Updating risk prediction tools a case study in prostate cancer

Posted by / 15-Oct-2017 12:13

Updating risk prediction tools a case study in prostate cancer

By definition, Grade A evidence is evidence about which the Panel has a high level of certainty, Grade B evidence is evidence about which the Panel has a moderate level of certainty, and Grade C evidence is evidence about which the Panel has a low level of certainty.

The AUA nomenclature system explicitly links statement type to body of evidence strength, level of certainty, magnitude of benefit or risk/burdens, and the Panel’s judgment regarding the balance between benefits and risks/burdens (Table 2).

Conditional Recommendations also can be supported by any evidence strength.

When body of evidence strength is Grade A, the statement indicates that benefits and risks/burdens appear balanced, the best action depends on patient circumstances, and future research is .

When body of evidence strength Grade C is used, there is uncertainty regarding the balance between benefits and risks/burdens, alternative strategies may be equally reasonable, and better evidence is Risks/Burdens (or vice versa)Net benefit (or net harm) appears substantial Applies to most patients in most circumstances but better evidence is likely to change confidence(rarely used to support a Strong Recommendation) The Localized Prostate Cancer Panel was created in 2012 by the American Urological Association Education and Research, Inc. The Practice Guidelines Committee (PGC) of the AUA selected the Panel Chair who in turn appointed the Vice Chair.

In a collaborative process, additional Panel members, including members of the American Society for Radiation Oncology (ASTRO), the American Society of Clinical Oncology (ASCO), and Society of Urologic Oncology (SUO), with specific expertise in this area were then nominated and approved by the PGC. The draft guideline document was distributed to peer reviewers.

Additional supplemental searches were conducted adding additional literature in August 2015 and August 2016.

Two researchers assessed methodologic risk of bias for each study and resolved discrepancies by consensus.

When consensus could not be reached, a third researcher adjudicated.

To be considered as having medium risk of bias, the study met neither the criteria for low risk of bias nor the criteria for high risk of bias.

The categorization of evidence strength is conceptually distinct from the quality of individual studies.

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Evidence strength refers to the body of evidence available for a particular question and includes not only individual study quality but consideration of study design, consistency of findings across studies, adequacy of sample sizes, and generalizability of samples, settings, and treatments for the purposes of the guideline.

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