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Effectiveness of Recombinant Human Growth Hormone (rhGH) in the Treatment of Patients with Cystic Fibrosis

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Rating the Strength of Evidence From the CER: A Modification of the GRADE Methodology

To determine the strength of the evidence identified in the systematic review, researchers used the grading process outlined for Evidence-based Practice Centers in version 1.0 of the Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews that is based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system of the GRADE Working Group. This system uses four required domains — risk of bias, consistency, directness, and precision — for assessments. All assessments were made by two investigators who resolved disagreements through discussion. The strength of evidence pertaining to each key research question of the CER is classified into four broad categories or grades:

High: High confidence that the evidence reflects the true effect. Further research is very unlikely to change our confidence in the estimate of effect.

Moderate: Moderate confidence that the evidence reflects the true effect.  Further research may change our confidence in the estimate of effect and may change the estimate.

Low: Low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of effect and is likely to change the estimate.

Insufficient: Evidence is either unavailable or does not permit estimation of an effect.