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Classification of evidence ranges Grades of suggestions 1++ High-high quality meta-analyses, systematic At least one meta-analysis, systematic reviews evaluations of randomised controlled trials or A or randomised managed trial rated as 1++ randomised controlled trials with a very low and immediately applicable to the goal risk of bias inhabitants; or 1+ Well-performed meta-analyses, systematic A systematic evaluate of randomised controlled critiques of randomised managed trials trials or a physique of proof consisting or randomised managed trials with a principally of studies rated as 1+, instantly low danger of bias relevant to the target inhabitants and demonstrating overall consistency of outcomes 1– Meta-analyses, systematic reviews of randomised controlled trials or A physique of evidence together with studies rated as randomised managed trials with a high B 2++ directly applicable to the goal danger of bias inhabitants and demonstrating general consistency of results; or 2++ High-high quality systematic critiques of Extrapolated evidence from studies rated as case–control or cohort research or high- 1++ or 1+ quality case–management or cohort studies with a very low danger of confounding, bias A body of evidence together with studies rated as or chance and a high likelihood that the C 2+ directly applicable to the target inhabitants relationship is causal and demonstrating general consistency of results; or 2+ Well-carried out case–control or cohort Extrapolated proof from studies rated as research with a low danger of confounding, 2++ bias or likelihood and a reasonable prob- capability that the connection is causal Evidence stage three or four; or D Extrapolated proof from studies rated as 2– Case–control or cohort research with a 2+ high danger of confounding, bias or likelihood and a big risk that the relationship is not causal Good apply level 3 Non-analytical studies;. 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