Organizations that have endorsed or that are using GRADE*
Some organizations in their enthusiasm to use GRADE, have modified the GRADE approach. We recommend against such modifications because the elements of the GRADE process are interlinked, because modifications may confuse some evidence and guideline users, and because such changes compromise the goal of a single system with which clinicians, policy-makers and patients can become familiar.
*some endorsements have included minor modifications, most commonly collapsing low and very low quality evidence into a single category
**Groups submitting guidelines to the BMJ are encouraged to use GRADE