What is a top layer

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A top layer is defined as the minimum amount of information clinicians need to apply the recommendation in their own practice, and are developed through extensive user testing with clinicians in seven countries through the research project DECIDE.
The top layer format is specially adapted for use in the guidelines that follow GRADE method.

The top layer consists of comprises:

• Recommendation: Written in a structured and active language.
• Strength of recommendation: Provided with color codes and explaining text.
• Key information: short summaries on the four factors from GRADE when moving from evidence to recommendations: the balance between benefits and harms, quality of evidence, preferences and values and resource considerations.
• Rationale: The trade-off made between the various key factors leading to the current direction and strength of recommendation.

In addition to this there each recommendation related:

• Documentation: relevant results tables (Summary of Findings tables)

• Practical information about the treatments and tools for risk stratification.

• Adaptation: For modified recommendations provides a description of the change and its rationale under a separate category called "adaptation".

• "Decision aids": this is under development and not an integral part of the policy yet.