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Glucocorticoid-Induced Adrenal Insufficiency

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25 GRADE Classification of Guideline Recommendations Certainty of Evidence Interpretation High ⊕⊕⊕⊕ We are very confident that the true effect lies close to that of the estimate of the effect. Moderate ⊕⊕⊕ We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low ⊕⊕ Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very Low ⊕ We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect. Source: Reprinted with permission from Schünemann HJ, Brożek J, Guyatt GH, Oxman AD. GRADE Handbook. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Updated October 2013. GRADE Strength of Recommendation Classifications and Interpretation Strength of recommendation Criteria Interpretation by patients Interpretation by health care providers Interpretation by policy makers 1 – Strong recommendation for or against Desirable consequences CLEARLY OUTWEIGH the undesirable consequences in most settings (or vice versa). Most individuals in this situation would want the recommended course of action, and only a small proportion would not. Most individuals should receive the recommended course of action. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. The recommendation can be adopted as policy in most situations. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. 2 – Conditional recommendation for or against Desirable consequences PROBABLY OUTWEIGH undesirable consequences in most settings (or vice versa). The majority of individuals in this situation would want the suggested course of action, but many would not. Decision aids may be useful in helping patients make decisions consistent with their individual risks, values and preferences. Clinicians should recognize that different choices will be appropriate for each individual and that clinicians must help each individual arrive at a management decision consistent with the individual's values and preferences. Policy-making will require substantial debate and involvement of various stakeholders. Performance measures should assess whether decision making is appropriate. Source: Data from Schünemann HJ, et al. Blood Adv, 2018, Nov 27; 2(22):3198–3225 ©

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