Literature critique methods and grading systems

Grading

In medical science, grading systems are used to determine the most effective methods of treatment and the most useful research evidence. The use of a grading system to determine the quality of research and evidence has been instigated by the GRADE goup, a team that has brought into being a number of guidelines regarding the grading of evidence for medical purposes. In my nursing practice, the system I use is the ACCP grading system. This is a system created by an American College of Chest Physicians (hence, ACCP).

According to Guyatt et al. (2006), grading systems exist to determine the strength of recommendations made for treatment and the quality of the evidence presented for such treatement. In this way, grading systems enhance the usefulness of clinical guidelines, being that they use empirical evidence. What makes the ACCP system particularly useful in this regard is that it has provided enhanced the simplicity and transparency, along with the explicitness and consistency of recommended methodologies. The authors note that some grading systems offer a wide array of criteria to be applied, thereby somewhat defeating their own purpose in that they are both time consuming and intricate.

The ACCP system is somewhat simpler without detracting from the thorough nature of grading evidence. The system was developed by examining current grading systems and modified them in a way that provided for more usefulness while also mitigating the complications arising from including a large amount of criteria.

The ACCP system is set up to classify recommendations according to two gades (including 1 and 2, representing "strong" and "weak" respectively). The grades are determined with the use of the criteria balance among benefits, risks, burdens, cost, and the degree of confidence when determining benfits, risks, and burdens. Qaulity of evidence is rated as grade A, which is "high," grade B, which is "moderate," or grade C, which is "low." Factors used for this grading include study desgin, consistency of result, and evidence directness.

Future guidelines in the ACCP system will be constructed according to a simple and transparent approach. However, the approach is also consistent with current developments in order to strike a useful balance between quality and usefulness in terms of time efficiency. In this way, it has not discarded what is currently done or what has been accomplished in the field thus far. Instead, it has discarded only those elements of grading that have adversely affected the professional's ability to make a well-informed decision in good time. As such, the ACCP system has created a trend that strives towards uniformity among the grading approaches, which will ultimately benefit clinicians and patients alike.

When deciding upon treatment options, these can then be weighed against benefits, risks, burdens, and potential costs, where benefits are maximized and the other elements minimized. As such, the grading system can minimize bias when deciding upon a specific treatment method, while interpretation is assisted.