Cited by 246Clinical practice guidelines implementationMeta-analysis and systematic reviewsDelphi Technique in Research

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The GRADE System for Rating Clinical Guidelines

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Kavanagh, Brian P.·2009·PLoS Medicine

DOI 10.1371/journal.pmed.1000094PMC PMC2735782

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Early goal-directed therapy in the treatment of severe sepsis and septic shock
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., Peterson, E., & Tomlanovich, M. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa010307 · Cited by 10,743 · cited 1×
“, on the basis of the protocol of a commonly cited single-centre study”
Background
Intensive insulin therapy in critically ill patients.
Van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninckx, F., Schetz, M., Vlasselaers, D., Ferdinande, P., Lauwers, P., & Bouillon, R. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa011300 · Cited by 9,977 · cited 1×
“. No evidence exists for moderate glucose control in this context, whereas the value of tight control was supported by one single-centre randomized controlled trial (RCT)”
Background
Grading quality of evidence and strength of recommendations
(2004) · BMJ · doi:10.1136/bmj.328.7454.1490 · Cited by 8,477 · cited 5×
“Given also that the GRADE criteria are conveyed as ‘‘explicit and clear’’ [6], there should be little need for intensive methodological consultation from the GRADE group when experts produce guidelines.”
BackgroundInfluential
Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008
Dellinger, R. P., Levy, M. M., Carlet, J. M., Bion, J., Parker, M. M., Jaeschke, R., Reinhart, K., Angus, D. C., Brun‐Buisson, C., Beale, R. J., et al. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0934-2 · Cited by 6,789
Intensive versus Conventional Glucose Control in Critically Ill Patients
(2009) · New England Journal of Medicine · doi:10.1056/nejmoa0810625 · Cited by 5,119 · cited 1×
“14) [24].”
Intensive insulin therapy in the medical ICU
Van den Berghe, G., Wilmer, A., Hermans, G., Meersseman, W., Wouters, P. J., Milants, I., Van Wijngaerden, E., Bobbaers, H., & Bouillon, R. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa052521 · Cited by 3,639 · cited 2×
“, intensive insulin therapy) in most intensive care unit (ICU) patients [18–21].”
BackgroundResult
Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock
Dellinger, R. P., Carlet, J. M., Masur, H., Gerlach, H., Calandra, T., Cohen, J., Gea‐Banacloche, J., Keh, D., Marshall, J. C., Parker, M. M., et al. (2004) · Intensive Care Medicine · doi:10.1007/s00134-004-2210-z · Cited by 3,309
What is ‘quality of evidence’ and why is it important to clinicians?
Guyatt, G. H., Oxman, A. D., Kunz, R., Vist, G. E., Falck-Ytter, Y., & Schünemann, H. J. (2008) · BMJ · doi:10.1136/bmj.39490.551019.be · Cited by 3,250
Users' Guides to the Medical Literature
Guyatt, G. H. (1993) · JAMA · doi:10.1001/jama.270.17.2096 · Cited by 3,083
Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock
Dellinger, R. P., Carlet, J. M., Masur, H., Gerlach, H., Calandra, T., Cohen, J., Gea‐Banacloche, J., Keh, D., Marshall, J. C., Parker, M. M., et al. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000117317.18092.e4 · Cited by 3,038 · cited 4×
“In 2004 the SSC guidelines recommended that for serious sepsis, intravenous antibiotic therapy should be rapidly instituted [10]; this guideline was given a grade ‘‘E.”
BackgroundMethodInfluential

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“…in literature that is currently considered our best evidence leads to the conclusion so succinctly stated by the late Kavanagh that “…it is not clear that the opinion of a conscientious, judicious, well-educated and experienced clinician would necessarily be inferior to a systemized opinion” [22].”
Chest Wall Injury Society recommendation for surgical stabilization of nonunited rib fractures to decrease pain, reduce opiate use, and improve patient reported outcomes in patients with rib fracture nonunion after trauma
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“The certainty of evidence was evaluated following the GRADE guidelines 28 .”
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“, 2009 ) . t h e G r a D e f r a m e w o r k i s w i d e l y s u pp o r t e d b y e B M e x p e r t s ( G u y a tt e t a l ., 2015 ) , a f a c t w h i c h t h e y a l e C r i t i q u e a c k n o w l e d g e s e l s e w h e r e i n t h e d o c u m e n t . t h e y a l e C r i t i q u e ’ s i m p l i…”
Influential
An Antimicrobial Treatment Assessment of Serratia marcescens Bacteremia and Endocarditis
Slain, D., Howard, C. A., & Cooper, C. G. (2022) · Frontiers in Antibiotics · doi:10.3389/frabi.2022.942721 · Cited by 14
“guidance document provides “suggested approaches” based on clinical experience, expert opinion, and a review of the available literature, rather than using evidence-based grading criteria like GRADE or the US Public Health criteria (Kavanagh, 2009).”
Method
Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System
Krishan, S., Dhiman, R. K., Kalra, N., Sharma, R., Baijal, S. S., Arora, A., Gulati, A., Eapan, A., Verma, A. K., Keshava, S., et al. (2019) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2019.07.005 · Cited by 14
Hemodynamic Monitoring in Patients With Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis
Simonassi, F., Ball, L., Badenes, R., Millone, M., Citerio, G., Zona, G., Pelosi, P. P., & Robba, C. (2020) · Journal of Neurosurgical Anesthesiology · doi:10.1097/ana.0000000000000679 · Cited by 13
Is Cadmium a Risk Factor for Breast Cancer – Results from a Nested Case–Control Study Using Data from the Malmö Diet and Cancer Study
Andersson, E. M., Sandsveden, M., Forsgard, N., Sällsten, G., Manjer, J., Engström, G., & Barregård, L. (2021) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-21-0181 · Cited by 13
Exclusion of ‘nonRCT evidence’ in guidelines for chronic diseases – is it always appropriate? The Look AHEAD study
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Development of clinical guidelines for inborn errors of metabolism: Commentary
Vockley, J., Chapman, K. A., & Arnold, G. L. (2013) · Molecular Genetics and Metabolism · doi:10.1016/j.ymgme.2013.01.013 · Cited by 13
“Anothermethod is the GRADE systemwhich divides evidence into the categories of high, medium, low, and very low quality (or the chance of changing practice based on findings) [2].”
Background
Is There Not Sufficient Evidence to Show That Haemodiafiltration Is Superior to Conventional Haemodialysis in Treating End-Stage Kidney Disease Patients?
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Australasian hidradenitis suppurativa management guidelines
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Surgical Infection Society: Chest Wall Injury Society Recommendations for Antibiotic Use during Surgical Stabilization of Traumatic Rib or Sternal Fractures to Reduce Risk of Implant Infection
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“For qualitative synthesis, quality and certainty of published evidence was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) deﬁnitions [20,21].”
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Effect of Postoperative Hormonal Suppression on Fertility in Patients With Endometriosis After Conservative Surgery
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Multifidus atrophy and/or dysfunction following lumbar radiofrequency ablation: A systematic review
Francio, V. T., Glicksman, M., Leavitt, L., Gill, B., Shah, A. S., Westerhaus, B. D., Lam, C. M., & D'Souza, R. S. (2024) · PM&R · doi:10.1002/pmrj.13202 · Cited by 9
“29 Upon completion of the assessment of risk of bias and quality assessment, all authors reviewed the results for unani-mous conclusions.”
Clinical vs. statistical significance: considerations for clinical laboratories
Hakan, H., Tran, M. T. C., Markus, C., Ho, C. S., Loh, T. P., Zakaria, R., Cooke, B. R., Theodorsson, E., & Greaves, R. F. (2025) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2025-0219 · Cited by 10
“Several publications [59 – 61] and books [62, 63] have subsequently elucidated this ﬁ eld of evidence-based medicine, including the GRADE system [64, 65].”
Optimizing exercise dosage for executive function in alzheimer’s disease: A Bayesian dose-response meta-analysis of randomized trials
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Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II’s method
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“This finding suggests that the issue of disagreement on which grading system should be elected as the gold standard,which arouses concern over the validity of any grading system, remains unresolved (46).”
Background
Infections and Smartphone Use in Nursing Practice: A Systematic Review
Mario, S. D., Dionisi, S., Simone, E. D., Liquori, G., Cianfrocca, C., Muzio, M. D., & Giannetta, N. (2022) · Florence Nightingale Journal of Nursing · doi:10.54614/fnjn.2022.21190 · Cited by 9
“A qualitative evaluation of the evidence related to the individual outcomes was conducted (GRADE Handbook) (Kavanagh, 2009).”
Method
Treatment of pain in length-dependent peripheral neuropathy with the use of spinal cord stimulation: a systematic review
D'Souza, R. S., ElSaban, M., Alvarez, G. A. M., Jin, M. Y., Kubrova, E., & Hassett, L. C. (2023) · Pain Medicine · doi:10.1093/pm/pnad091 · Cited by 9
Improving Rehabilitation Research to Optimize Care and Outcomes for People with Chronic Primary Low Back Pain: Methodological and Reporting Recommendations from a WHO Systematic Review Series
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“GRADE focuses on intervention effectiveness, is used to classify the certainty of evidence in systematic reviews and clinical practice guidelines, and is endorsed by organizations around the world [67].”
Background
Role of closed loop stimulation pacing (CLS) in vasovagal syncope
Ruzieh, M., Ammari, Z. A., Dasa, O., Karim, S., & Grubb, B. P. (2017) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13194 · Cited by 9
Pharmacist authorship on clinical practice guidelines
Thompkins, A. W., Norman, B. F., Hill, B. K., Antosz, K., & Bookstaver, P. B. (2018) · JACCP JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY · doi:10.1002/jac5.1056 · Cited by 10
“of rating systems have been utilized with varying reliability and reproducibility.(8,9) Most recently, the Grades of Recommendation, Assess-”
Method
Including values in evidence-based policy making for breast screening: An empirically grounded tool to assist expert decision makers
Parker, L. M. (2017) · Health Policy · doi:10.1016/j.healthpol.2017.03.002 · Cited by 9
Surgical Infection Society–Chest Wall Injury Society Recommendations for Management of Surgical Site or Implant-Related Infections After Surgical Stabilization of Traumatic Rib or Sternal Fractures
Forrester, J. D., Faliks, B. T., Cardarelli, C. L., Choudhry, M. S., Patel, B. M., Ricaurte, D., Sarani, B., Sfakianos, M. G., Kartiko, S., & Huston, J. M. (2023) · Surgical Infections · doi:10.1089/sur.2023.086 · Cited by 8
“10,11 Using a process of iterative consensus, all committee members voted to accept or reject the recommendation.”
Beyond binary comparisons: a Bayesian dose-response meta-analysis of exercise on executive function in children and adolescents with ADHD
Pan, Q., Zheng, S., & He, P. (2025) · Pediatric Research · doi:10.1038/s41390-025-04325-1 · Cited by 8
The importance of clinical pathways and protocols in pediatric nephrology
Mammen, C., Matsell, D., & Lemley, K. (2014) · Pediatric nephrology (Berlin, West) · doi:10.1007/s00467-013-2577-6 · Cited by 10
“Such concerns had earlier led to the development of the GRADE approach to evaluating clinical evidence [22] (used by KDIGO, the Cochrane Collaboration, and the US Agency for Healthcare Research and Quality, among other organizations), which has recently been questioned [23].”
Method
Should Guidelines for Glycemic Control of the Critically Ill Be Individualized?: Weighing the Evidence From Randomized and Observational Investigations
Krinsley, J. S. (2014) · Hospital Practice · doi:10.3810/hp.2014.04.1099 · Cited by 8
American thyroid association guidelines are inconsistent with Grading of Recommendations Assessment, Development, and Evaluations—A meta-epidemiologic study
Bautista-Orduno, K. G., Dorsey-Treviño, E. G., González‐González, J. G., Castillo-Gonzalez, D. A., García-Leal, M., Raygoza-Cortez, K., Gionfriddo, M. R., & Rodríguez‐Gutiérrez, R. (2020) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.02.010 · Cited by 8
The Diagnostic Validity of Clinical Tests in Temporomandibular Internal Derangement: A Systematic Review and Meta-analysis
Chaput, E., Gross, A., Stewart, R., Nadeau, G., & Goldsmith, C. H. (2011) · Physiotherapy Canada · doi:10.3138/ptc.2010-54 · Cited by 8
Perioperative Resuscitation and Life Support (PeRLS): An Update
Moitra, V. K., Banerjee, A., Ben-Jacob, T. K., Cortegiani, A., Einav, S., Gitman, M., Ippolito, M., Klock, P. A., Lakbar, I., Maccioli, G. A., et al. (2025) · Anesthesiology · doi:10.1097/aln.0000000000005728 · Cited by 7
Adjunctive cariprazine as a novel effective strategy for treating major depressive disorder: A systematic review and meta-analysis
Xie, M., Qiu, Y., Wang, M., Wei, X., Tao, Y., Duan, A., Shang, J., Gao, W., & Wang, Z. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.02.018 · Cited by 8
Can Anesthesiologists Help? Analysis of the American Heart Association–Emergency Cardiac Care Recommendations for Cardiopulmonary Resuscitation, with a Focus on Management of Airway and Breathing
Einav, S., Kaufman, N., & O'Connor, M. C. (2015) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000000560 · Cited by 7
CHIMERAS showed better inter-rater reliability and inter-consensus reliability than GRADE in grading quality of evidence: A randomized controlled trial
Wu, X. Y., Chung, V. C., Wong, C. H. L., Yip, B. H. K., Cheung, W. K. W., & Wu, J. C. Y. (2018) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2018.10.008 · Cited by 7
Pain, Analgesic Effectiveness, and Long-Term Opioid Dependency
Skrobik, Y. K., & Flood, P. D. (2019) · Lessons from the ICU · doi:10.1007/978-3-030-24250-3_15 · Cited by 7
Efficacy and safety of nutrition therapy for patients undergoing abdominal surgery: a systematic review and network meta-analysis
Wang, T., Huang, J., Shang, Z., Deng, M., Su, J., Duan, X., & Kong, D. (2025) · European Journal of Clinical Nutrition · doi:10.1038/s41430-025-01637-7 · Cited by 6
“We used odds ratios (ORs) as an effect value for dichotomous outcomes and standardized mean differences (SMD) as an effect value for continuous outcomes, both with 95% con ﬁ dence intervals (CIs).”
Management of Liver Injuries: The Panamerican Trauma Society 2018 Consensus Guidelines
Ottolino, P., Pust, G. D., Peck, G., & Razek, T. S. (2014) · Panamerican Journal of Trauma Critical Care & Emergency Surgery · doi:10.5005/jp-journals-10030-1247 · Cited by 6
Obstetric Anal Sphincter Injury and Female Sexual Dysfunction: A Systematic Review
Jericevic, D., Cervantes, I. A., Nwaba, A. U. A., Thibault, M. D., & Siddique, M. (2024) · Urogynecology · doi:10.1097/spv.0000000000001593 · Cited by 6
Can you trust clinical practice guidelines for laparoscopic surgery? A systematic review of clinical practice guidelines for laparoscopic surgery
Leung, J., Leong, J., Yeung, K. A., Hao, B. Z., McCluskey, A., Kayani, Y., Davidson, B. R., & Gurusamy, K. S. (2021) · Updates in Surgery · doi:10.1007/s13304-021-01168-3 · Cited by 6
“This is done to provide the guideline users a sense with information on the reliability and quality of the guidelines [11].”
BackgroundInfluential
Science and Evidence: Separating Fact from Fiction
HESS, D. R. (2013) · Respiratory Care · doi:10.4187/respcare.02591 · Cited by 6
Surgical treatment for cryptoglandular and Crohn’s perianal fistulas: Protocol of an umbrella review
Mei, Z., Qin, F., Du, P., Li, B., Fang, C., Gu, J., Li, Y., Zhou, H., Shao, Z., Ge, M., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0251460 · Cited by 6
Surgical Infection Society Guidelines for Total Abdominal Colectomy versus Diverting Loop Ileostomy with Antegrade Intra-Colonic Lavage for the Surgical Management of Severe or Fulminant, Non-Perforated Clostridioides difficile Colitis
Forrester, J. D., Colling, K. P., Diaz, J. J., Faliks, B. T., Kim, P. K., Tessier, J. M., Tung, J. T., & Huston, J. M. (2021) · Surgical Infections · doi:10.1089/sur.2021.126 · Cited by 6
“The GRADE framework was applied to all quantiﬁed outcomes for assessment for risk of bias, publication inconsistency, imprecision, and indirectness [7].”
Endometrial scratching can be offered outside clinical research setting: let us show you why
Vitagliano, A., Sardo, A. D. S., Noventa, M., Carugno, J. A., Cicinelli, E., Pacheco, L. A., Vitale, S. G., Campo, R., Laganà, A. S., Haimovich, S., et al. (2021) · Human Reproduction · doi:10.1093/humrep/deab060 · Cited by 6
Updating The General Practitioner on The Association Between Teeth Loss and Temporomandibular Disorders: A Systematic Review
Leal, M. D. C. F., Castro, M. M. L., & Sosthenes, M. C. K. (2022) · European Journal of Dentistry · doi:10.1055/s-0042-1757209 · Cited by 5
“31 This tool aimed to summarize the evidencetracked, based on thefour stepsand considering the riskof bias, inconsistency, indirectness, imprecision focusing on the certainty of evidence among included studies in the systematic review.”
Robotic Versus Laparoscopic Versus Open Surgery for Non-Metastatic Pancreatic Neuroendocrine Tumors (pNETs): A Systematic Review and Network Meta-Analysis
Bousi, S.-E., Zachiotis, M., Papapanou, M., Frountzas, M., Symeonidis, D., Raptis, D. G., Papaziogas, B., Toutouzas, K. G., Felekouras, E. S., & Schizas, D. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216303 · Cited by 6
“The evaluation of study quality and grading of recommendations were conducted , and Evaluation” (GRADE) approach [67].”
Method
Wrong guidelines: how to detect them and what to do in the case of flawed recommendations
Iannone, P., Costantino, G., Montano, N., Podda, G. M., Minardi, M., Doyle, J., & Cartabellotta, A. (2016) · BMJ Evidence-Based Medicine · doi:10.1136/ebmed-2016-110607 · Cited by 5
“Furthermore, there is the potential to create a serious obstacle to otherwise necessary research.(20) The scientific organisation producing that suspicious guideline should be notified and medicolegal value of that guideline downgraded.”
Background
Is science the answer?
Keane, M. J., & Berg, C. (2017) · British Journal of Anaesthesia · doi:10.1093/bja/aex334 · Cited by 5
The use of GRADE approach in Cochrane reviews of TCM was insufficient: a cross-sectional survey
Wang, Q., Xiao, Y., Guo, T., Zhu, H., Li, J., Lai, H., Zhang, Y., Yang, F., Liu, Y., Yang, K., et al. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.11.004 · Cited by 5
Practical guidelines and apps for improvement of guideline implementation
Bischoff, S. C., Cuerda, C., & Barazzoni, R. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.07.031 · Cited by 5
Effects of Wii-Fit games training on motor skills, balance, and agility in children with developmental coordination disorder: a systematic review and meta-analysis
Chang, J., Lei, Z., Ma, P., Cui, J., & Zhu, W. (2025) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-025-01384-z · Cited by 5
Use of Grading of Recommendations, Assessment, Development, and Evaluation to Combat Fake News: A Case Study of Influenza Vaccination in Pregnancy
Zafar, S., Habboush, Y. Y., & Beidas, S. (2018) · JMIR Medical Education · doi:10.2196/10347 · Cited by 4
“GRADE has been adopted by many organizations including the World Health Organization, American College of Physicians, The Endocrine Society, Infectious Diseases Society of America, The Canadian Task Force on Preventive Health Care, UpToDate, and other domestic and international organizations [2].”
Method
Discussion: Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study
Selvaggi, G., Andréasson, M., & Georgas, K. (2018) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000005114 · Cited by 4
The French Guidelines on muscle relaxants and reversal in anaesthesia: The chain is finally broken and the soul is freed
Brull, S. J., & Eriksson, L. I. (2020) · Anaesthesia Critical Care & Pain Medicine · doi:10.1016/j.accpm.2020.01.004 · Cited by 4
Guidelines in Gastroenterology: Careful Interpretation Is Essential
Correia, C., Almeida, N., & Figueiredo, P. (2021) · GE Portuguese Journal of Gastroenterology · doi:10.1159/000518322 · Cited by 4
Superiority of sugammadex in preventing postoperative pulmonary complications
Liu, H., Luo, R., Cao, S.-J., Zheng, B., Ye, L., & Zhang, W. (2023) · Chinese Medical Journal · doi:10.1097/cm9.0000000000002381 · Cited by 4
“GradingofRecommendations, Assessment, Development, and Evaluation (GRADE) approach was used to analyze the quality of evidence for outcomes derived from the same research type.([22])”
Method
Optimal exercise dosage and type for improving post-traumatic stress disorder: a systematic review and network meta-analysis of randomized controlled trials
Li, X.-J., Xia, H., Yu, G.-H., Hu, Y., & Zhu, F. (2025) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2025.102004 · Cited by 3
Overall and modality-specific exercise doses for motor skill improvement in cerebral palsy: a systematic review and Bayesian network dose-response meta-analysis
Xiong, Q., Duan, X.-L., & He, P.-W. (2026) · PeerJ · doi:10.7717/peerj.21035 · Cited by 3
“Evidence certainty was graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework ( Kavanagh, 2009 ), which considers methodological limitations, consistency, indirectness, imprecision, and risk of publication bias.”
Principles governing heart failure therapy re-examined relative to standard evidence-based medicine-driven guidelines
Tan, L., Chinnappa, S., Tan, D. K., & Hall, A. S. (2011) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.11.105 · Cited by 3
Teratogenic Risk Impact and Mitigation (TRIM): Study Protocol for the Development of a Decision Support Tool to Prioritize Medications for Risk Mitigation
Winterstein, A. G., Ewig, C. L. Y., Wang, Y., Smolinski, N. E., Toyserkani, G. A., LaCivita, C., Lackey, L. G., Eggers, S. L., Zhou, E. H., Diaby, V., et al. (2024) · Drug Safety · doi:10.1007/s40264-024-01488-4 · Cited by 3
Comparison of Spontaneous Breathing Trials in Clinical Practice and Current Clinical Practice Guidelines
Sorg, M. E., & McHenry, K. L. (2025) · Respiratory Care · doi:10.1089/respcare.12478 · Cited by 3
“9 This approach provides the reader with an understanding of how strong the evidence is in providing the recommendation.”
The effectiveness of trace element supplementation following severe burn injury: A systematic review protocol
Kurmis, R., Aromataris, E., & Greenwood, J. (2013) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2013-1134 · Cited by 3
Enhancing fundamental motor skills through active play: a systematic review and meta-analysis of educational contexts
Ramos-Munell, J., Gallardo‐Gómez, D., Álvarez‐Barbosa, F., Alfonso‐Rosa, R. M., Reilly, J. J., Okely, A. D., Cruz, B. D. P., & del Pozo-Cruz, J. (2025) · European Early Childhood Education Research Journal · doi:10.1080/1350293x.2025.2487929 · Cited by 3
“The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to rate the quality of evidence presented in this meta-analysis (Kavanagh 2009).”
International Clinical Practice Guidelines
Postelnicu, R., Rhodes, A., & Evans, L. (2018) · Springer eBooks · doi:10.1007/978-3-319-73506-1_7 · Cited by 3
Clinical Practice Guidelines in Anesthesiology: Adjusting Our Expectations
Neuman, M. D., & Apfelbaum, J. L. (2021) · Anesthesiology · doi:10.1097/aln.0000000000003809 · Cited by 3
Indoor tanning: Evidence surrounding advertised health claims
Laughter, M. R., Anderson, J. B., Aguilera, M. N., Sadeghpour, M., & Pugliano‐Mauro, M. A. (2021) · Clinics in Dermatology · doi:10.1016/j.clindermatol.2021.08.015 · Cited by 2
Optimal dose and effectiveness of different types of physical activity to improve blood pressure in people with type 2 diabetes mellitus: A systematic review and network meta-analysis
Álvarez‐Barbosa, F., Ramos-Munell, J., del Pozo-Cruz, J., Cruz, B. D. P., Ceballos-Sánchez, J. L., & Gallardo‐Gómez, D. (2025) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-025-10005-6 · Cited by 3
Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines
Shin, E.-S., Jang, J.-E., Yeon, J.-Y., Kim, D.-S., Chang, S., & Lee, Y. S. (2018) · Journal of Korean Medical Science · doi:10.3346/jkms.2018.33.e79 · Cited by 2
Disparities between randomized clinical trial participants and sepsis patients in real-world
Bai, X., Zeng, P., Wang, B., Zhang, Z., Jin, X., Kang, Y., Cheng, Y., & Wu, Q. (2023) · Journal of Critical Care · doi:10.1016/j.jcrc.2023.154362 · Cited by 3
A Digital Tool for Clinical Evidence–Driven Guideline Development by Studying Properties of Trial Eligible and Ineligible Populations: Development and Usability Study
Mumtaz, S., McMinn, M., Cole, C., Gao, C., Hall, C., Guignard‐Duff, M., Huang, H., McAllister, D., Morales, D. R., Jefferson, E., et al. (2024) · Journal of Medical Internet Research · doi:10.2196/52385 · Cited by 3
“In principle, guideline developers following GRADE [11] already consider applicability as part of the assessment of indirectness.”
Influential
A pragmatic approach to selecting a grading system for clinical practice recommendations in palliative care
Voznyuk, S., Carter, R. Z., & Ridley, J. (2024) · Palliative Medicine · doi:10.1177/02692163241286658 · Cited by 2
“3,4 This allows for nuance when high-quality studies are associated with burdensome therapy or low-quality studies with improved patient satisfaction.”
Strength of evidence and handling uncertainty: practical considerations and general observations
Bedford, M. R., Pettersen, K., & Minhas, R. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.11.024 · Cited by 2
“For example, its application in the Surviving Sepsis Campaign guidelines relating to how the weighting of individual recommendations based on expert opinion on sepsis may differ from that derived by a GRADE process [15].”
Method
Clinical Trial Design Methodology for Pain Outcome Studies
Vetter, T. R., & Chou, R. (2013) · Elsevier eBooks · doi:10.1016/b978-0-323-08340-9.00080-3 · Cited by 2
Infection prevention strategies for procedures performed outside operating rooms: A conceptual integrated model
Masse, V., Edmond, M. B., & Diekema, D. J. (2017) · American Journal of Infection Control · doi:10.1016/j.ajic.2017.07.030 · Cited by 2
Another oral cancer clinical guideline - but does it propose changes to dental practice?
Crossan, L., & Conway, D. I. (2019) · Evidence-Based Dentistry · doi:10.1038/s41432-019-0005-x · Cited by 2
Influence of health interventions on quality of life in seriously ill children at the end of life: a systematic review protocol
Piette, V. E., Cohen, J., Deliëns, L., Pauwels, N., ten Bosch, J. V. D. W., & Beernaert, K. (2019) · Systematic Reviews · doi:10.1186/s13643-019-1059-8 · Cited by 2
Hepatorenal Syndrome
Divens, L. L., & Rivera, S. L. (2022) · Critical Care Nursing Clinics of North America · doi:10.1016/j.cnc.2022.04.010 · Cited by 2
Response to Comment on: The Efficacy of Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis Symptoms and Structural Changes: A Systematic Review and Meta-Analysis
Sax, O. C., Chen, Z., Mont, M. A., & Delanois, R. E. (2022) · The Journal of Arthroplasty · doi:10.1016/j.arth.2022.06.001 · Cited by 2
Do Prospective Intent and Established Metrics Correlate with Journal Impact Factor in Musculoskeletal Physical Therapy Trials?: A Secondary Analysis of A Methodological Review
Riley, S. P., Swanson, B. T., Shaffer, S. M., Sawyer, S. F., & Cleland, J. A. (2022) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2022.2041285 · Cited by 2
“[5], and Physiotherapy Evidence Database (PEDro) scale [6] to critically appraise randomized clinical trials (RCTs), important considerations are whether the research questions were generated prospectively and if the authors subsequently followed their prospective intent when analyzing and interpreting the data [7].”
Background
Making the GRADE: Providing Clinical Practice Guidance to the European Association of Urology
Canfield, S. E., Omar, M. I., & Ribal, M. J. (2023) · European Urology · doi:10.1016/j.eururo.2023.03.006 · Cited by 2
Effect of early intervention for early-stage psychotic disorders on suicidal behaviours – a systematic review protocol
Tahmazov, E., Blachier, A., Nabbé, P., Guillou-Landréat, M., Walter, M., & Lemey, C. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1359764 · Cited by 1
Adaptation of Clinical Practice Guideline for Assessment of Liver Fibrosis in Patients with Non Alcoholic Fatty Liver Disease in Isfahan Province
Hosseeini, S. M., Jafari, M., Tahmasebi, M., & Adibi, P. (2024) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_284_22 · Cited by 1
“[4,8] Thirty‑five eligible members of the Isfahan Association of Adult Gastroenterology and Hepatology were enrolled by a census of all available people and the people participated voluntarily for the survey.”
Background
Efficacy and safety of 11 oral preparations of single-source traditional Chinese medicines in the treatment of unstable angina pectoris: a systematic review and network meta-analysis
Li, X. C., Li, X., Zhu, X., Xin, X., Sheng, R., Wang, T., Kan, J.-M., & Huang, Y. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1582661 · Cited by 1
“In this study, the certainty of evidence was systematically evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework (Kavanagh, 2009).”
The effects of exercise modality and dose on improving executive function in stroke patients: A systematic review and Bayesian network dose-response meta-analysis
Zheng, S., Pan, Q., & Chen, L. (2025) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2025.106117 · Cited by 1
Outcomes of assisted reproductive technology in patients with immune-mediated rheumatic diseases: A systematic review and meta-analysis
Kontogiannis, A., Papapanou, M., Kalouta, N., Syristatidi, K., & Siristatidis, C. S. (2026) · Journal of Reproductive Immunology · doi:10.1016/j.jri.2026.104836 · Cited by 1
Effects of overall and modality-specific exercise dose on lower-limb functional mobility in middle-aged and older adults with stroke: A systematic review and bayesian dose-response meta-analysis
Bai, P., Xiong, Q., & Wu, T. (2026) · Geriatric Nursing · doi:10.1016/j.gerinurse.2026.103842 · Cited by 1
Effects of different exercise interventions on quality of life in breast cancer survivors after treatment: a systematic review and network meta-analysis
Zhao, X., Wang, Y., Yi, Y., Zhan, H., Chen, H., & Song, Q. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1775358 · Cited by 1
Effects of acute and long-term exercise modalities and doses on brain-derived neurotrophic factor in patients with stroke: a Bayesian network meta-analysis
Yang, H., Rao, Y., & Chen, L. (2026) · Frontiers in Systems Neuroscience · doi:10.3389/fnsys.2026.1905191 · Cited by 1
“The certainty of evidence was evaluated using the GRADE framework (Kavanagh, 2009).”
The Evidence Hierarchy
Paul, M. (2018) · Springer eBooks · doi:10.1007/978-3-319-78966-8_2 · Cited by 1
Is GRADE the Right Choice for Clinical Practice Guidelines Developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation?
Bur, A. M., & Rosenfeld, R. M. (2019) · Otolaryngology · doi:10.1177/0194599819846458 · Cited by 1
Pseudoscience and attacks on transgender people
Murib, Z. (2025) · European Journal of Politics and Gender · doi:10.1332/25151088y2025d000000095 · Cited by 1

Authors: Kavanagh, B. P.
Affiliations: University of Toronto (CA)
Corresponding author: Kavanagh, Brian P.
Venue: PLoS Medicine
Publisher: Public Library of Science (PLoS)
Published: 2009-09-15
Volume: 6
Issue: 9
Pages: e1000094
ISSN: 1549-1277 (ISSN-L)
1549-1676
DOI: 10.1371/journal.pmed.1000094
PMC: PMC2735782
OpenAlex: W1991363364
Cited by: 246
References: 61
Citations by year: 2026: 17 · 2025: 18 · 2024: 19 · 2023: 17 · 2022: 18 · 2021: 20 · 2020: 16 · 2019: 19 · 2018: 21 · 2017: 14 · 2016: 10 · 2015: 7 · 2014: 7 · 2013: 15 · 2012: 8
FWCI: 9.41
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS Medicine (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: American Thoracic Society
World Health Organization
University of Pennsylvania
Society of Thoracic Surgeons
European Respiratory Society
Agency for Healthcare Research and Quality
Socialstyrelsen
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
Social Sciences › Sociology and Political Science › Delphi Technique in Research
Keywords: GRADE system, guideline quality assessment, evidence-based medicine, health policy
MeSH terms: Humans, Respiration, Artificial, Respiratory Distress Syndrome, Practice Guidelines as Topic, Sepsis, Evidence-Based Medicine

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