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Korean Translation of the GRADE Series Published in the BMJ, ‘Use of GRADE Grid to Reach Decisions on Clinical Practice Guidelines When Consensus Is Elusive’ (A Secondary Publication)
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Hyun Jin Jung, Eu Chang Hwang, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hong Wook Kim, Jae Hung Jung, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2020;15(3):83-89. Published online December 31, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.3.83
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- This article is the last of a series providing guidance for the use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for rating the quality of evidence and grading the strength of recommendations in systematic reviews and clinical practice guidelines. Formulating recommendations with the applicable evidence can be difficult due to the large and diverse nature of guideline committees. This article describes a simple technique called the GRADE grid for clarifying the opinions from guideline panels, dealing with disagreement, and achieving consensus among guideline panels. The grid may be helpful for any guideline groups who want to use GRADE to develop their guidelines and achieve consensus or understand the patterns of uncertainty that surround the interpretation of scientific evidence.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: Incorporating Considerations of Resources Use into Grading Recommendations’ (A Secondary Publication)
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Hong Wook Kim, Jae Hung Jung, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Eu Chang Hwang, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2020;15(2):57-62. Published online August 31, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.2.57
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- This article is the fifth translation of a GRADE series published in the BMJ for incorporating the considerations of resources use into grading recommendations. Clinical recommendations inevitably involve judgments about the allocation of resources use (costs). Although costs differ from typical healthcare outcomes, such as mortality, morbidity, and quality of life, costs are another potentially important outcome that differs across and within a jurisdiction. A balance sheet is a useful method for determining if the net benefits are worth the incremental costs. Resource use, not just monetary values, should always be presented in an evidence profile. Formal economic modeling may or may not help judge the certainty of the evidence for resource use.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: Grading Quality of Evidence and Strength of Recommendations for Diagnostic Tests and Strategies’ (A Secondary Publication)
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Jae Hung Jung, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Eu Chang Hwang, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2020;15(1):16-25. Published online April 30, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.1.16
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- This article is the fourth translation of a GRADE series published in the BMJ, which graded the quality of evidence and strength of recommendations for diagnostic tests or strategies, as a comprehensive and transparent approach for developing recommendations. Randomized trials for diagnostic approaches represent the ideal study design for intervention studies. On the other hand, cross-sectional or cohort studies with a direct comparison of the test results with an appropriate reference standard can provide high-quality evidence. The guideline panel must be reminded that the test accuracy is a surrogate for patient-important outcomes, so such studies often provide a low quality of evidence for recommendations regarding diagnostic tests, even when the studies do not have serious limitations. Diagnostic accuracy studies showing that a diagnostic test or strategy improves important patient outcomes will require the availability of effective treatment, reduction of test-related adverse effects or anxiety, or improvement of the patients’ well-being from prognostic information. Therefore, it is important to assess the directness of the test results regarding the consequences of diagnostic recommendations that are important to patients.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: Going from Evidence to Recommendations’ (A Secondary Publication)
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Eu Chang Hwang, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Jae Hung Jung, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2019;14(3):99-103. Published online December 31, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.3.99
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- This article is the third translation of a GRADE series published in the BMJ for developing and presenting recommendations for managing patients. The strength of a recommendation reflects the extent to which we can be confident that desirable effects of an intervention outweigh any undesirable effects. GRADE classifies the strength of recommendations as strong or weak. The strength of recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, quality of the evidence, variability in values and preferences, and the appropriate usage of resources.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: What Is “Quality of Evidence” and Why Is It Important to Clinicians?’ (A Secondary Publication)
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Ho Won Kang, Jae Hung Jung, Do Kyung Kim, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Eu Chang Hwang, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2019;14(2):64-70. Published online August 30, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.2.64
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- This article is second translation of a GRADE series published in the BMJ to create a highly structured, transparent, and informative system for rating quality of evidence for developing recommendations. The process to develop a guideline, we should formulate a clear question with specification of all outcomes of importance to patients. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) offers four levels of evidence quality: high, moderate, low, and very low for these patient-important outcomes. Randomized trials begin as high quality evidence and observational studies as low quality evidence. Although randomized trials begin as high quality evidence, quality may be downgraded as a result of study limitations (risk of bias), inconsistency (variability in results), indirectness, imprecision (wide confidence intervals), or publication bias. While the quality of evidence derived from observational studies starts at ‘low’ but may be upgraded based on a very large magnitude of effect, a dose-response gradient, and if all plausible biases would reduce an apparent treatment effect.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations’ (A Secondary Publication)
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Do Kyung Kim, Eu Chang Hwang, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Jae Hung Jung, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2019;14(1):28-32. Published online April 30, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.1.28
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- Clinical practice guidelines are statements that include recommendations intended to optimize patient care based on a systematic review of the evidence assessing the benefits and harm of alternative care options. Guideline developers should use an explicit, judicious, and transparent methodology to make trustworthy guidelines. Although there are a variety of frameworks that can help translate enormous medical knowledge into recommendations, the most widely adopted tool for grading the quality of evidence and making recommendations is GRADE (Grading of Recommendations, Assessment, Development and Evaluations). This article is the first translation of a series published in the BMJ with regard to the GRADE Approach for Evidence Based Clinical Practice Guideline Development to provide informative knowledge for moving from evidence to recommendations to Korean guideline developers.
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Incidence and Risk Factors of Urinary Tract Infection after Endoscopic Therapy for Vesicoureteral Reflux in Children
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Ja Yoon Ku, Bu Kyung Park, Sang Don Lee
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Korean J Urogenit Tract Infect Inflamm 2014;9(1):34-38. Published online April 30, 2014
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The purpose of this study is to evaluate the incidence and risk factors of febrile urinary tract infection (UTI) after endoscopic therapy for vesicoureteral reflux (VUR).
Materials and Methods: Analysis of the clinical data of 88 children (128 refluxing renal units; male 60%, female 40%) in a single institution during March 2011-June 2013 including age, gender, sorts and volume of agent for injection, preoperative VUR grade, recurrent UTI, bladder dysfunction, nephropathy, postoperative VUR, urinalysis, and urine culture results was performed retrospectively. All patients were followed for three to 62 months (average 25 months).
Results: After the first injection, the complete resolutions rate of VUR (by ureter) was 72.7%, consisting of grade I 4 (90%), grade II 11 (84.6%), grade III 29 (76.3%), grade IV 33 (66%), and grade V 93 (72.7%) ureters. Preoperative UTI and febrile UTI were present in 81 (92.0%) and 49 patients (55.7%), respectively. Preoperative recurrent UTI and febrile UTI were observed in 53 (60.2%) and 30 patients (34.1%), respectively. Postoperative UTI and febrile UTI occurred in eight (9.1%) and in five patients (5.7%), respectively. In multivariate analysis, only preoperative recurrent UTI (odds ratio [OR], 0.17; p=0.04) and bladder trabeculation (OR, 0.104; p=0.038) were independent variables after endoscopic therapy.
Conclusions: Our data support that the successful endoscopic correction of VUR is associated with a low incidence of febrile UTI. The highest risk factor for post injection UTI is preoperative recurrent UTI and bladder dysfunction. Therefore, patients with preoperative recurrent UTI and bladder dysfunction require careful observation after endoscopic therapy for VUR.
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