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Guidelines for Rating the Strength of Recommendations in Clinical Review Articles
We realize there are various rating systems for levels of evidence described in the medical literature. Working with the editors of other leading primary care publications, we have developed a new system that rates the evidence from A to C. We ask that you use this system to rate key recommendations on diagnosis and treatment:
|Strength of Recommendation||Definition|
|A||Recommendation based on consistent and good quality patient-oriented evidence|
|B||Recommendation based on inconsistent or limited quality patient-oriented evidence|
|C||Recommendation based on consensus, usual practice, expert opinion, disease-oriented evidence, and case series for studies of diagnosis, treatment, prevention, or screening.|
|Key Clinical Recommendation||Strength of Recommendation||References||Comments (optional)|
|Ambulatory blood pressure monitoring is recommended for patients with labile blood pressure and suspected white coat hypertension||B||2||Recommendation from consensus guideline based on observational studies|
|Diuretics and beta-blockers are first-line agents for hypertension.||A||3||Meta-analysis of randomized trials|
|Angiotensin receptor blockers provide similar clinical outcomes to ACE inhibitors||A||4,5,6||Consistent findings from randomized controlled trials and recommendation from evidence-based practice guideline|
|Terazosin is not recommended as a first or second line agent, particularly for African-American patients.||A||7||Randomized controlled trial|
For more information on how to apply these ratings, please see Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach to Grading Evidence in the Medical Literature, an explanatory article published in the February 1, 2004, issue of AFP, as well as the algorithm for rating the strength of evidence. You should create a summary table with the recommendations and references for each recommendation.