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5.1 The GRADE system

What is the GRADE system?
The “Grading of Recommendations Assessment, Development, and Evaluation” working group (GRADE) offers a transparent and structured process for developing and presenting summaries of evidence, including assessment of its quality, for development of systematic reviews and recommendations in health care.

Steps for grading the evidence and formulating recommendations

Steps for the formulation of recommendations are summarized in the following figure:

Essentially are:
* Select relevant outcomes.
* Assessment of overall quality of scientific evidence.
* Grade the strength of recommendations.

Look for relevant outcomes
Outcomes (primary, secondary, “hard”, surrogate, etc.) evaluated for the same problem in different studies are not the same and usually have also different “relative weights”.