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The parts of a cow that are not eaten by people are cooked, dried, ground into a powder, and used for many purposes, including as ingredients in animal feed. A cow gets BSE by eating feed contaminated with parts that came from another cow that was sick with BSE. The contaminated feed contains the abnormal prion, and a cow becomes infected with the abnormal prion when it eats the feed. If a cow gets BSE, it most likely ate the contaminated feed during its first year of life. Remember, if a cow becomes infected with the abnormal prion when it is one-year-old, it usually will not show signs of BSE until it is five-years-old or older.
Issue (and what should be considered)
Quality of evidence
Strong recommendations usually require at least
moderate-quality evidence for all the critical outcomes. The lower the
quality of evidence, the less likely there should be a strong
Relative importance of the outcomes
(benefits, harms, burdens) Authors and editors consider the relative values and preferences that patients and other stakeholders place on outcomes and the variability in values and preferences across patients. If values and preferences vary widely, a strong recommendation becomes less likely. Baseline risks of adverse outcomes
(typically most relevant for benefits) The higher the baseline risk of an adverse outcome, the greater the magnitude of benefit a treatment will offer, and the more likely there should be a strong recommendation. If the baseline risk is very different for two subpopulations, then UpToDate may make separate recommendations for these different groups. Magnitude of effect (benefits - eg,
reduction in RR; harms - eg, increase in RR; burden) Larger relative risk reductions with treatment make a strong recommendation for treatment more likely, while larger increases in the relative risk of harms make a strong recommendation for treatment less likely. Absolute magnitude of the effect (benefits,
harms, burden) The larger the absolute benefits with treatment, the greater the likelihood of a strong recommendation in favor of treatment. The larger the absolute increase in harms, the less likely there should be a strong recommendation in favor of treatment. Precision of the estimates of the effects
(benefits, harms and burdens) The greater the precision, the more likely there should be a strong recommendation. Cost The higher the incremental cost, the less the likelihood of a strong recommendation in favor of a treatment.