Evidence map›Paper›PMID 14517128›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2003

Letters, numbers, symbols and words: how to communicate grades of evidence and recommendations.

Holger J Schünemann, Dana Best, Gunn Vist, Andrew D Oxman, GRADE Working Group

Erratum issuedAbstract read
PubMed Full text at PMC
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 145 papers, 41 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
145citing papers in PubMed, 41 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

145 citing papers in PubMed, 41 syntheses or guidelines pooled it.

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  8. Effectiveness of unguided web-based interventions for the treatment of depressive symptoms in improving the quality of life: a meta-analysis.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2025
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  10. Guideline
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  17. Efficacy of ChemoimmunotherapyCurrent medicinal chemistry · 2024
    Pooled it
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85 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Holger J SchünemannDepartment of Medicine, University of Buffalo, Buffalo, NY, USA. hjs@buffalo.edu
Dana Best
Gunn Vist
Andrew D Oxman
GRADE Working Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The GRADE Working Group is developing and evaluating a common, sensible approach to grading quality of evidence and strength of recommendations in health care. In this article, we discuss the advantages and disadvantages of using letters, numbers, symbols or words to represent grades of evidence and recommendations. Using multiple strategies, we searched for comparative studies of alternative ways of representing ordered categories in any context. In addition, we contacted experts and reviewed theoretical work and qualitative research on how best to communicate grades of any kind quickly and clearly. We were unable to identify health care research that addressed, either directly or indirectly, the best way to present grades of evidence and recommendations. We found examples of symbols used by government, commercial and consumer organizations to communicate quality of evidence or strength of recommendations, but no comparative studies. Although a number of grading systems are used in health care and other fields, there is little or no evidence of how well various presentations are understood. Before promoting the use of specific symbols, numbers, letters or words, the extent to which the intended message is comprehended should be evaluated.

Indexed as

CommunicationSymbolismEvidence-Based MedicineHumans

Identifiers

PMID14517128
PMCPMC202287

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.