A large number of taxonomies are used to rate the quality of an individual study and the strength of a recommendation based on a body of evidence. We have developed a new grading scale that will be used by several family medicine and primary care journals (required or optional), with the goal of allowing readers to learn one taxonomy that will apply to many sources of evidence. Our scale is called the Strength of Recommendation Taxonomy. It addresses the quality, quantity, and consistency of evidence and allows authors to rate individual studies or bodies of evidence. The taxonomy is built around the information mastery framework, which emphasizes the use of patient-oriented outcomes that measure changes in morbidity or mortality. An A-level recommendation is based on consistent and good quality patient-oriented evidence; a B-level recommendation is based on inconsistent or limited quality patientoriented evidence; and a C-level recommendation is based on consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention, or screening. Levels of evidence from 1 to 3 for individual studies also are defined. We hope that consistent use of this taxonomy will improve the ability of authors and readers to communicate about the translation of research into practice. Review articles (or overviews) are highly valued by physicians as a way to keep up to date with the medical literature. Sometimes, though, these articles are based more on the authors' personal experience, or anecdotes, or incomplete surveys of the literature than on a comprehensive collection of the best available evidence. As a result, there is an ongoing effort in the medical publishing field to improve the quality of review articles through the use of more explicit grading of the strength of evidence on which recommendations are based.

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OBJECTIVE -Understanding how individuals weigh the quality of life associated with complications and treatments is important in assessing the economic value of diabetes care and may provide insight into treatment adherence. We quantify patients' utilities (a measure of preference) for the full array of diabetes-related complications and treatments.RESEARCH DESIGN AND METHODS -We conducted interviews with a multiethnic sample of 701 adult patients living with diabetes who were attending Chicago area clinics. We elicited utilities (ratings on a 0 -1 scale, where 0 represents death and 1 represents perfect health) for hypothetical health states by using time-tradeoff questions. We evaluated 9 complication states (e.g., diabetic retinopathy and blindness) and 10 treatment states (e.g., intensive glucose control vs. conventional glucose control and comprehensive diabetes care [i.e., intensive control of multiple risk factors]). CONCLUSIONS -End-stage complications have the greatest perceived burden on quality of life; however, comprehensive diabetes treatments also have significant negative quality-of-life effects. Acknowledging these effects of diabetes care will be important for future economic evaluations of novel drug combination therapies and innovations in drug delivery. RESULTS Diabetes Care 30:2478-2483, 2007D iabetes significantly increases an individual's risk of developing multiple microvascular and cardiovascular complications, and the risk of these complications can be significantly reduced with intensive and comprehensive diabetes care (1). Current recommendations for the ideal risk factor targets (e.g., A1C Ͻ7%) and specific therapies (e.g., prophylactic aspirin) for diabetes care reflect the findings of multiple clinical trials (2-4).Although intensive and comprehensive diabetes care may generate significant health benefits, the current level of adoption of comprehensive diabetes care is incomplete. Quality-of-care studies indicate that there has been a steady rise in the proportion of patients taking beneficial medications such as aspirin and that there have been reductions in the proportion of patients with poor risk factor control (5). At the same time, large proportions of patients continue to have poor glycemic (20%), blood pressure (33%), and cholesterol control (40%) (5). These ongoing deficiencies have led to a large public investment in diabetes quality improvement programs (6).The success of these quality improvement efforts depends, in part, on whether or not patients are willing to take the multiple medications that comprise comprehensive diabetes care. Patients' willingness to adopt this care is likely to be determined, in part, by their perceptions of the relative quality-of-life effects of complications and treatments (7,8). These perceptions are also critical for economic evaluations of quality improvement efforts and treatment innovations. The development of combination drugs such as the polypill, a proposed treatment combining an aspirin, a diuretic, an ACE inhibitor, a ␤-blocker, fo...

Screening ultrasonography did not improve perinatal outcome as compared with the selective use of ultrasonography on the basis of clinician judgment.

ABSTRACT. Objective. To determine the role of household composition as an independent risk factor for fatal inflicted injuries among young children and describe perpetrator characteristics.Design, Setting, and Population. A population-based, case-control study of all children <5 years of age who died in Missouri between January 1, 1992, and December 31, 1999. Missouri Child Fatality Review Program data were analyzed. Cases all involved children with injuries inflicted by a parent or caregiver. Two age-matched controls per case child were selected randomly from children who died of natural causes.Main Outcome Measure. Inflicted-injury death. Household composition of case and control children was compared by using multivariate logistic regression. We hypothesized that children residing in households with adults unrelated to them are at higher risk of inflicted-injury death than children residing in households with 2 biological parents.Results. We identified 149 inflicted-injury deaths in our population during the 8-year study period. Children residing in households with unrelated adults were nearly 50 times as likely to die of inflicted injuries than children residing with 2 biological parents (adjusted odds ratio: 47.6; 95% confidence interval: 10.4 -218). Children in households with a single parent and no other adults in residence had no increased risk of inflicted-injury death (adjusted odds ratio: 0.9; 95% confidence interval: 0.6 -1.9). Perpetrators were identified in 132 (88.6%) of the cases. The majority of known perpetrators were male (71.2%), and most were the child's father (34.9%) or the boyfriend of the child's mother (24.2%). In households with unrelated adults, most perpetrators (83.9%) were the unrelated adult household member, and only 2 (6.5%) perpetrators were the biological parent of the child.Conclusions. Young children who reside in households with unrelated adults are at exceptionally high risk for inflicted-injury death. Most perpetrators are male, and most are residents of the decedent child's household at the time of injury. Using vital-records data makes it possible to conduct large, population-based studies to identify risk factors for fatal inflicted injuries. It is well documented, however, that studies based on vital records severely underestimate child maltreatment deaths, with 50% to 85% of child maltreatment deaths misclassified as resulting from other causes. [3][4][5][6][7] In addition, vital-records data are typically limited to a small subset of maternal and child variables and provide no information on household composition, the perpetrators, or their relationship to the decedent child. This combination of pronounced misclassification and lack of risk-factor information in vital records severely limits the usefulness of these data for child-maltreatment research. 1,[8][9][10] Combining data from multiple sources, now a common practice in many state-based child-fatalityreview programs, can greatly reduce the misclassification of maltreatment fatalities as resulting from other c...