ブックタイトルカテーテル関連尿路感染の予防のためのCDCガイドライン 2009｜株式会社メディコン

概要

カテーテル関連尿路感染の予防のためのCDCガイドライン 2009｜株式会社メディコン

After determining the GRADE of the evidence base for each outcome of a given intervention orquestion, we calculated the overall GRADE of the evidence base for that intervention or question.The overall GRADE was based on the lowest GRADE for the outcomes deemed critical to makinga recommendation.Table 3. Rating the Quality of Evidence Using the GRADE ApproachType ofEvidenceInitialGradeCriteria to DecreaseGradeCriteria to IncreaseGradeOverallQuality GradeRCTObservationalstudyAny otherevidence(e.g., expertopinion)HighLowVerylowQualitySerious (-1 grade) orvery serious (-2 grades)limitation to study qualityConsistencyImportant inconsistency(-1 grade)DirectnessSome (-1 grade) or major(-2 grades) uncertaintyabout directnessPrecisionImprecise or sparse data(-1 grade)Publication biasHigh risk of bias (-1 grade)Strong associationStrong (+1 grade) orvery strong evidenceof association (+2grades)Dose-responseEvidence of a doseresponsegradient (+1grade)UnmeasuredConfoundersInclusion ofunmeasuredconfoundersincreases themagnitude of effect(+1 grade)HighModerateLowVery lowFormulating RecommendationsNarrative evidence summaries were then drafted by the working group using the evidence andGRADE tables. One summary was written for each theme that emerged under each keyquestion. The working group then used the narrative evidence summaries to develop guidelinerecommendations. Factors determining the strength of a recommendation included 1) the valuesand preferences used to determine which outcomes were "critical," 2) the harms and benefits thatresult from weighing the "critical" outcomes, and 3) the overall GRADE of the evidence base forthe given intervention or question (Table 4). 33 If weighing the "critical outcomes" for a givenintervention or question resulted in a "net benefit" or a "net harm," then a "Category IRecommendation" was formulated to strongly recommend for or against the given interventionrespectively. If weighing the "critical outcomes" for a given intervention or question resulted in a"trade off" between benefits and harms, then a "Category II Recommendation" was formulated torecommend that providers or institutions consider the intervention when deemed appropriate. Ifweighing the "critical outcomes" for a given intervention or question resulted in an "uncertaintrade off" between benefits and harms, then a "No Recommendation" was formulated to reflectthis uncertainty.< 原文 > VII. Methods79