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Beer, Hans de

0000-0001-6621-3269

A5047905180 | I4210165777

Mayo Clinic

Guide2Guidance, Lemelerberg 7, Utrecht, Netherlands

Citations 6

Core GRADE 6: presenting the evidence in summary of findings tables

BMJ | May 27, 2025 | Volume: 389 | Issue: No issue available | Pages: e083866

10.1136/bmj-2024-083866 | PMID 40425239

Core GRADE 5: rating certainty of evidence—assessing indirectness

BMJ | May 20, 2025 | Volume: 389 | Issue: No issue available | Pages: e083865

10.1136/bmj-2024-083865 | PMID 40393729

Core GRADE 3: rating certainty of evidence—assessing inconsistency

BMJ | May 6, 2025 | Volume: 389 | Issue: No issue available | Pages: e081905

10.1136/bmj-2024-081905 | PMID 40328467

Core GRADE 2: choosing the target of certainty rating and assessing imprecision

BMJ | April 29, 2025 | Volume: 389 | Issue: No issue available | Pages: e081904

10.1136/bmj-2024-081904 | PMID 40300802

Core GRADE 1: overview of the Core GRADE approach

BMJ | April 22, 2025 | Volume: 389 | Issue: No issue available | Pages: e081903

10.1136/bmj-2024-081903 | PMID 40262844

Rating certainty when the target threshold is the null and the point estimate is close to the null

BMJ Evidence-Based Medicine | March 5, 2025 | Volume: 30 | Issue: 3 | Pages: 202-207

10.1136/bmjebm-2024-113077 | PMID 40044276

When one initially targets the null effect and the point estimate falls close to the null, two challenges exist in rating certainty of evidence. First, when the point estimate is near the null and the data, therefore, suggests little or no effect, rating certainty in a benefit or harm is misleading. Second, since in general the narrower the confidence interval (CI) the more precise the estimate, if the CI is narrow, rating down for imprecision due simply to crossing the null is inappropriate. This paper addresses these issues and provides a solution: to revise the target of certainty rating from a non-zero effect to a little or no effect. This solution requires estimating a range in which the minimal important difference (MID) for benefit and an MID for harm might lie, and thus establishing a range that represents little or no effect. If GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) users are confident that the point estimate represents an effect less than the smallest plausible MID, they will revise their target and rate certainty to a little or no effect. If the entire CI falls within the range of little or no effect, they will not rate down for imprecision. Otherwise (if the CI includes an important effect), they will rate down. Using the solution provided in this paper GRADE users can make an optimal choice of the target of certainty rating.