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Table 9 Example of a modified GRADE evidence profile quality assessment. Table 9 and 10 is what Table 1 and 2 became when including the improvements made based on the pilot study experience.

From: Systems for grading the quality of evidence and the strength of recommendations II: Pilot study of a new system

Outcome: Depression severity (measured with Hamilton Depression Rating Scale after 4 to 12 weeks)
Studies Design Quality Consistency Directness SD SA RB DR PC
8 trials Citalopram
38 trials Fluoxetine
25 trials Fluvoxamine
2 trials Nefazodone
18 trials Paroxetine
4 trials Sertaline
4 trials Velafaxine 		RCTs No serious limitations No important inconsistency Some uncertainty about directness (outcome measure)* No No No No No
Outcome: Transient side effects resulting in discontinuation of treatment
8 trials Citalopram
50 trials Fluoxetine
27 trials Fluvoxamine
4 trials Nefazodone
23 trials Paroxetine
6 trials Sertaline
5 trials Velafaxine 		RCTs No serious limitations No important inconsistency Direct No No No No No
Outcome: Poisoning fatalities
Office for National Statistics (British) Observational data Serious limitation** Only one study Direct No ++ No No No
  1. *There was uncertainty about the directness of the outcome measure because of the short duration of the trials.
  2. **It is possible that people at lower risk were more likely to have been given SSRI's and it is uncertain if changing antidepressant would have deterred suicide attempts.
  3. SD = Sparse data (Yes or No)
  4. SA = Strong association (No, + = strong, ++ = very strong)
  5. RB = Reporting bias (Yes or No)
  6. DR = Dose response (Yes or No)
  7. PC = All plausible confounders would have reduced the effect (Yes or No)
  8. CI = confidence interval
  9. WMD = weighted mean difference
  10. RRR = relative risk reduction
Question: Should depressed patients be treated with SSRIs rather than tricyclics?Setting: Primary carePatients: Moderately depressed adult patientsReference: North of England Evidence Based Guideline Development Project. Evidence based clinical practice guideline: the choice of antidepressants for depression in primary care. Newcastle upon Tyne: Centre for Health Services Research, 1997.
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BMC Health Services Research

ISSN: 1472-6963

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