Cited by 980Clinical practice guidelines implementationMeta-analysis and systematic reviewsHealth Sciences Research and Education

The DOI matches its Crossref record; 39 of the 39 references it cites were found in a registry or an index.

Users' Guides to the Medical Literature: IX. A Method for Grading Health Care Recommendations

Guyatt, Gordon H.·1995·JAMA

DOI 10.1001/jama.1995.03530220066035

Open this paper in CoChat — free account

Abstract

THE ULTIMATE PURPOSE of applied health research is to improve health care. Summarizing the literature to adduce recommendations for clinical practice is an important part of the process. Recently, the health sciences community has reduced the bias and imprecision of traditional literature summaries and their associated recommendations through the development of rigorous criteria for both literature overviews1-3and practice guidelines.4,5Even when recommendations come from such rigorous approaches, however, it is important to differentiate between those based on weak vs strong evidence. Recommendations based on inadequate evidence often require reversal when sufficient data become available,6while timely implementation of recommendations based on strong evidence can save lives.6In this article, we suggest an approach to classifying strength of recommendations. We direct our discussion primarily at clinicians who make treatment recommendations that they hope their colleagues will follow. However, we believe that any clinician who attends to

Integrity signals

Registry

Crossref · 10.1001/jama.1995.03530220066035

Cites

39 of 39 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Book Reviews: Statistical Methods for Meta-Analysis Larry V. Hedges and Ingram Olkin New York: Academic Press, 1985. xxii + 369 pp
Wasserman, S. S., Hedges, L. V., & Olkin, I. (1988) · Journal of Educational Statistics · doi:10.2307/1164953 · Cited by 10,377
Measurement of health state utilities for economic appraisal
Torrance, G. W. (1986) · Journal of Health Economics · doi:10.1016/0167-6296(86)90020-2 · Cited by 2,220
An Assessment of Clinically Useful Measures of the Consequences of Treatment
Laupacis, A., Sackett, D. L., & Roberts, R. S. (1988) · New England Journal of Medicine · doi:10.1056/nejm198806303182605 · Cited by 1,681
Rules of Evidence and Clinical Recommendations on the Use of Antithrombotic Agents
Sackett, D. L. (1989) · CHEST Journal · doi:10.1378/chest.95.2_supplement.2s · Cited by 1,369
Statistics with Confidence: Confidence Intervals and Statistical Guidelines.
JOLLIFFE, F. R., Gardner, M. J., & Altman, D. G. (1990) · Journal of the Royal Statistical Society Series A (Statistics in Society) · doi:10.2307/2982808 · Cited by 1,319
Meta-Analysis in Clinical Research
L'ABBÉ, K. A., DETSKY, A. S., & O'ROURKE, K. (1987) · Annals of Internal Medicine · doi:10.7326/0003-4819-107-2-224 · Cited by 1,267
Meta-Analyses of Randomized Controlled Trials
Sacks, H. S., Berrier, J., Reitman, D., Ancona-Berk, V. A., & Chalmers, T. C. (1987) · New England Journal of Medicine · doi:10.1056/nejm198702193160806 · Cited by 1,257
Analysis and interpretation of treatment effects in subgroups of patients in randomized clinical trials
Yusuf, S. (1991) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1991.03470010097038 · Cited by 1,014
Risk Factors for Gastrointestinal Bleeding in Critically Ill Patients
Cook, D. J., Fuller, H. D., Guyatt, G. H., Marshall, J. C., Leasa, D., Hall, R., Winton, T. L., Rutledge, F., Todd, T., Roy, P., et al. (1994) · New England Journal of Medicine · doi:10.1056/nejm199402103300601 · Cited by 1,010
Self-citation
Users' Guides to the Medical Literature
Oxman, A. D. (1994) · JAMA · doi:10.1001/jama.1994.03520170077040 · Cited by 925

Show all 39 references

Sorted by citations

Items 901–980 of 980

Light and Laser-based Treatments for Hidradenitis Suppurativa: A Systematic Review
Mukovozov, I., Mirali, S., Khaslavsky, S., & Kalia, S. (2021) · SKIN The Journal of Cutaneous Medicine · doi:10.25251/skin.5.6.4
Evidence-Based Medicine in the ICU
Jaeschke, R., Guyatt, G. H., & Meade, M. (1999) · Springer eBooks · doi:10.1007/978-88-470-2145-7_7
Self-citation
Design
Culliford, D. J. (2021) · Springer eBooks · doi:10.1007/978-3-030-87410-0_3
Introduction
Rowe, B. H., & Klassen, T. P. (2005) · Wiley eBooks · doi:10.1002/9780470987377.ch1
Bibliography
Petticrew, M. P., & Roberts, H. M. (2006) · Wiley eBooks · doi:10.1002/9780470754887.biblio
Evidence-Based Surgery
McLeod, R. S. (2008) · Springer eBooks · doi:10.1007/978-0-387-68113-9_2
Fluid Resuscitation
Fontana, J. R., & Rainey, T. G. (2001) · Springer eBooks · doi:10.1007/978-1-4757-6645-5_4
Nocturia
Tikkinen, K. A. O., Johnson, T. M., & Weiss, J. P. (2014) · Springer eBooks · doi:10.1007/978-1-4614-9047-0_15
Leakage and Interference between Variants
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.028
Ramping Experiment Exposure: Trading Off Speed, Quality, and Risk
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.020
References
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.030
Preface
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.001
Instrumentation
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.018
Scaling Experiment Analyses
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.021
Organizational Metrics
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.009
Was heißt EBM für die Klinik?
Janssens, U. (2005) · Springer eBooks · doi:10.1007/3-540-26858-8_3
Evidence Base
Procter, H. G., & Winter, D. A. (2020) · Palgrave texts in counselling and psychotherapy · doi:10.1007/978-3-030-52177-6_13
Complementary Techniques
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.014
Introduction and Motivation
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.003
Quimioterapia em dose densa no tratamento adjuvante do câncer de mama localizado
Duarte, I. L. (2015) · doi:10.47749/t/unicamp.2015.950906
Research in cancer
Hills, R. K. (2015) · Cambridge University Press eBooks · doi:10.1017/cbo9781107280250.009
Outcome
Osterhoff, G., & Lefaivre, K. A. (2017) · Springer eBooks · doi:10.1007/978-3-319-66572-6_24
Further Reading, Keeping Up-to-date and Retrieving Information
(2010) · Elsevier eBooks · doi:10.1016/b978-0-7295-3935-7.10015-x
Biostatistics
Rahbar, E., Desai, S. S., Mowatt-Larssen, E., & Rahbar, M. H. (2013) · Springer eBooks · doi:10.1007/978-3-319-01812-6_25
Number Needed to Treat: Overview
Bender, R. (2014) · Wiley StatsRef: Statistics Reference Online · doi:10.1002/9781118445112.stat04972
Letters to the Editor
(1999) · The Canadian Journal of Psychiatry · doi:10.1177/070674379904400416
Basics of Clinical Investigation
Furth, S. L., & Fadrowski, J. J. (2014) · Springer eBooks · doi:10.1007/978-3-642-27843-3_15-1
Network Meta-analysis
Salanti, G., Caldwell, D. M., Chaimani, A., & Higgins, J. P. T. (2017) · Health services research · doi:10.1007/978-1-4939-6704-9_13-1
Pharmacovigilance
Hobbiger, S. F., Patel, B., & Swain, E. (2013) · Wiley eBooks · doi:10.1002/9781118532331.ch11
Index
Kohavi, R., Tang, D., & XU, Y. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108653985.031
Scientific Evidence and the Courts
SHARP, E. W. (2014) · CRC Press eBooks · doi:10.1201/b16882-3
Research in cancer
Hills, R. K. (2008) · Cambridge University Press eBooks · doi:10.1017/cbo9780511545375.006
Art and Science of Guideline Formation
Ondoma, S. M., Resnick, D. K., & Bono, C. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-40030-5.00215-x
Preface
(2008) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195183450.002.0005
Copyright Page
(2008) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195183450.002.0003
Dedication
(2008) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195183450.002.0004
List of Abbreviations
(2008) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195183450.005.0001
Evidence of Effectiveness of Social Marketing
Carins, J., & Rundle-Thiele, S. R. (2022) · Springer eBooks · doi:10.1007/978-3-030-14449-4_8-1
The applicability and utilization of systematic reviews for clinical practice
Lindsley, K. B. (2022) · Utrecht University Repository (Utrecht University) · doi:10.33540/1513
The evidence base for intra-articular lidocaine for closed manual reduction of acute anterior shoulder dislocation continues to grow
Wakai, A., & Mar, P. D. (2022) · Canadian Journal of Emergency Medicine · doi:10.1007/s43678-022-00425-7
A Research Perspective on Social Marketing Meta-Analyses
Carins, J. (2022) · Springer eBooks · doi:10.1007/978-3-030-14449-4_19-1
Design principles
Solomon, A. J., & Nezami, N. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-823026-8.00008-0
Factors Associated To Diagnostic Delay Of Oromaxillofacial Cancers
Mabika Bredel, D. D., Lysette, N., Faye, A. D., Eboungabeka, T., Oball Mond, A., & Ngouoni, G. C. (2023) · Cancer Science & Research · doi:10.33425/2639-8478.1098
Búsqueda de información científica en ciencias de la salud: conceptos, herramientas y valoración de los resultados.
Tajes, G. A. S., Salgado, J. M., D'Agostino, F. A. N., & Vizioli, N. A. (2023) · Revista Iberoamericana ConCiencia. · doi:10.32654/conciencia.8-2.1
Design principles
Haley, K. E., & Huber, K. E. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-88423-5.00081-9
Health economic evaluation of an electronic mindfulness-based intervention (eMBI) to improve maternal mental health during pregnancy – a randomized controlled trial (RCT)
Hasemann, L., Elkenkamp, S., Müller, M., Bauer, A., Wallwiener, S., & Greiner, W. (2024) · Health Economics Review · doi:10.1186/s13561-024-00537-z
Oftalmología basada en la evidencia
Fernández, J. (2024) · Oftalmología clínica y experimental. · doi:10.70313/2718.7446.v17.n02.318
A Brief History of the Systematic Review
Purssell, E., & McCrae, N. (2024) · Springer eBooks · doi:10.1007/978-3-031-71159-6_1
Levels of evidence
Field, R. E. (2024) · Journal of Hip Preservation Surgery · doi:10.1093/jhps/hnae047
A Systematic Review of Removable vs Fixed Treatment Modalities in Completely Edentulous Jaws: A Clinical-radiographic Analysis of the Posttreatment Outcome
Sharma, A., Saxena, D., Rawat, P., Tomar, S., & Swarnkar, A. (2025) · World Journal of Dentistry · doi:10.5005/jp-journals-10015-2569
A bibliometric analysis of the top 100 most-cited articles in interventional cardiology: trends, authors, journals, origins, and gender representation
Abdullah, A., Qadeer, M. A., Jamil, A., Nadeem, Z. A., Siddique, A., Azhar, H., Sabahat, S. E., Kailash, S. J., & Virk, H. U. H. (2025) · Annals of Medicine and Surgery · doi:10.1097/ms9.0000000000003928
Basics of Clinical Investigation
Furth, S. L., & Fadrowski, J. J. (2015) · Springer eBooks · doi:10.1007/978-3-662-43596-0_15
Additional file 1 of The conceptualisation and operationalisation of ‘marketing’ in public health research: a review of reviews focused on food marketing using principles from critical interpretive synthesis
Forde, H., Chavez‐Ugalde, Y., Jones, R. A., Garrott, K., Kotta, P. A., Greaves, F., Targett, V. C., White, M., & Adams, J. (2023) · Figshare · doi:10.6084/m9.figshare.23740655
Additional file 4 of The conceptualisation and operationalisation of ‘marketing’ in public health research: a review of reviews focused on food marketing using principles from critical interpretive synthesis
Forde, H., Chavez‐Ugalde, Y., Jones, R. A., Garrott, K., Kotta, P. A., Greaves, F., Targett, V. C., White, M., & Adams, J. (2023) · Figshare · doi:10.6084/m9.figshare.23740667
Additional file 2 of The conceptualisation and operationalisation of ‘marketing’ in public health research: a review of reviews focused on food marketing using principles from critical interpretive synthesis
Forde, H., Chavez‐Ugalde, Y., Jones, R. A., Garrott, K., Kotta, P. A., Greaves, F., Targett, V. C., White, M., & Adams, J. (2023) · Figshare · doi:10.6084/m9.figshare.23740661
Additional file 5 of The conceptualisation and operationalisation of ‘marketing’ in public health research: a review of reviews focused on food marketing using principles from critical interpretive synthesis
Forde, H., Chavez‐Ugalde, Y., Jones, R. A., Garrott, K., Kotta, P. A., Greaves, F., Targett, V. C., White, M., & Adams, J. (2023) · Figshare · doi:10.6084/m9.figshare.23740670
Additional file 3 of The conceptualisation and operationalisation of ‘marketing’ in public health research: a review of reviews focused on food marketing using principles from critical interpretive synthesis
Forde, H., Chavez‐Ugalde, Y., Jones, R. A., Garrott, K., Kotta, P. A., Greaves, F., Targett, V. C., White, M., & Adams, J. (2023) · Figshare · doi:10.6084/m9.figshare.23740664
Additional file 1 of Reduction in number to treat versus number needed to treat
Zhang, C., & Yin, G. (2021) · Figshare · doi:10.6084/m9.figshare.14189799
Additional file 1 of Health economic evaluation of an electronic mindfulness-based intervention (eMBI) to improve maternal mental health during pregnancy – a randomized controlled trial (RCT)
Hasemann, L., Elkenkamp, S., Müller, M., Bauer, A., Wallwiener, S., & Greiner, W. (2024) · Figshare · doi:10.6084/m9.figshare.26755789
Changes in Clinical Practice After Publication of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Randomized Controlled Trial
Sabharwal, S., Becker, R., Monument, M. J., Schneider, P., Schubert, T., Ghert, M. A., & Morris, C. D. (2025) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-25-00374
Including patient experiences from online sources in guidelines: A natural language processing study on scabies
Lösch, L., Kampman, C. J. G., Syurina, E. V., Kunneman, F., Liekens, H., Doughty, T., Stein, M. L., Smid, L., Timen, A., & Zuiderent‐Jerak, T. (2026) · PLoS ONE · doi:10.1371/journal.pone.0339358
From Experience to Evidence: Evidence-Based Psychotherapy in Child and Adolescent Psychiatry
Yoo, J. H. (2026) · Journal of korean Academy of Child and Adolescent Psychiatry · doi:10.5765/jkacap.250064
Lessons we have learned from osseointegration can guide us when using artificial intelligence
Sadowsky, S. J. (2026) · Journal of Prosthetic Dentistry · doi:10.1016/j.prosdent.2026.01.003
Restorative justice and the evidence hierarchy: implications for policy and practice
Robinson, C. G., Logan, M. W., Dulisse, B. C., Adams, I. T., & Morgan, M. A. (2026) · Evidence Base · doi:10.1080/30679125.2026.2632868
Generalizing a causal effect from a trial to a target population : methodological and theoretical contributions
Colnet, B. (2023) · theses.fr (ABES) · doi:10.70675/11bb1cf9za376z4336z8998z647534b40e3e
Ten Questions for Ethics Committees Evaluating the Strength of Evidence in Support of Early Phase Trials
Hey, S. P., Fedyk, M., & Kimmelman, J. (2026) · Ethics & Human Research · doi:10.1002/eahr.70010
I Servizi di Salute Mentale: dal desiderio al disincanto
Bello, F., & Tombolini, L. (2026) · GRUPPI · doi:10.3280/gruoa1-2024oa22680
The effectiveness of integrated interventions to reduce violence against women and children and harmful norms in low- and middle-income countries: a meta-regression of systematic reviewsPreprint
Snow, K., Langan, D., Cislaghi, B., Shenderovich, Y., Siu, G., Guedes, A. C., Heise, L., & Gardner, F. E. M. (2026) · Research Square · doi:10.21203/rs.3.rs-9897766/v1
Halk Sağlığı Usul ve Üslubu Altıncı Kitap Tenkid
Turaman, C. (2026) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.4202
Optimizing Nurse-Led Rounds to Reduce Ventilator Days in a Bronchopulmonary Dysplasia Cohort
Loughran, M. E., & Powell, R. (2026) · Advances in Neonatal Care · doi:10.1097/anc.0000000000001405
Librarians and information specialists: Partners in evidence-based toxicology and other disciplines
Price, C. L., & Rethlefsen, M. L. (2026) · Evidence-Based Toxicology · doi:10.1080/2833373x.2026.2728359
Clinical Epidemiology and Evidence-Based Health Care
Germini, F., Marcucci, M., Bognanni, A., & Schünemann, H. J. (2025) · Springer eBooks · doi:10.1007/978-1-4614-6625-3_30-1
What works to change social norms that sustain intimate partner violence in low- and middle-income countries? A systematic review with meta-analyses and meta-regressionsPreprint
Snow, K. (2026) · Research Square · doi:10.21203/rs.3.rs-10909540/v1
What Works to Change Social Norms That Sustain Child Marriage? A Systematic Review with Meta-Analyses and Meta-RegressionsPreprint
Snow, K., Langan, D., Cislaghi, B., Backman-Levy, J. K., Steele, B., Blackwell, A., Backhaus, S., Shenderovich, Y., Langwenya, N., & Gardner, F. E. M. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.7408978
Decision Framework for Prioritizing Systematic Reviews Versus Primary/translational Research in Low- and Middle-income Countries
Bhattacharya, S., Kumari, A., Ramanathan, V., Kundu, S., Prabhakaran, C. V., Bhagat, A., Singh, A., & Singh, A. (2026) · Indian Journal of Community Medicine · doi:10.4103/ijcm.ijcm_166_26
What works to change social norms that sustain intimate partner violence in low- and middle-income countries? A systematic review with meta-analyses and meta-regressionsPreprint
Snow, K., Langan, D., Cislaghi, B., Backman-Levy, J. K., Steele, B., Little, M. T., Blackwell, A., Backhaus, S., Rodriguez-Baena, D., Shenderovich, Y., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-10909540/v2
Comparative Effectiveness Research
Martinez, A. I., Brouwer, E., & Moga, D. C. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-26472-6.00209-6
Characteristics of Prediabetes, predictors of progression and strategies to prevent Type 2 Diabetes Mellitus in a multiethnic population in the United Kingdom
Srinivasan, B. T. (2011) · Leicester Research Archive (University of Leicester)
Evaluating Ophthalmic Literature
Eisenberg, D., & Schacknow, P. N. (2010) · Springer eBooks · doi:10.1007/978-0-387-76700-0_13
Untitled work
(2006) · doi:10.1044/1058-0360(2006/031

Authors: Guyatt, G. H.
Corresponding author: Guyatt, Gordon H.
ORCID: Guyatt, Gordon H.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 1995-12-13
Volume: 274
Issue: 22
Pages: 1800
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.1995.03530220066035
OpenAlex: W2168226052
Cited by: 846
References: 39
Citations by year: 2026: 16 · 2025: 16 · 2024: 15 · 2023: 24 · 2022: 21 · 2021: 18 · 2020: 57 · 2019: 31 · 2018: 24 · 2017: 27 · 2016: 23 · 2015: 35 · 2014: 30 · 2013: 33 · 2012: 23
FWCI: 28.74
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords: strength of recommendation, evidence-based medicine, clinical guidelines, guideline implementation, classification of evidence, clinical decision-making

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Users' Guides to the Medical Literature: IX. A Method for Grading Health Care Recommendations

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Citations

Cites

Cited by

Related

Metadata

Record

About these checks