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

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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

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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

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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

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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.

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

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