1、使用GRADEpro評估證據(jù)質(zhì)量，武漢市大學公共衛(wèi)生學院傳染病研究室2011年十一月，GRADE系統(tǒng)簡介，GRADE(Grading of recommendations assessment，開發(fā)和評估)，GRADE系統(tǒng)比其他系統(tǒng)占優(yōu)勢。廣泛的代表性國際指南開發(fā)小組明確定義了證據(jù)質(zhì)量和推薦強度，明確評價了不同治療方案的重要結(jié)局，對各種等級證據(jù)的升級和降級進行了明確、綜合的標準證據(jù)到推薦的整個過程，明確承認了價值觀念和意志，承認了推薦意見的強弱。從林爽醫(yī)生、患者、政策制定者的角度出發(fā)，明確而實用的解釋適用于制作系統(tǒng)評價、衛(wèi)生技術(shù)評價和指導、證據(jù)質(zhì)量(GRADEpro)，為了實現(xiàn)透明而簡化的目標

2、，GRADE系統(tǒng)將證據(jù)質(zhì)量分為高、中、低、非常低的4個等級。使用GRADE系統(tǒng)的一些組織甚至將低的和非常低的分類為第一等級。在使用推薦等級、GRADE系統(tǒng)時，指導小組使用“強推薦”表示確信相關(guān)干預比弊更有利。作為“弱推薦”，干預措施可能比弊更有利，但他們掌握得不好。GRADE的證據(jù)質(zhì)量和建議級別，主要階段1，導入RevMan檔案，主要階段2確定結(jié)果重要性的階段，GRADE系統(tǒng)推薦9級確定結(jié)果重要性。 13:不重要的結(jié)果46:重要結(jié)果(important)觀察性研究(包括隊列研究、病例-對照研究、病例-歷史對照研究)質(zhì)量等級低和低。病例報告、病例分析等其他研究質(zhì)量等級很低，很低。第四階段證據(jù)質(zhì)量

3、評價，根據(jù)研究設(shè)計，可根據(jù)5茄子降級因素和4茄子升級因素提高或降低等級。決定證據(jù)質(zhì)量的因素，可以降低證據(jù)質(zhì)量的因素研究的局限性結(jié)果不一致的間接證據(jù)準確度不足，可以提高證據(jù)質(zhì)量的因素效果值大幅度增加的混合因素，可以降低療效的劑量-效果關(guān)系，研究設(shè)計和證據(jù)質(zhì)量，高：不降級的隨機實驗和對二級上升的觀察性研究；中：降級的隨機實驗和一級升級的觀察性研究；低：降低2級的隨機實驗和沒有上升級的觀察性研究；極低：降低3級的隨機實驗，降低1級的觀察性研究，病例分析/病例報告。幫助文檔教程要點，研究的局限性(RCTs)隱藏組缺失實名法缺失(尤其是結(jié)果指標為主觀性指標，評價易受偏向性分析)，訪問過多，未進行意圖性分

4、析，治療效果過早結(jié)束，或未報告結(jié)果(通常未觀察到)，To rate study limitations: if you think any limitations were negligible choose no if you think there were serious limitations choose serious This will downgrade the quality of ee，I2，one set of criteria would say that an I2 of less than 40% is low 3060% may be moderate 5090%

5、 may be substantial 75100% is connection if you think any inconsistency was negligible choose no if you think There was serious inconsistency choose serious this will downgrade the quality OOS to rate in directness If you think the evidence is direct choose no If you have serious doubts about direct

6、ness choose serious this will downgrade the ee a threshold rule-of-thumb value total number of events is less than 300(dichotomous)total population size is less than 400(:To ration size is less than 400) Publication bias，Publication bias arises when investigator s fail to report studies they have un

7、der taken methods to detect the possibility of publication bias in systematic reviews exist，Although authors of the reviews and guideline panels must offlist典型的情況是，公開證據(jù)僅限于少數(shù)實驗，牙齒實驗都要在企業(yè)贊助時質(zhì)疑發(fā)表偏向。funnel plot，to rate probability of the publication bias :If you think there is no evidence of publication

8、 bias choose unlikely If tttl，to rate magnitude of the effect 3360，If the effect was not large(RR between 0.5 and 2.0)Choose no If the effect was large(RR eiths(plausible confounding would change the effect)，on occasion，All plausible confounding from observational studies or randomised tudiesto rate the effect of all plausible residual confounding : if there is no evidence that The influence of all plausible confounding would reduce a demonstrated effect or suggest a spurious effect when results sults