Subject(s)
COVID-19 , SARS-CoV-2 , Asymptomatic Diseases , Asymptomatic Infections , Delivery of Health Care , Humans , PathologistsSubject(s)
Blood Glucose Self-Monitoring/methods , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 2/diagnosis , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Referral and Consultation/organization & administration , Adolescent , Blood Glucose , Child , Child, Preschool , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/drug therapy , Disease Management , Drug Administration Schedule , Fatigue , Humans , Insulin/blood , Medical History Taking , Patient Education as Topic , Polydipsia , Polyuria , Practice Guidelines as Topic , Weight LossABSTRACT
OBJECTIVES: Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a system for rating the confidence in estimates of effect and grading guideline recommendations. It promotes evaluation of the quality of the evidence for each outcome and an assessment of balance between desirable and undesirable outcomes leading to a judgment about the strength of the recommendation. In 2007, the National Institute for Health and Clinical Excellence began introducing GRADE across its clinical guideline program to enable separation of judgments about the evidence quality from judgments about the strength of the recommendation. STUDY DESIGN AND SETTING: We describe the process of implementing GRADE across guidelines. RESULTS: Use of GRADE has been positively received by both technical staff and guideline development group members. CONCLUSION: A shift in thinking about confidence in the evidence was required leading to a more structured and transparent approach to decision making. Practical problems were also encountered; these have largely been resolved, but some areas require further work, including the application of imprecision and presenting results from analyses considering more than two alternative interventions. The use of GRADE for nonrandomized and diagnostic accuracy studies needs to be refined.
Subject(s)
Epidemiology/standards , Evidence-Based Practice/organization & administration , Guideline Adherence/standards , Practice Guidelines as Topic , Quality Assurance, Health Care/standards , Humans , Program Development , Program Evaluation , Randomized Controlled Trials as Topic , United StatesSubject(s)
Brain Diseases/complications , Muscle Relaxants, Central/therapeutic use , Muscle Spasticity/etiology , Muscle Spasticity/therapy , Occupational Therapy , Orthopedic Procedures , Physical Therapy Modalities , Adolescent , Baclofen/administration & dosage , Botulinum Toxins, Type A/administration & dosage , Brain Diseases/epidemiology , Cerebral Palsy/complications , Child , Humans , Injections, Spinal , Muscle Spasticity/epidemiology , Orthotic Devices/statistics & numerical data , Rhizotomy , United Kingdom/epidemiology , Young AdultSubject(s)
Pregnancy, Multiple , Prenatal Care/methods , Female , Gestational Age , Humans , Practice Guidelines as Topic , Pregnancy , Triplets , TwinsSubject(s)
Hypertension/therapy , Practice Guidelines as Topic , Pregnancy Complications, Cardiovascular/therapy , Chronic Disease , Female , Fetal Monitoring/methods , Humans , Hypertension, Pregnancy-Induced/therapy , Postnatal Care/methods , Pre-Eclampsia/therapy , Preconception Care/methods , Pregnancy , Prenatal Care/methods , Risk Assessment , Risk FactorsSubject(s)
Bacteremia/therapy , Meningitis, Bacterial/therapy , Adolescent , Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Child , Child, Preschool , Contraindications , Fluid Therapy , Humans , Infant , Long-Term Care , Meningitis, Bacterial/diagnosis , Meningitis, Meningococcal/diagnosis , Meningitis, Meningococcal/therapy , Risk Factors , Spinal PunctureSubject(s)
Diabetes, Gestational/therapy , Guidelines as Topic , Cost-Benefit Analysis , Diabetes, Gestational/economics , Female , Government Agencies/organization & administration , Government Agencies/standards , Health Services Accessibility , Humans , Pregnancy , Quality of Health Care , Societies, Medical , Societies, Scientific , United Kingdom , United StatesABSTRACT
BACKGROUND: A sulphur dioxide (SO(2)) episode occurred in the United Kingdom in 1998. The worst affected area was the city of Nottingham. METHODS: Emergency hospital admissions in Nottingham in the episode week were compared with those in the previous week. RESULTS: A statistically significant increase in admissions for all respiratory diseases occurred in the episode week (odds ratio (OR) = 1.40, 95 per cent confidence interval (CI) = 1.00-1.94). Ten of the 25 excess admissions were for asthma, although the excess for asthma alone was not statistically significant (OR = 1.90, 95 per cent CI = 0.87-4.15). CONCLUSIONS: The excess admissions for respiratory diseases could have been caused by exposure to SO(2), to other pollutants present in increased concentrations during the pollution episode, or by seasonal variations in the frequency of asthma symptoms, or prevailing weather conditions. This study shows how simple analyses of routinely collected health data can be used to assess public health impacts of pollution episodes.