临床建议：机制在 GRADE 框架中的作用。,Studies in history and philosophy of science

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临床建议：机制在 GRADE 框架中的作用。
Studies in history and philosophy of science Pub Date : 2022-09-17 , DOI: 10.1016/j.shpsa.2022.08.018
Lucie Perillat ₁ , Mathew Mercuri ₂

Affiliation

推荐分级评估、制定和评估 (GRADE) 框架已成为评估研究质量和制定临床建议的最有影响力的框架之一。GRADE 框架已作为循证医学 (EBM) 运动的演变提出。GRADE 和 EBM 都强调来自人群水平临床试验的效果估计，因此贬低了机制作为临床决策基础的作用。尽管机制在 EBM 推理中不具有严格临床试验的认知特权，但本文将论证机制似乎在 GRADE 的使用和应用中很重要，如文献中所述。到目前为止，机制在临床建议制定中看似必要的作用，很少受到关注，也没有在描述 GRADE 的文献中明确提及。本文中对 GRADE 框架的分析揭示了 EBM 淡化机制的意愿与它们在 GRADE 中似乎不可避免的使用之间明显的紧张关系。在本文中，我们的立场是，如果在使用 GRADE 时不可避免地要进行机械推理，那么关于该框架的教学文献将受益于对如何考虑和整合机制的更明确的讨论。

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Clinical recommendations: The role of mechanisms in the GRADE framework.

The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework has become one of the most influential frameworks for assessing quality of research and developing clinical recommendations. The GRADE framework has been presented as an evolution in the Evidence-Based Medicine (EBM) movement. Both GRADE and EBM emphasize effect estimates derived from population-level clinical trials and, as a consequence, devalue the role of mechanisms as the basis for clinical decisions. Although mechanisms do not hold the epistemic privilege of rigorous clinical trials in EBM reasoning, this paper will argue that mechanisms appear to be important in the use and application of GRADE, as described in the literature. The seemingly necessary role of mechanisms in the development of clinical recommendations has, so far, received little attention and is not explicitly featured in the literature describing GRADE. The analysis of the GRADE framework presented in this paper reveals an apparent tension between EBM's willingness to downplay mechanisms and what seems their inevitable use in GRADE. In this paper, we take the position that if mechanistic reasoning is inevitable in the use of GRADE, then the instructional literature on the framework would benefit from more explicit discussion of how to consider and integrate mechanisms.

更新日期：2022-09-16

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