A Modified Approach to Grading of Evidence

作者：Laxmaiah Manchikanti · 发表于：Pain Physician · 年份：2014 · DOI：10.36076/ppj.2014/17/e319 · 被引用次数：115 · 研究领域：Medical Imaging and Analysis

H H ealth care organization, delivery, and outcomes of care are the basic requirements of and the focus of health care for research, practice, and policy (1,2).Since the inception of evidence-based medicine in 1992, the emphasis on evidence-based medicine, comparative effectiveness research, evidence synthesis and the development of guidelines continues to grow (1).The emphasis on evidence synthesis and development of guidelines has been the focus of the Institute of Medicine (IOM) leading to the re-engineering of its definition of clinical guidelines in 2011, along with the establishment of standards for systematic reviews (3,4).Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are formed by a systematic review of evidence (3).The IOM also described a systematic review as a scientific investigation that focuses on a specific question and uses explicit, pre-specified scientific methods to identify, select, assess, and summarize the findings of similar but separate studies.Meta-analysis, in contrast to a systematic review, is the statistical pooling of data across studies to generate a summaries or pooled estimate of effects (5).However, challenges in implementing the IOM's systematic review standards and deficiencies of IOM's standards in guideline development have ALSO been described.It has been shown that the IOM failed to follow its own standards (6) and that even the Agency for Healthcare Research and Quality (...