title: GRADE system: new paradigm.
abstract: OBJECTIVE
  An exposition of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to recommendations.
  
  
  RESULTS
  In this review, we outline the process whereby the strength of evidence from the literature undergoes a systematic reappraisal. The GRADE system allows four grades of evidence (high quality, moderate, low, and very low) and strength of recommendation is qualified as strong, weak, or conditional to an intervention (pro or con) and defined as the level of confidence that desirable effects predominate over untoward ones with a certain intervention. We provide research and clinical reviews in various settings in which this approach has been used.
  
  
  CONCLUSIONS
  Evidence-based medicine requires integrating the best available 'benchmark' literature with patient preferences and values (bedside) and is an evaluation process involving both patient and clinician, with a systematic assessment of the rated evidence from state-of-the-art medical literature. The GRADE methodology was developed as an application of evidence-based medicine to the field of recommendations and their formulation. The GRADE working group brings together clinical researchers and methodologists who developed a rating system to assess the quality of evidence for the purpose of making clinical practice recommendations.
authors.affiliation: Department of Paediatrics, Melloni Hospital, Milan, Italy. terrycom1957@gmail.com
authors.forename: Luigi
authors.initials: L
authors.lastname: Terracciano
authors.forename: Jan
authors.initials: J
authors.lastname: Brozek
authors.forename: Enrico
authors.initials: E
authors.lastname: Compalati
authors.forename: Holger
authors.initials: H
authors.lastname: Schünemann
mesh_terms: D005069:Evaluation Studies as Topic; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards; D006287:Health Planning Guidelines; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards