedures and trauma. Rockville, MD: US Department of Health and Human Services, 1992.
8.	Eccles M, Clapp Z, Grimshaw J, et al. North of England evidence based guidelines development project: methods of guideline development. BMJ, 1996, 312(7033): 760-762.
9.	USPSTF. U. S. Preventive Services Task Force procedure manual. Rockville, MD: U. S. Preventive Services Task Force, 2021.
10.	丁泓帆, 楊楠, 鄧圍, 等. WHO 指南制定的基本原則和方法. 中國循證醫學雜志, 2016, 16(4): 471-477.
11.	中華醫學會神經病學分會腦血管病學組急性缺血性腦卒中診治指南撰寫組. 中國急性缺血性腦卒中診治指南 2010. 中華神經科雜志, 2010, 14(35): 146-153.
12.	OCEBM Levels of Evidence Working Group. The 2011 Oxford CEBM evidence levels of evidence. Oxford: Oxford Centre for Evidence-Based Medicine, 2011.
13.	Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
14.	劉鳴, 張蘇明, 郝子龍. 中國急性缺血性卒中診治指南 2010 版的制定及解讀. 中華神經科雜志, 2011, 44(6): 369-374.
15.	Steiner T, Dichgans M, Norrving B, et al. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines. Eur Stroke J, 2021, 6(3): CXXII-CXXXIV.
16.	Ntaios G, Bornstein NM, Caso V, et al. The European Stroke Organisation Guidelines: a standard operating procedure. Int J Stroke, 2015, 10(Suppl A100): 128-135.
17.	Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
18.	衛茂玲, 劉鳴. 中國臨床指南循證制定的方法學現狀分析. 中國循證醫學雜志, 2013, 13(8): 927-932.
19.	楊楠, 趙巍, 潘旸, 等. 針對臨床實踐指南科學性、透明性和適用性的評級工具研發. 中華醫學雜志, 2022, 102(30): 2329-2337.
20.	中華醫學會雜志社指南與標準研究中心, 中國醫學科學院循證評價與指南研究創新單元, 世界衛生組織指南實施與知識轉化合作中心. 2021 年醫學期刊發表中國指南和共識的科學性、透明性和適用性的評級. 中華醫學雜志, 2022, 102(30): 2319-2328.
21.	中華醫學會雜志社指南與標準研究中心, 中國醫學科學院循證評價與指南研究創新單元, 世界衛生組織指南實施與知識轉化合作中心, STAR 工作組. 2022 年醫學期刊發表中國指南和共識的科學性、透明性和適用性的評級. 中華醫學雜志, 2023, 103(37): 2912-2920.
22.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組, 中華醫學會神經病學分會神經血管介入協作組. 中國急性缺血性卒中早期血管內介入診療指南 2022. 中華神經科雜志, 2022, 55(6): 565-580.
23.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國缺血性卒中和短暫性腦缺血發作二級預防指南 2022. 中華神經科雜志, 2022, 55(10): 1071-1110.

1. 蔣朱明, 詹思延, 賈曉巍, 等. 制訂/修訂《臨床診療指南》的基本方法及程序. 中華醫學雜志, 2016, 96(4): 250-253.
2. 陳耀龍, 楊克虎, 王小欽, 等. 中國制訂/修訂臨床診療指南的指導原則(2022 版). 中華醫學雜志, 2022, 102(10): 697-703.
3. Glasziou P, Vandenbroucke JP, Chalmers I. Assessing the quality of research. BMJ, 2004, 328(7430): 39-41.
4. 陳耀龍, 李幼平, 杜亮, 等. 醫學研究中證據分級和推薦強度的演進. 中國循證醫學雜志, 2008, 8(2): 127-133.
5. Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J, 1979, 121(9): 1193-1254.
6. Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest, 1986, 89(2 Suppl): 2S-3S.
7. Agency for Health Care Policy and Research. Clinical Practice Guideline No. 1: acute pain management: operative or medical procedures and trauma. Rockville, MD: US Department of Health and Human Services, 1992.
8. Eccles M, Clapp Z, Grimshaw J, et al. North of England evidence based guidelines development project: methods of guideline development. BMJ, 1996, 312(7033): 760-762.
9. USPSTF. U. S. Preventive Services Task Force procedure manual. Rockville, MD: U. S. Preventive Services Task Force, 2021.
10. 丁泓帆, 楊楠, 鄧圍, 等. WHO 指南制定的基本原則和方法. 中國循證醫學雜志, 2016, 16(4): 471-477.
11. 中華醫學會神經病學分會腦血管病學組急性缺血性腦卒中診治指南撰寫組. 中國急性缺血性腦卒中診治指南 2010. 中華神經科雜志, 2010, 14(35): 146-153.
12. OCEBM Levels of Evidence Working Group. The 2011 Oxford CEBM evidence levels of evidence. Oxford: Oxford Centre for Evidence-Based Medicine, 2011.
13. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
14. 劉鳴, 張蘇明, 郝子龍. 中國急性缺血性卒中診治指南 2010 版的制定及解讀. 中華神經科雜志, 2011, 44(6): 369-374.
15. Steiner T, Dichgans M, Norrving B, et al. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines. Eur Stroke J, 2021, 6(3): CXXII-CXXXIV.
16. Ntaios G, Bornstein NM, Caso V, et al. The European Stroke Organisation Guidelines: a standard operating procedure. Int J Stroke, 2015, 10(Suppl A100): 128-135.
17. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
18. 衛茂玲, 劉鳴. 中國臨床指南循證制定的方法學現狀分析. 中國循證醫學雜志, 2013, 13(8): 927-932.
19. 楊楠, 趙巍, 潘旸, 等. 針對臨床實踐指南科學性、透明性和適用性的評級工具研發. 中華醫學雜志, 2022, 102(30): 2329-2337.
20. 中華醫學會雜志社指南與標準研究中心, 中國醫學科學院循證評價與指南研究創新單元, 世界衛生組織指南實施與知識轉化合作中心. 2021 年醫學期刊發表中國指南和共識的科學性、透明性和適用性的評級. 中華醫學雜志, 2022, 102(30): 2319-2328.
21. 中華醫學會雜志社指南與標準研究中心, 中國醫學科學院循證評價與指南研究創新單元, 世界衛生組織指南實施與知識轉化合作中心, STAR 工作組. 2022 年醫學期刊發表中國指南和共識的科學性、透明性和適用性的評級. 中華醫學雜志, 2023, 103(37): 2912-2920.
22. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組, 中華醫學會神經病學分會神經血管介入協作組. 中國急性缺血性卒中早期血管內介入診療指南 2022. 中華神經科雜志, 2022, 55(6): 565-580.
23. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國缺血性卒中和短暫性腦缺血發作二級預防指南 2022. 中華神經科雜志, 2022, 55(10): 1071-1110.

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