Key Points
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GRADE provides a framework for assessing quality that encourages transparency and an explicit accounting of the judgments made.
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GRADE distinguishes between quality assessment conducted as part of a systematic review and that undertaken as part of guideline development.
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The optimal application of GRADE requires systematic review of the impact of alternative management strategies on all patient-important outcomes.
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Information about study limitations, imprecision, inconsistency, indirectness, and publication bias is necessary for decision makers, clinicians, and patients to understand and have confidence in the assessment of quality and estimate of effect size.