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7%; 36/67). CONCLUSION Approximately one in three US based organizations developing evidence-based guidelines report the use of GRADE but adherence to published criteria is inconsistent. As uptake of the GRADE approach increases in the US, continued efforts to train guideline methodologists and panel members are important. To make healthcare decisions, patients, clinicians, clinical practice guideline developers, researchers, policy-makers and health system managers need a comprehensive, critical, accessible, actionable and up-to-date