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HERRERA ET AL .
3.4.3 | Strength of consensus
• the underlying quality of evidence, reflecting the degree of cer- tainty/uncertainty of the evidence and robustness of study results • the grade of the recommendation, reflecting the criteria considered to make the judgement; the strength of consensus, indicating the degree of agreement within the guideline panel and the number of abstentions due to potential CoI.
The consensus determination process followed the recommendations by the German Association of the Scientific Medical Societies (AWMF) and Standing Guidelines Commission, 2012. Where consen- sus could not be reached, different points of view were documented in the guideline text (see Table 6).
3.4.1 | Quality of evidence
3.5
Editorial independence
|
The quality of evidence was assessed using a recommended rating scheme (Balshem et al., 2011; Schunemann et al., 2019).
3.5.1 | Funding of the guideline
The development of this guideline and its subsequent publication were financed entirely by internal funds of the EFP, without any sup- port from industry or other organizations.
3.4.2 | Strength of recommendations
The grading of the recommendations used the grading scheme (Table 5) by the German Association of the Scientific Medical Socie- ties (AWMF) and Standing Guidelines Commission (2012), taking into account not only the quality of evidence, but also considering a judge- ment guided by the following criteria: • relevance of outcomes and quality of evidence for each relevant outcome; • consistency of study results; • direct applicability of the evidence to the target population/PICOS specifics; • precision of effect estimates using CIs; • magnitude of the effects; • balance of benefit and harm; • ethical, legal and economic considerations; • patient preferences. The grading of the quality of evidence and the strength of a rec- ommendation may therefore differ, but where they do, the justifica- tion and context are clearly documented in the background narrative that follows each recommendation table.
3.5.2 | Declaration of interests and management of potential conflicts
All members of the guideline panel declared secondary interests using the standardized form provided by the International Committee of Medical Journal Editors (ICMJE 2013). Management of CoIs was discussed in the WGs and the plenary ses- sions, following the principles provided by the Guidelines International Network (Schunemann et al., 2015). According to these principles, panel members with relevant, potential CoIs abstained from voting on guide- line statements and recommendations within the consensus process. Those abstentions were recorded in each recommendation table.
3.6
Peer review
|
All 13 SRs underwent a multi-step peer review process. First, the draft documents were evaluated by members of the EFP Workshop Commit- tee and the methodological consultants using a custom-made appraisal tool to assess (i) the methodological quality of the SRs using the AMSTAR 2 checklist (Shea et al., 2017), and (ii) whether all PICOS ques- tions were addressed as planned. Detailed feedback was then provided for the SR authors. Subsequently, all 13 SRs underwent the regular edito- rial peer review process defined by the Journal of Clinical Periodontology .
TABLE 5 Strength of recommendations: Grading scheme (German Association of the Scientific Medical Societies (AWMF) and Standing Guidelines Commission, 2012).
Gradeof recommendation grade a
Description
Syntax
TABLE 6 Strength of consensus: Determination scheme (German Association of the Scientific Medical Societies (AWMF) and Standing Guidelines Commission, 2012).
A
Strong
We recommend ( "" )/we recommend not to ( ## )
recommendation
B
Recommendation We suggest to ( " )/we suggest not to ( # )
Unanimous consensus
Agreement of 100% of participants
0
Open
May be considered ( $ )
Strong consensus
Agreement of >95% of participants
recommendation
Agreement of 75% – 95% of participants
Consensus
a If the group felt that evidence was not clear enough to support a recommendation, statements were formulated, including the need (or not) for additional research.
Agreement of 50% – 74% of participants
Simple majority
No consensus
Agreement of <50% of participants
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