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Suggested Citation:"Appendix B: GRADE Grid Template." Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. doi: 10.17226/19012.
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Suggested Citation:"Appendix B: GRADE Grid Template." Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. doi: 10.17226/19012.
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GRADE score
2 1 0 -1 -2
 
Balance between desirable and undesirable consequences of inclusion as a core or required symptom Desirable clearly outweigh undesirable Desirable probably outweigh undesirable Trade-offs equally balanced or uncertain Undesirable probably outweigh desirable Undesirable clearly outweigh desirable
 
Assessment of quality of evidence Strong: “definitely include as required” Weak: “probably include as required” No specific recommendation Weak: “probably don’t include as required” Strong: “definitely don’t include as required”
 
For each symptom or category of symptoms below, please mark with an “X” the cell that best corresponds to your assessment of the available evidence, in terms of benefits versus disadvantages for inclusion as a core or required symptom.
 
Post-exertional malaise
(exacerbation of symptoms or fatigue triggered by physical or mental exertion and lasting > 24 hours after exercise)
 
Sleep
(unrefreshing sleep, sleep disturbance/dysfunction)
 
Neurocognitive manifestations
(mental fatigue, memory impairment, concentration difficulties, confusion)
Suggested Citation:"Appendix B: GRADE Grid Template." Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. doi: 10.17226/19012.
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Autonomic manifestations
(orthostatic intolerance, cardiovascular irregularities, gastrointestinal impairments, genitourinary impairments)
 
Immune manifestations
(sore throat, tender lymph nodes)
 
Neuroendocrine manifestations
(loss of thermostatic stability, sweating episodes, intolerance of temperature extremes)
 
Pain
(headaches, muscle pain, joint pain)

Balance between desirable and undesirable effects of inclusion as a required or core symptom or symptom category
Desirable consequence: The specific symptom or symptom category is present in a majority of ME/CFS patients, and its inclusion as a required symptom could prevent incorrect diagnoses of ME/CFS in those that do not have it.
Undesirable consequence: The specific symptom or symptom category is not present in a majority of ME/CFS patients, and its requirement could thus exclude patients with ME/CFS from diagnosis.
The larger the difference between the desirable and undesirable effects, the more likely a strong recommendation is warranted. The narrower the gradient, the more likely a weak recommendation is warranted.
Quality of evidence: The higher the quality of evidence, the more likely a strong recommendation is warranted.

Suggested Citation:"Appendix B: GRADE Grid Template." Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. doi: 10.17226/19012.
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Suggested Citation:"Appendix B: GRADE Grid Template." Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. doi: 10.17226/19012.
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Page253
Suggested Citation:"Appendix B: GRADE Grid Template." Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. doi: 10.17226/19012.
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Page254
Suggested Citation:"Appendix B: GRADE Grid Template." Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. doi: 10.17226/19012.
×
Page255
Suggested Citation:"Appendix B: GRADE Grid Template." Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. doi: 10.17226/19012.
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Page256
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Myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are serious, debilitating conditions that affect millions of people in the United States and around the world. ME/CFS can cause significant impairment and disability. Despite substantial efforts by researchers to better understand ME/CFS, there is no known cause or effective treatment. Diagnosing the disease remains a challenge, and patients often struggle with their illness for years before an identification is made. Some health care providers have been skeptical about the serious physiological - rather than psychological - nature of the illness. Once diagnosed, patients often complain of receiving hostility from their health care provider as well as being subjected to treatment strategies that exacerbate their symptoms.

Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome proposes new diagnostic clinical criteria for ME/CFS and a new term for the illness - systemic exertion intolerance disease(SEID). According to this report, the term myalgic encephalomyelitis does not accurately describe this illness, and the term chronic fatigue syndrome can result in trivialization and stigmatization for patients afflicted with this illness. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome stresses that SEID is a medical - not a psychiatric or psychological - illness. This report lists the major symptoms of SEID and recommends a diagnostic process.One of the report's most important conclusions is that a thorough history, physical examination, and targeted work-up are necessary and often sufficient for diagnosis. The new criteria will allow a large percentage of undiagnosed patients to receive an accurate diagnosis and appropriate care.

Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome will be a valuable resource to promote the prompt diagnosis of patients with this complex, multisystem, and often devastating disorder; enhance public understanding; and provide a firm foundation for future improvements in diagnosis and treatment.

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