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Tympanostomy Tubes 2022

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29 Strength of Action Terms in Guideline Statements and Implied Levels of Obligation Strength Definition Implied Obligation Strong Recommendation A strong recommendation means the benefits of the recommended approach clearly exceed the harms (or, in the case of a strong negative recommendation, the harms clearly exceed the benefits) and that the quality of the supporting evidence is high (Grade A or B). a In some clearly identified circumstances, strong recommendations may be made based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present. Recommendation A recommendation means the benefits exceed the harms (or, in the case of a negative recommendation, the harms exceed the benefits), but the quality of evidence is not as high (Grade B or C). a In some clearly identified circumstances, recommendations may be made based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits outweigh the harms. Clinicians should also generally follow a recommendation, but should remain alert to new information and sensitive to patient preferences. Option b An option means that either the quality of evidence is suspect (Grade D) a or that well-done studies (Grade A, B, or C) a show little clear advantage to one approach versus another. Clinicians should be flexible in their decision- making regarding appropriate practice, although they may set bounds on alternatives. Patient preference should have a substantial influencing role. a Adapted from American Academy of Pediatrics (AAP) classification scheme. b Option is similar to the "weak recommendation" used in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.

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