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Jeremy Howick

Jeremy Howick. Centre for Evidence-Based Medicine. 1. There are no hierarchies: GRADE. Step 1: Initial ranking. Step 2: upgrade/downgrade. Step 3: assign final grade. Downgrade for: - Inconsistency - Indirectness - Imprecision - Publication bias. HIGH MODERATE LOW VERY LOW. RT:

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Jeremy Howick

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  1. Jeremy Howick Centre for Evidence-Based Medicine

  2. 1. There are no hierarchies: GRADE Step 1: Initial ranking Step 2: upgrade/downgrade Step 3: assign final grade Downgrade for: - Inconsistency - Indirectness - Imprecision - Publication bias HIGH MODERATE LOW VERY LOW RT: High OS: low Upgrade for: - Large consistent effect - Dose response - Confounders only reducing size of effect

  3. 1. There are no hierarchies: OCEBM PICK A BOX! Cohort Study randomized trial Case Series Mechanistic reasoning systematic review

  4. 2. EBM has always recognized a role for mechanisms

  5. 3. Proponents of mechanisms have ignore problems with mechanisms

  6. 4. Getting the contrast class right

  7. 4. Effect size

  8. Thanks again! jeremy.howick@phc.ox.ac.uk

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