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Record W4410991630 · doi:10.1136/bmj-2024-083867

Core GRADE 7: principles for moving from evidence to recommendations and decisions

2025· article· en· W4410991630 on OpenAlexaff
Gordon Guyatt, Per Olav Vandvik, Alfonso Iorio, Arnav Agarwal, Liang Yao, Prashanti Eachempati, Linan Zeng, Derek K. Chu, Rohan D’Souza, Thomas Agoritsas, M. Hassan Murad, Stefan Schandelmaier, Jamie Rylance, Benjamin Djulbegović, Víctor M. Montori, Monica Hultcrantz, Romina Brignardello‐Petersen

Bibliographic record

VenueBMJ · 2025
Typearticle
Languageen
FieldMedicine
TopicClinical practice guidelines implementation
Canadian institutionsMcMaster UniversityImpact
Fundersnot available
KeywordsComputer scienceCore (optical fiber)Data scienceTelecommunications

Abstract

fetched live from OpenAlex

This seventh article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for moving from evidence to recommendations or policy decisions. Core GRADE users make strong recommendations for an intervention versus a comparator when the desirable consequences clearly outweigh the undesirable consequences, and a conditional (weak) recommendation when the balance is less clear. Primary considerations in deciding on recommendations considering an individual patient perspective include balance of benefits, harms, and burdens; the certainty of evidence; and values and preferences. Secondary considerations, most important from a population perspective, include costs, feasibility, acceptability, and equity. Moving from evidence to recommendations begins with considering evidence regarding patients’ values and preferences and choosing the smallest difference in each outcome that patients perceive as important (the minimal important difference). Core GRADE users construct statements that make clear the values and preferences underlying their recommendations. In general, Core GRADE users make strong recommendations only when certainty of evidence is high or moderate. When evidence certainty is low, recommendations will be conditional under all but special circumstances.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame machine prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.

metaresearch head score (Codex)0.378
metaresearch head score (Gemma)0.670
Version: metacan-v3-hybrid-931329e0061cValidation status: machine_predicted_unvalidated
Candidate categoriesMetaresearch
Consensus categoriesMetaresearch
DomainCandidate signal: Methods · Consensus signal: none
Study designCandidate signal: Theoretical or conceptual · Consensus signal: none
GenreCandidate signal: Methods · Consensus signal: none
Teacher disagreement score0.622
Threshold uncertainty score0.767

Distilled classifier scores by category (both heads)

CategoryCodexGemma
Metaresearch0.3780.670
Meta-epidemiology (narrow)0.0050.008
Meta-epidemiology (broad)0.0100.019
Bibliometrics0.0300.018
Science and technology studies0.0060.009
Scholarly communication0.0310.011
Open science0.0250.021
Research integrity0.0290.037
Insufficient payload (model declined to judge)0.0260.024

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.723
GPT teacher head0.620
Teacher spread0.103 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.

Study designTheoretical or conceptual
DomainMethods
GenreMethods

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations41
Published2025
Admission routes1
Has abstractyes

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