Journal of clinical epidemiology
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To examine compliance with International Committee of Medical Journal Editors' (ICMJE) policy on prospective trial registration along with predictors of compliance. ⋯ Twenty-eight percent of trials published in high-impact journals were retrospectively registered including nearly 10% that were registered after primary end point ascertainment could have had taken place. Prospective registration should be prompted and enforced to ensure transparency and accountability in clinical research.
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This article responds to issues raised by Antilla et al. in the Journal of Clinical Epidemiology about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's approach to rating imprecision and GRADE's use of statistics. They argue that GRADE confuses statistical terms and should provide a stepwise rating of imprecision for making decisions. Here, a clarification of those perceptions is provided. ⋯ The RIS focuses only on plausible rather plausible and worthwhile effects. The advantages of using the RIS include avoiding the reliance on statistical significance alone and the varying thresholds resulting from the importance and the baseline risk of the outcome on which the OIS relies. Finally, I argue that GRADE's certainty in the evidence is related to the statistical definition of accuracy but given GRADE's broad application to other ratings of certainty such as qualitative evidence, statistical accuracy does not serve as a definition for GRADE's quality or certainty in the evidence.
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The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) is a widely used methodology for the development of clinical practice guideline. Although its reproducibility is good for evaluating the quality of evidence, it has not been tested in context of developing recommendations. The objective of this study was to assess the reproducibility of all GRADE factors that determine the direction and strength of a recommendation among the guideline panel members with limited exposure to GRADE methodology. ⋯ Although not all elements of GRADE system had good agreement, the interrater agreement for assessing the quality of evidence and issuing a recommendation of for vs. against among panel members who had limited exposure to GRADE methodology was good. This is probably because GRADE has operationalized these two areas in more detail than other domains. Further operationalization of all GRADE domains such as with the GRADE evidence to decision frameworks would likely improve its reproducibility.
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The objective of our article is to show how "quality of evidence" and "imprecision," as they are defined in Grading of Recommendations Assessment, Development, and Evaluation (GRADE) articles, may lead to confusion. We focus only on the context of systematic reviews. ⋯ We believe that "conclusiveness" rather than "imprecision" would be a suitable term to use when the question whether the CI excludes or includes certain critical margins is being addressed. Conclusiveness could also replace quality of evidence as the final step for a systematic reviewer.