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Dan, Yes, anyone can use our scheme as long as they credit us. We've taught thousands of people using this method - almost none of them were using any scheme at all and now many are now using ours because it is easy to use. Plus even when we are talking with people who aren't familiar with our scheme, we are immediately able to communicate understandable information to them using it. That gets us on the same page, where other schemes frequently do not. Mike -- Michael Stuart MD President, Delfini Group, Clinical Asst Professor, UW School of Medicine 6831 31st Ave N.E. Seattle, Washington 98115 206-854-3680 Mobile Phone 206-527-6146 Home Office [log in to unmask] www.delfini.org -----Original Message----- From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Dan Mayer Sent: Friday, July 01, 2005 6:51 AM To: [log in to unmask] Subject: Re: Level of Evidence Assistance Hi Mike, I like your way of classification. However, I notice that you have copyrighted them. Can I use them in my course material such as lectures? Also, who else is using this schema. If the CEBM scheme is the one predominantly used, it just makes things more confusing to have another schema of classification out there. Thanks for sharing this, and best wishes, Dan ************************************************************************ **** Dan Mayer, MD Professor of Emergency Medicine Albany Medical College 47 New Scotland Ave. Albany, NY, 12208 Ph; 518-262-6180 FAX; 518-262-5029 E-mail; [log in to unmask] ************************************************************************ **** >>> Mike/Linda Stuart <[log in to unmask]> 07/01 9:58 AM >>> I would like to make a couple of other points regarding evidence grading. There over 100 evidence grading systems, many complex and difficult to use. No one system has been universally accepted. We developed an evidence grading system that provides meaningful information about both validity and clinical usefulness because many of groups we work with have difficulty remembering and applying evidence grades from other systems. Oursystem is easy to remember, easy to use and can be applied to studies, evidence syntheses, clinical guidelines and other health care information. The scale has four easy-to-remember grades-A, B, U and X. The details are below: Delfini Validity & Usability Grading Scale for Summarizing the Evidence for Interventions Grade A: Useful The evidence is strong and appears sufficient to use in making health care decisions - it is both valid and useful (e.g., clinical significance, of sufficient magnitude, physician and patient acceptability, etc.) -- Evidence from well-designed and conducted systematic reviews might fall into this category or they might be considered Grade B. Suggestion is to do a careful analysis of the review and the studies included. -- Several well-designed and conducted studies that consistently show similar results -- For therapy, screening, prevention and diagnostic studies: RCTs. In some cases a single, large well-designed and conducted RCT may be sufficient. -- For natural history and prognosis: Cohort studies Grade B: Possibly Useful The evidence is potentially strong and might be sufficient to use in making health care decisions. The evidence is strong enough to conclude that the results are probably valid and useful (see above); however, study results from multiple studies are inconsistent or the studies may have some (but not lethal) threats to validity. -- Evidence from well-designed and conducted systematic reviews might fall into this category or they might be considered Grade A. Suggestion is to do a careful analysis of the review and the studies included. -- Evidence from at least one well-designed and conducted RCT (cohort studies for natural history and prognosis; for diagnosis, valid studies assessing test accuracy for detecting a condition when there is evidence of effectiveness from valid, applicable RCTs.) Grade U Uncertain Validity and Usefulness (with 3 subgroups) The evidence is sufficiently uncertain to urge caution regarding its use in making health care decisions. -- Uncertain Validity: This may be due to uncertain validity due to methodology (enough threats to validity to raise concern - our suggestion would be to not use such a study in most circumstances) or conflicting results. -- Uncertain Usefulness: This may be due to uncertain applicability due to results (good methodology, but questions due to effect size, applicability of results such as due to results relating to biologic markers or other issues). These latter studies may be useful and should be viewed in the context of the weight of the evidence. -- Uncertain Validity and Usefulness: This is a combination of the above. Grade X: Not Useful --The evidence reviewed has lethal threats to validity or other problems (e.g., applicability) and should not be used in making health care decisions. C Delfini Group, LLC, 2005. All Rights Reserved World Wide. Hope this is useful. -- Michael Stuart MD President, Delfini Group, Clinical Asst Professor, UW School of Medicine 6831 31st Ave N.E. Seattle, Washington 98115 206-854-3680 Mobile Phone 206-527-6146 Home Office [log in to unmask] www.delfini.org -----Original Message----- From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Underhill Jonathan Sent: Friday, July 01, 2005 12:56 AM To: [log in to unmask] Subject: Re: Level of Evidence Assistance ->>>>>>>>>>>>>>>>>>>> I would add that there are a number of systems out there that provide a way to rank levels of evidence/grades of recommendation - which makes things hard for us sometimes. Although rather complicated and perhaps loosing something in user friendliness the CEBM at Oxford (Olive & Co) presented a system which may assist in addressing your question. See http://www.cebm.net/levels_of_evidence.asp, perhaps level 2a or 3a fit (depending on the design of the observational studies). <<<<<<<<<<<<<<<, Of course some would suggest that a more robust system of classification is the SORT criteria, which takes into account both validity AND, very importantly, relevance: http://www.aafp.org/afp/20040201/548.html Comments? Cheers (8(|) Jonathan --------------------------------------------------------------------- Jonathan Underhill MRPharmS Assistant Director, Education and Development National Prescribing Centre The Infirmary 70 Pembroke Place Liverpool L69 3GF Tel: 0151-794-8143 Fax: 0151-794-8067 Mobile: 07968 851325 email: [log in to unmask] website: www.npc.co.uk ------------------------------------------------------------------------ ---- DISCLAIMER: This e-mail may contain confidential and/or proprietary information some or all of which may be legally privileged. It is for the intended recipient only. 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