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id="toc-Steps-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Evidence_reviews" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Evidence_reviews"> <div class="vector-toc-text"> 2.2 Evidence reviews </div> </a> <ul id="toc-Evidence_reviews-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Assessing_the_quality_of_evidence" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Assessing_the_quality_of_evidence"> <div class="vector-toc-text"> 2.3 Assessing the quality of evidence </div> </a> <ul id="toc-Assessing_the_quality_of_evidence-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Categories_of_recommendations" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Categories_of_recommendations"> <div class="vector-toc-text"> 2.4 Categories of recommendations </div> </a> <ul id="toc-Categories_of_recommendations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Statistical_measures" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Statistical_measures"> <div class="vector-toc-text"> 2.5 Statistical measures </div> </a> <ul id="toc-Statistical_measures-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Quality_of_clinical_trials" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Quality_of_clinical_trials"> <div class="vector-toc-text"> 2.6 Quality of clinical trials </div> </a> <ul id="toc-Quality_of_clinical_trials-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Limitations_and_criticism" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Limitations_and_criticism"> <div class="vector-toc-text"> 3 Limitations and criticism </div> </a> <ul id="toc-Limitations_and_criticism-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Application_of_evidence_in_clinical_settings" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Application_of_evidence_in_clinical_settings"> <div class="vector-toc-text"> 4 Application of evidence in clinical settings </div> </a> <ul id="toc-Application_of_evidence_in_clinical_settings-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Education" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Education"> <div class="vector-toc-text"> 5 Education </div> </a> <ul id="toc-Education-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> 6 See also </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 7 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Bibliography" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Bibliography"> <div class="vector-toc-text"> 8 Bibliography </div> </a> <ul id="toc-Bibliography-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 9 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Evidence-based medicine</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" 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Available in 34 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-34" aria-hidden="true" > 34 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Bewysgebaseerde_medisyne" title="Bewysgebaseerde medisyne – Afrikaans" lang="af" hreflang="af" data-title="Bewysgebaseerde medisyne" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target">Afrikaans</a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%B7%D8%A8_%D9%85%D8%B3%D9%86%D8%AF_%D8%A8%D8%A7%D9%84%D8%AF%D9%84%D9%8A%D9%84" title="طب مسند بالدليل – Arabic" lang="ar" hreflang="ar" data-title="طب مسند بالدليل" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Medicina_basada_en_l%27evid%C3%A8ncia" title="Medicina basada en l'evidència – Catalan" lang="ca" hreflang="ca" data-title="Medicina basada en l'evidència" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cv mw-list-item"><a href="https://cv.wikipedia.org/wiki/%D3%96%D0%BD%D0%B5%D0%BD%D1%82%D0%B5%D1%80%D3%B3%D0%BB%D0%BB%C4%95_%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D0%B0" title="Ӗнентерӳллĕ медицина – Chuvash" lang="cv" hreflang="cv" data-title="Ӗнентерӳллĕ медицина" data-language-autonym="Чӑвашла" data-language-local-name="Chuvash" class="interlanguage-link-target">Чӑвашла</a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Evidence-based_medicine" title="Evidence-based medicine – Czech" lang="cs" hreflang="cs" data-title="Evidence-based medicine" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target">Čeština</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Evidensbaseret_medicin" title="Evidensbaseret medicin – Danish" lang="da" hreflang="da" data-title="Evidensbaseret medicin" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Evidenzbasierte_Medizin" title="Evidenzbasierte Medizin – German" lang="de" hreflang="de" data-title="Evidenzbasierte Medizin" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/T%C3%B5endusp%C3%B5hine_meditsiin" title="Tõenduspõhine meditsiin – Estonian" lang="et" hreflang="et" data-title="Tõenduspõhine meditsiin" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target">Eesti</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Medicina_basada_en_la_evidencia" title="Medicina basada en la evidencia – Spanish" lang="es" hreflang="es" data-title="Medicina basada en la evidencia" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/La%C5%ADindika%C4%B5a_medicino" title="Laŭindikaĵa medicino – Esperanto" lang="eo" hreflang="eo" data-title="Laŭindikaĵa medicino" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Ebidentzian_Oinarritutako_Medikuntza" title="Ebidentzian Oinarritutako Medikuntza – Basque" lang="eu" hreflang="eu" data-title="Ebidentzian Oinarritutako Medikuntza" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%BE%D8%B2%D8%B4%DA%A9%DB%8C_%D9%85%D8%A8%D8%AA%D9%86%DB%8C_%D8%A8%D8%B1_%D8%B4%D9%88%D8%A7%D9%87%D8%AF" title="پزشکی مبتنی بر شواهد – Persian" lang="fa" hreflang="fa" data-title="پزشکی مبتنی بر شواهد" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/M%C3%A9decine_fond%C3%A9e_sur_les_faits" title="Médecine fondée sur les faits – French" lang="fr" hreflang="fr" data-title="Médecine fondée sur les faits" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Leigheas_ar_Bhonn_Fianaise" title="Leigheas ar Bhonn Fianaise – Irish" lang="ga" hreflang="ga" data-title="Leigheas ar Bhonn Fianaise" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target">Gaeilge</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EA%B7%BC%EA%B1%B0%EC%A4%91%EC%8B%AC%EC%9D%98%ED%95%99" title="근거중심의학 – Korean" lang="ko" hreflang="ko" data-title="근거중심의학" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%B8%E0%A4%BE%E0%A4%95%E0%A5%8D%E0%A4%B7%E0%A5%8D%E0%A4%AF_%E0%A4%86%E0%A4%A7%E0%A4%BE%E0%A4%B0%E0%A4%BF%E0%A4%A4_%E0%A4%9A%E0%A4%BF%E0%A4%95%E0%A4%BF%E0%A4%A4%E0%A5%8D%E0%A4%B8%E0%A4%BE" title="साक्ष्य आधारित चिकित्सा – Hindi" lang="hi" hreflang="hi" data-title="साक्ष्य आधारित चिकित्सा" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target">हिन्दी</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Kedokteran_berbasis_bukti" title="Kedokteran berbasis bukti – Indonesian" lang="id" hreflang="id" data-title="Kedokteran berbasis bukti" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Medicina_basata_sulle_evidenze" title="Medicina basata sulle evidenze – Italian" lang="it" hreflang="it" data-title="Medicina basata sulle evidenze" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A8%D7%A4%D7%95%D7%90%D7%94_%D7%9E%D7%91%D7%95%D7%A1%D7%A1%D7%AA_%D7%A8%D7%90%D7%99%D7%95%D7%AA" title="רפואה מבוססת ראיות – Hebrew" lang="he" hreflang="he" data-title="רפואה מבוססת ראיות" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Bizony%C3%ADt%C3%A9kokon_alapul%C3%B3_orvosl%C3%A1s" title="Bizonyítékokon alapuló orvoslás – Hungarian" lang="hu" hreflang="hu" data-title="Bizonyítékokon alapuló orvoslás" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target">Magyar</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Evidence-based_medicine" title="Evidence-based medicine – Dutch" lang="nl" hreflang="nl" data-title="Evidence-based medicine" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%A0%B9%E6%8B%A0%E3%81%AB%E5%9F%BA%E3%81%A5%E3%81%8F%E5%8C%BB%E7%99%82" title="根拠に基づく医療 – Japanese" lang="ja" hreflang="ja" data-title="根拠に基づく医療" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Evidensbasert_medisin" title="Evidensbasert medisin – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Evidensbasert medisin" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Medycyna_oparta_na_faktach" title="Medycyna oparta na faktach – Polish" lang="pl" hreflang="pl" data-title="Medycyna oparta na faktach" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Medicina_baseada_em_evid%C3%AAncias" title="Medicina baseada em evidências – Portuguese" lang="pt" hreflang="pt" data-title="Medicina baseada em evidências" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Medicin%C4%83_bazat%C4%83_pe_dovezi" title="Medicină bazată pe dovezi – Romanian" lang="ro" hreflang="ro" data-title="Medicină bazată pe dovezi" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%94%D0%BE%D0%BA%D0%B0%D0%B7%D0%B0%D1%82%D0%B5%D0%BB%D1%8C%D0%BD%D0%B0%D1%8F_%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D0%B0" title="Доказательная медицина – Russian" lang="ru" hreflang="ru" data-title="Доказательная медицина" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Z_dokazi_podprta_medicina" title="Z dokazi podprta medicina – Slovenian" lang="sl" hreflang="sl" data-title="Z dokazi podprta medicina" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target">Slovenščina</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/N%C3%A4ytt%C3%B6%C3%B6n_perustuva_l%C3%A4%C3%A4ketiede" title="Näyttöön perustuva lääketiede – Finnish" lang="fi" hreflang="fi" data-title="Näyttöön perustuva lääketiede" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Evidensbaserad_medicin" title="Evidensbaserad medicin – Swedish" lang="sv" hreflang="sv" data-title="Evidensbaserad medicin" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B9%80%E0%B8%A7%E0%B8%8A%E0%B8%9B%E0%B8%8F%E0%B8%B4%E0%B8%9A%E0%B8%B1%E0%B8%95%E0%B8%B4%E0%B8%AD%E0%B8%B4%E0%B8%87%E0%B8%AB%E0%B8%A5%E0%B8%B1%E0%B8%81%E0%B8%90%E0%B8%B2%E0%B8%99" title="เวชปฏิบัติอิงหลักฐาน – Thai" lang="th" hreflang="th" data-title="เวชปฏิบัติอิงหลักฐาน" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target">ไทย</a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%94%D0%BE%D0%BA%D0%B0%D0%B7%D0%BE%D0%B2%D0%B0_%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D0%B0" title="Доказова медицина – Ukrainian" lang="uk" hreflang="uk" data-title="Доказова медицина" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target">Українська</a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/Y_h%E1%BB%8Dc_th%E1%BB%B1c_ch%E1%BB%A9ng" title="Y học thực chứng – Vietnamese" lang="vi" hreflang="vi" data-title="Y học thực chứng" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target">Tiếng Việt</a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E5%BE%AA%E8%AF%81%E5%8C%BB%E5%AD%A6" title="循证医学 – Chinese" lang="zh" hreflang="zh" data-title="循证医学" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target">中文</a></li> </ul> <div class="after-portlet after-portlet-lang"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q691640#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> <nav aria-label="Namespaces"> <div id="p-associated-pages" class="vector-menu vector-menu-tabs mw-portlet mw-portlet-associated-pages" > <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li id="ca-nstab-main" class="selected vector-tab-noicon mw-list-item"><a href="/wiki/Evidence-based_medicine" title="View the content page [c]" accesskey="c">Article</a></li><li id="ca-talk" 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<div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Illness diagnosis, treatment and prevention based on data collection and analysis</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"Science-based medicine" redirects here. 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screen{html.skin-theme-clientpref-night .mw-parser-output .sidebar:not(.notheme) .sidebar-list-title,html.skin-theme-clientpref-night .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle{background:transparent!important}html.skin-theme-clientpref-night .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle a{color:var(--color-progressive)!important}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .sidebar:not(.notheme) .sidebar-list-title,html.skin-theme-clientpref-os .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle{background:transparent!important}html.skin-theme-clientpref-os .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle a{color:var(--color-progressive)!important}}@media print{body.ns-0 .mw-parser-output .sidebar{display:none!important}}</style><table class="sidebar nomobile nowraplinks"><tbody><tr><td class="sidebar-pretitle">Part of <a href="/wiki/Category:Evidence-based_practices" title="Category:Evidence-based practices">a series</a> on</td></tr><tr><th class="sidebar-title-with-pretitle"><a href="/wiki/Evidence-based_practice" title="Evidence-based practice">Evidence-based practices</a></th></tr><tr><td class="sidebar-content hlist"> <ul><li><a href="/wiki/Evidence-based_assessment" title="Evidence-based assessment">Assessment</a></li> <li><a href="/wiki/Evidence-based_design" title="Evidence-based design">Design</a></li> <li><a href="/wiki/Evidence-based_management" title="Evidence-based management">Management</a></li> <li><a href="/wiki/Metascience" title="Metascience">Research</a></li> <li><a href="/wiki/Evidence-based_scheduling" title="Evidence-based scheduling">Scheduling</a></li></ul> <hr /> <ul><li><a href="/wiki/Evidence-based_dentistry" title="Evidence-based dentistry">Dentistry</a></li> <li><a href="/wiki/Evidence-based_medical_ethics" title="Evidence-based medical ethics">Medical ethics</a></li> <li><a class="mw-selflink selflink">Medicine</a></li> <li><a href="/wiki/Evidence-based_nursing" title="Evidence-based nursing">Nursing</a></li> <li><a href="/wiki/Evidence-based_pharmacy_in_developing_countries" title="Evidence-based pharmacy in developing countries">Pharmacy</a></li> <li><a href="/wiki/Evidence-based_toxicology" title="Evidence-based toxicology">Toxicology</a></li></ul> <hr /> <ul><li><a href="/wiki/Evidence-based_conservation" title="Evidence-based conservation">Conservation</a></li> <li><a href="/wiki/Evidence-based_education" title="Evidence-based education">Education</a></li> <li><a href="/wiki/Evidence-based_legislation" title="Evidence-based legislation">Legislation</a></li> <li><a href="/wiki/Evidence-based_library_and_information_practice" title="Evidence-based library and information practice">Library and information practice</a></li> <li><a href="/wiki/Evidence-based_policy" title="Evidence-based policy">Policy</a></li> <li><a href="/wiki/Evidence-based_policing" title="Evidence-based policing">Policing</a></li> <li><a href="/wiki/Evidence-based_prosecution" title="Evidence-based prosecution">Prosecution</a></li></ul></td> </tr><tr><td class="sidebar-navbar"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Evidence-based_practices" title="Template:Evidence-based practices"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Evidence-based_practices" title="Template talk:Evidence-based practices"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Evidence-based_practices" title="Special:EditPage/Template:Evidence-based practices"><abbr title="Edit this template">e</abbr></a></li></ul></div></td></tr></tbody></table> Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research."<a href="#cite_note-sackett2-1">[1]</a> The aim of EBM is to integrate the experience of the clinician, the values of the <a href="/wiki/Patient" title="Patient">patient</a>, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.<a href="#cite_note-Guyatt-2">[2]</a> The EBM Pyramid is a tool that helps in visualizing the <a href="/wiki/Hierarchy_of_evidence" title="Hierarchy of evidence">hierarchy of evidence</a> in medicine, from least authoritative, like expert opinions, to most authoritative, like systematic reviews.<a href="#cite_note-3">[3]</a> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Background,_history,_and_definition">Background, history, and definition</h2>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=1" title="Edit section: Background, history, and definition">edit</a>]</div> Medicine has a long history of scientific inquiry about the prevention, diagnosis, and treatment of human disease.<a href="#cite_note-4">[4]</a><a href="#cite_note-pmid11058989-5">[5]</a> In the 11th century AD, <a href="/wiki/Avicenna" title="Avicenna">Avicenna</a>, a Persian physician and philosopher, developed an approach to EBM that was mostly similar to current ideas and practises.<a href="#cite_note-6">[6]</a><a href="#cite_note-7">[7]</a> The concept of a controlled clinical trial was first described in 1662 by <a href="/wiki/Jan_Baptist_van_Helmont" title="Jan Baptist van Helmont">Jan Baptist van Helmont</a> in reference to the practice of <a href="/wiki/Bloodletting" title="Bloodletting">bloodletting</a>.<a href="#cite_note-8">[8]</a> Wrote Van Helmont: <style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style><blockquote class="templatequote">Let us take out of the Hospitals, out of the Camps, or from elsewhere, 200, or 500 poor People, that have fevers or Pleuritis. Let us divide them in Halfes, let us cast lots, that one halfe of them may fall to my share, and the others to yours; I will cure them without blood-letting and sensible evacuation; but you do, as ye know ... we shall see how many Funerals both of us shall have...</blockquote> The first published report describing the conduct and results of a controlled clinical trial was by <a href="/wiki/James_Lind" title="James Lind">James Lind</a>, a Scottish naval surgeon who conducted research on <a href="/wiki/Scurvy" title="Scurvy">scurvy</a> during his time aboard <a href="/wiki/HMS_Salisbury_(1746)" title="HMS Salisbury (1746)">HMS Salisbury</a> in the <a href="/wiki/Channel_Fleet" title="Channel Fleet">Channel Fleet</a>, while patrolling the <a href="/wiki/Bay_of_Biscay" title="Bay of Biscay">Bay of Biscay</a>. Lind divided the sailors participating in his experiment into six groups, so that the effects of various treatments could be fairly compared. Lind found improvement in symptoms and signs of scurvy among the group of men treated with lemons or oranges. He published a treatise describing the results of this experiment in 1753.<a href="#cite_note-9">[9]</a> An early critique of statistical methods in medicine was published in 1835, in Comtes Rendus de l’Académie des Sciences, Paris, by a man referred to as "Mr Civiale".<a href="#cite_note-10">[10]</a> The term 'evidence-based medicine' was introduced in 1990 by <a href="/wiki/Gordon_Guyatt" title="Gordon Guyatt">Gordon Guyatt</a> of <a href="/wiki/McMaster_University" title="McMaster University">McMaster University</a>.<a href="#cite_note-11">[11]</a><a href="#cite_note-12">[12]</a><a href="#cite_note-13">[13]</a><a href="#cite_note-14">[14]</a> <div class="mw-heading mw-heading3"><h3 id="Clinical_decision-making">Clinical decision-making</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=2" title="Edit section: Clinical decision-making">edit</a>]</div> <a href="/wiki/Alvan_Feinstein" title="Alvan Feinstein">Alvan Feinstein</a>'s publication of Clinical Judgment in 1967 focused attention on the role of clinical reasoning and identified biases that can affect it.<a href="#cite_note-feinstein-15">[15]</a> In 1972, <a href="/wiki/Archie_Cochrane" title="Archie Cochrane">Archie Cochrane</a> published Effectiveness and Efficiency, which described the lack of controlled trials supporting many practices that had previously been assumed to be effective.<a href="#cite_note-cochraneal-16">[16]</a> In 1973, <a href="/wiki/John_Wennberg" title="John Wennberg">John Wennberg</a> began to document wide variations in how physicians practiced.<a href="#cite_note-wennberg-17">[17]</a> Through the 1980s, <a href="/wiki/David_M._Eddy" title="David M. Eddy">David M. Eddy</a> described errors in clinical reasoning and gaps in evidence.<a href="#cite_note-eddy2-18">[18]</a><a href="#cite_note-eddy3-19">[19]</a><a href="#cite_note-eddy4-20">[20]</a><a href="#cite_note-eddy5-21">[21]</a> In the mid-1980s, Alvin Feinstein, <a href="/wiki/David_Sackett" title="David Sackett">David Sackett</a> and others published textbooks on clinical <a href="/wiki/Epidemiology" title="Epidemiology">epidemiology</a>, which translated epidemiological methods to physician decision-making.<a href="#cite_note-feinstein2-22">[22]</a><a href="#cite_note-sackett-23">[23]</a> Toward the end of the 1980s, a group at <a href="/wiki/RAND" class="mw-redirect" title="RAND">RAND</a> showed that large proportions of procedures performed by physicians were considered inappropriate even by the standards of their own experts.<a href="#cite_note-chassin-24">[24]</a> <div class="mw-heading mw-heading3"><h3 id="Evidence-based_guidelines_and_policies">Evidence-based guidelines and policies</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=3" title="Edit section: Evidence-based guidelines and policies">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Medical_guideline" title="Medical guideline">Medical guideline</a></div> David M. Eddy first began to use the term 'evidence-based' in 1987 in workshops and a manual commissioned by the Council of Medical Specialty Societies to teach formal methods for designing clinical practice guidelines. The manual was eventually published by the <a href="/wiki/American_College_of_Physicians" title="American College of Physicians">American College of Physicians</a>.<a href="#cite_note-eddy1992-25">[25]</a><a href="#cite_note-field-26">[26]</a> Eddy first published the term 'evidence-based' in March 1990, in an article in the Journal of the American Medical Association (<a href="/wiki/JAMA" title="JAMA">JAMA</a>) that laid out the principles of evidence-based guidelines and population-level policies, which Eddy described as "explicitly describing the available evidence that pertains to a policy and tying the policy to evidence instead of standard-of-care practices or the beliefs of experts. The pertinent evidence must be identified, described, and analyzed. The policymakers must determine whether the policy is justified by the evidence. A rationale must be written."<a href="#cite_note-eddy6-27">[27]</a> He discussed evidence-based policies in several other papers published in JAMA in the spring of 1990.<a href="#cite_note-eddy6-27">[27]</a><a href="#cite_note-eddy7-28">[28]</a> Those papers were part of a series of 28 published in JAMA between 1990 and 1997 on formal methods for designing population-level guidelines and policies.<a href="#cite_note-eddy8-29">[29]</a> <div class="mw-heading mw-heading3"><h3 id="Medical_education">Medical education</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=4" title="Edit section: Medical education">edit</a>]</div> The term 'evidence-based medicine' was introduced slightly later, in the context of medical education. In the autumn of 1990, <a href="/wiki/Gordon_Guyatt" title="Gordon Guyatt">Gordon Guyatt</a> used it in an unpublished description of a program at <a href="/wiki/McMaster_University" title="McMaster University">McMaster University</a> for prospective or new medical students.<a href="#cite_note-howick-30">[30]</a> Guyatt and others first published the term two years later (1992) to describe a new approach to teaching the practice of medicine.<a href="#cite_note-Guyatt-2">[2]</a> In 1996, David Sackett and colleagues clarified the definition of this tributary of evidence-based medicine as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research."<a href="#cite_note-sackett2-1">[1]</a> This branch of evidence-based medicine aims to make individual decision making more structured and objective by better reflecting the evidence from research.<a href="#cite_note-katz-31">[31]</a><a href="#cite_note-grobbee-32">[32]</a> Population-based data are applied to the care of an individual patient,<a href="#cite_note-doi-33">[33]</a> while respecting the fact that practitioners have clinical expertise reflected in effective and efficient diagnosis and thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences.<a href="#cite_note-sackett2-1">[1]</a> Between 1993 and 2000, the Evidence-Based Medicine Working Group at McMaster University published the methods to a broad physician audience in a series of 25 "Users' Guides to the Medical Literature" in JAMA. In 1995 Rosenberg and Donald defined individual-level, evidence-based medicine as "the process of finding, appraising, and using contemporaneous research findings as the basis for medical decisions."<a href="#cite_note-rosenberg2-34">[34]</a> In 2010, <a href="/wiki/Trisha_Greenhalgh" title="Trisha Greenhalgh">Greenhalgh</a> used a definition that emphasized quantitative methods: "the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation or management of individual patients."<a href="#cite_note-greenhalgh1-35">[35]</a><a href="#cite_note-sackett2-1">[1]</a> The two original definitions[<a href="/wiki/Wikipedia:Avoid_weasel_words" class="mw-redirect" title="Wikipedia:Avoid weasel words">which?</a>] highlight important differences in how evidence-based medicine is applied to populations versus individuals. When designing guidelines applied to large groups of people in settings with relatively little opportunity for modification by individual physicians, evidence-based policymaking emphasizes that good evidence should exist to document a test's or treatment's effectiveness.<a href="#cite_note-Eddy1990-36">[36]</a> In the setting of individual decision-making, practitioners can be given greater latitude in how they interpret research and combine it with their clinical judgment.<a href="#cite_note-sackett2-1">[1]</a><a href="#cite_note-greenhalgh2-37">[37]</a> In 2005, Eddy offered an umbrella definition for the two branches of EBM: "Evidence-based medicine is a set of principles and methods intended to ensure that to the greatest extent possible, medical decisions, guidelines, and other types of policies are based on and consistent with good evidence of effectiveness and benefit."<a href="#cite_note-eddybmapproach-38">[38]</a> <div class="mw-heading mw-heading3"><h3 id="Progress">Progress</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=5" title="Edit section: Progress">edit</a>]</div> In the area of evidence-based guidelines and policies, the explicit insistence on evidence of effectiveness was introduced by the American Cancer Society in 1980.<a href="#cite_note-guidelines-39">[39]</a> The U.S. Preventive Services Task Force (USPSTF) began issuing guidelines for preventive interventions based on evidence-based principles in 1984.<a href="#cite_note-taskforce-40">[40]</a> In 1985, the Blue Cross Blue Shield Association applied strict evidence-based criteria for covering new technologies.<a href="#cite_note-rettig-41">[41]</a> Beginning in 1987, specialty societies such as the American College of Physicians, and voluntary health organizations such as the American Heart Association, wrote many evidence-based guidelines. In 1991, <a href="/wiki/Kaiser_Permanente" title="Kaiser Permanente">Kaiser Permanente</a>, a managed care organization in the US, began an evidence-based guidelines program.<a href="#cite_note-kaiserpermanente-42">[42]</a> In 1991, Richard Smith wrote an editorial in the British Medical Journal and introduced the ideas of evidence-based policies in the UK.<a href="#cite_note-smith-43">[43]</a> In 1993, the Cochrane Collaboration created a network of 13 countries to produce systematic reviews and guidelines.<a href="#cite_note-cochrane-44">[44]</a> In 1997, the US Agency for Healthcare Research and Quality (AHRQ, then known as the Agency for Health Care Policy and Research, or AHCPR) established Evidence-based Practice Centers (EPCs) to produce evidence reports and technology assessments to support the development of guidelines.<a href="#cite_note-ahrq-45">[45]</a> In the same year, a <a href="/wiki/National_Guideline_Clearinghouse" title="National Guideline Clearinghouse">National Guideline Clearinghouse</a> that followed the principles of evidence-based policies was created by AHRQ, the AMA, and the American Association of Health Plans (now America's Health Insurance Plans).<a href="#cite_note-guideline-46">[46]</a> In 1999, the <a href="/wiki/National_Institute_for_Health_and_Care_Excellence" title="National Institute for Health and Care Excellence">National Institute for Clinical Excellence</a> (NICE) was created in the UK.<a href="#cite_note-nice-47">[47]</a> In the area of medical education, medical schools in Canada, the US, the UK, Australia, and other countries<a href="#cite_note-48">[48]</a><a href="#cite_note-49">[49]</a> now offer programs that teach evidence-based medicine. A 2009 study of UK programs found that more than half of UK medical schools offered some training in evidence-based medicine, although the methods and content varied considerably, and EBM teaching was restricted by lack of curriculum time, trained tutors and teaching materials.<a href="#cite_note-medteach-50">[50]</a> Many programs have been developed to help individual physicians gain better access to evidence. For example, UpToDate was created in the early 1990s.<a href="#cite_note-uptodate-51">[51]</a> The Cochrane Collaboration began publishing evidence reviews in 1993.<a href="#cite_note-kaiserpermanente-42">[42]</a> In 1995, BMJ Publishing Group launched Clinical Evidence, a 6-monthly periodical that provided brief summaries of the current state of evidence about important clinical questions for clinicians.<a href="#cite_note-clinicalevidence-52">[52]</a> <div class="mw-heading mw-heading3"><h3 id="Current_practice">Current practice</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=6" title="Edit section: Current practice">edit</a>]</div> By 2000, use of the term evidence-based had extended to other levels of the health care system. An example is evidence-based health services, which seek to increase the competence of health service decision makers and the practice of evidence-based medicine at the organizational or institutional level.<a href="#cite_note-gray-53">[53]</a> The multiple tributaries of evidence-based medicine share an emphasis on the importance of incorporating evidence from formal research in medical policies and decisions. However, because they differ on the extent to which they require good evidence of effectiveness before promoting a guideline or payment policy, a distinction is sometimes made between evidence-based medicine and science-based medicine, which also takes into account factors such as prior plausibility and compatibility with established science (as when medical organizations promote controversial treatments such as <a href="/wiki/Acupuncture" title="Acupuncture">acupuncture</a>).<a href="#cite_note-AAFP2018-54">[54]</a> Differences also exist regarding the extent to which it is feasible to incorporate individual-level information in decisions. Thus, evidence-based guidelines and policies may not readily "hybridise" with experience-based practices orientated towards ethical clinical judgement, and can lead to contradictions, contest, and unintended crises.<a href="#cite_note-eddy5-21">[21]</a> The most effective "knowledge leaders" (managers and clinical leaders) use a broad range of management knowledge in their decision making, rather than just formal evidence.<a href="#cite_note-feinstein2-22">[22]</a> Evidence-based guidelines may provide the basis for <a href="/wiki/Governmentality" title="Governmentality">governmentality</a> in health care, and consequently play a central role in the governance of contemporary health care systems.<a href="#cite_note-sackett-23">[23]</a> <div class="mw-heading mw-heading2"><h2 id="Methods">Methods</h2>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=7" title="Edit section: Methods">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Steps">Steps</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=8" title="Edit section: Steps">edit</a>]</div> The steps for designing explicit, evidence-based guidelines were described in the late 1980s: formulate the question (population, intervention, comparison intervention, outcomes, time horizon, setting); search the literature to identify studies that inform the question; interpret each study to determine precisely what it says about the question; if several studies address the question, synthesize their results (<a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a>); summarize the evidence in evidence tables; compare the benefits, harms and costs in a balance sheet; draw a conclusion about the preferred practice; write the guideline; write the rationale for the guideline; have others review each of the previous steps; implement the guideline.<a href="#cite_note-eddy4-20">[20]</a> For the purposes of medical education and individual-level decision making, five steps of EBM in practice were described in 1992<a href="#cite_note-55">[55]</a> and the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers was summarized into five steps and published in 2005.<a href="#cite_note-Sicily_statement_on_evidence-based-56">[56]</a> This five-step process can broadly be categorized as follows: <ol><li>Translation of uncertainty to an answerable question; includes critical questioning, study design and levels of evidence<a href="#cite_note-57">[57]</a></li> <li>Systematic retrieval of the best evidence available<a href="#cite_note-58">[58]</a></li> <li>Critical appraisal of evidence for <a href="/wiki/Internal_validity" title="Internal validity">internal validity</a> that can be broken down into aspects regarding:<a href="#cite_note-doi-33">[33]</a> <ul><li>Systematic errors as a result of selection bias, information bias and confounding</li> <li>Quantitative aspects of diagnosis and treatment</li> <li>The effect size and aspects regarding its precision</li> <li>Clinical importance of results</li> <li>External validity or generalizability</li></ul></li> <li>Application of results in practice<a href="#cite_note-59">[59]</a></li> <li>Evaluation of performance<a href="#cite_note-60">[60]</a></li></ol> <div class="mw-heading mw-heading3"><h3 id="Evidence_reviews">Evidence reviews</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=9" title="Edit section: Evidence reviews">edit</a>]</div> <a href="/wiki/Systematic_review" title="Systematic review">Systematic reviews</a> of published research studies are a major part of the evaluation of particular treatments. The <a href="/wiki/Cochrane_Collaboration" class="mw-redirect" title="Cochrane Collaboration">Cochrane Collaboration</a> is one of the best-known organisations that conducts systematic reviews. Like other producers of systematic reviews, it requires authors to provide a detailed study protocol as well as a reproducible plan of their literature search and evaluations of the evidence.<a href="#cite_note-Tanjong2009-61">[61]</a> After the best evidence is assessed, treatment is categorized as (1) likely to be beneficial, (2) likely to be harmful, or (3) without evidence to support either benefit or harm.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] A 2007 analysis of 1,016 systematic reviews from all 50 Cochrane Collaboration Review Groups found that 44% of the reviews concluded that the intervention was likely to be beneficial, 7% concluded that the intervention was likely to be harmful, and 49% concluded that evidence did not support either benefit or harm. 96% recommended further research.<a href="#cite_note-Mapping2007-62">[62]</a> In 2017, a study assessed the role of systematic reviews produced by Cochrane Collaboration to inform US private payers' policymaking; it showed that although the medical policy documents of major US private payers were informed by Cochrane systematic reviews, there was still scope to encourage the further use.<a href="#cite_note-63">[63]</a> <div class="mw-heading mw-heading3"><h3 id="Assessing_the_quality_of_evidence">Assessing the quality of evidence</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=10" title="Edit section: Assessing the quality of evidence">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Levels_of_evidence" class="mw-redirect" title="Levels of evidence">Levels of evidence</a></div> Evidence-based medicine categorizes different types of clinical evidence and rates or grades them<a href="#cite_note-64">[64]</a> according to the strength of their freedom from the various biases that beset medical research. For example, the strongest evidence for therapeutic interventions is provided by systematic review of <a href="/wiki/Randomized" class="mw-redirect" title="Randomized">randomized</a>, well-blinded, <a href="/wiki/Placebo-controlled_trials" class="mw-redirect" title="Placebo-controlled trials">placebo-controlled trials</a> with allocation concealment and complete follow-up involving a homogeneous patient population and medical condition. In contrast, patient testimonials, <a href="/wiki/Case_report" title="Case report">case reports</a>, and even expert opinion have little value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, and difficulties in ascertaining who is an expert (however, some critics have argued that expert opinion "does not belong in the rankings of the quality of <a href="/wiki/Empirical_evidence" title="Empirical evidence">empirical evidence</a> because it does not represent a form of empirical evidence" and continue that "expert opinion would seem to be a separate, complex type of knowledge that would not fit into hierarchies otherwise limited to empirical evidence alone.").<a href="#cite_note-Tonelli99-65">[65]</a> Several organizations have developed grading systems for assessing the quality of evidence. For example, in 1989 the U.S. Preventive Services Task Force (USPSTF) put forth the following system:<a href="#cite_note-USPrevServTaskForce-66">[66]</a> <ul><li>Level I: Evidence obtained from at least one properly designed <a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">randomized controlled trial</a>.</li> <li>Level II-1: Evidence obtained from well-designed controlled trials without <a href="/wiki/Randomization" title="Randomization">randomization</a>.</li> <li>Level II-2: Evidence obtained from well-designed <a href="/wiki/Cohort_study" title="Cohort study">cohort studies</a> or <a href="/wiki/Case-control" class="mw-redirect" title="Case-control">case-control</a> studies, preferably from more than one center or research group.</li> <li>Level II-3: Evidence obtained from multiple <a href="/wiki/Time_series" title="Time series">time series</a> designs with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.</li> <li>Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.</li></ul> Another example are the Oxford CEBM Levels of Evidence published by the <a href="/wiki/Centre_for_Evidence-Based_Medicine" title="Centre for Evidence-Based Medicine">Centre for Evidence-Based Medicine</a>. First released in September 2000, the Levels of Evidence provide a way to rank evidence for claims about prognosis, diagnosis, treatment benefits, treatment harms, and screening, which most grading schemes do not address. The original CEBM Levels were Evidence-Based On Call to make the process of finding evidence feasible and its results explicit. In 2011, an international team redesigned the Oxford CEBM Levels to make them more understandable and to take into account recent developments in evidence ranking schemes. The Oxford CEBM Levels of Evidence have been used by patients and clinicians, as well as by experts to develop clinical guidelines, such as recommendations for the optimal use of phototherapy and topical therapy in <a href="/wiki/Psoriasis" title="Psoriasis">psoriasis</a><a href="#cite_note-67">[67]</a> and guidelines for the use of the BCLC staging system for diagnosing and monitoring <a href="/wiki/Hepatocellular_carcinoma" title="Hepatocellular carcinoma">hepatocellular carcinoma</a> in Canada.<a href="#cite_note-68">[68]</a> In 2000, a system was developed by the Grading of Recommendations Assessment, Development and Evaluation (<a href="/wiki/GRADE" class="mw-redirect" title="GRADE">GRADE</a>) working group. The GRADE system takes into account more dimensions than just the quality of medical research.<a href="#cite_note-GRADE-69">[69]</a> It requires users who are performing an assessment of the quality of evidence, usually as part of a systematic review, to consider the impact of different factors on their confidence in the results. Authors of GRADE tables assign one of four levels to evaluate the quality of evidence, on the basis of their confidence that the observed effect (a numeric value) is close to the true effect. The confidence value is based on judgments assigned in five different domains in a structured manner.<a href="#cite_note-balshem2011-70">[70]</a> The GRADE working group defines 'quality of evidence' and 'strength of recommendations' based on the quality as two different concepts that are commonly confused with each other.<a href="#cite_note-balshem2011-70">[70]</a> Systematic reviews may include randomized controlled trials that have low risk of bias, or observational studies that have high risk of bias. In the case of randomized controlled trials, the quality of evidence is high but can be downgraded in five different domains.<a href="#cite_note-GRADE_Handbook-71">[71]</a> <ul><li>Risk of bias: A judgment made on the basis of the chance that bias in included studies has influenced the estimate of effect.</li> <li>Imprecision: A judgment made on the basis of the chance that the observed estimate of effect could change completely.</li> <li>Indirectness: A judgment made on the basis of the differences in characteristics of how the study was conducted and how the results are actually going to be applied.</li> <li>Inconsistency: A judgment made on the basis of the variability of results across the included studies.</li> <li>Publication bias: A judgment made on the basis of the question whether all the research evidence has been taken to account.<a href="#cite_note-72">[72]</a></li></ul> In the case of observational studies per GRADE, the quality of evidence starts off lower and may be upgraded in three domains in addition to being subject to downgrading.<a href="#cite_note-GRADE_Handbook-71">[71]</a> <ul><li>Large effect: Methodologically strong studies show that the observed effect is so large that the probability of it changing completely is less likely.</li> <li>Plausible confounding would change the effect: Despite the presence of a possible confounding factor that is expected to reduce the observed effect, the effect estimate still shows significant effect.</li> <li>Dose response gradient: The intervention used becomes more effective with increasing dose. This suggests that a further increase will likely bring about more effect.</li></ul> Meaning of the levels of quality of evidence as per GRADE:<a href="#cite_note-balshem2011-70">[70]</a> <ul><li>High Quality Evidence: The authors are very confident that the presented estimate lies very close to the true value. In other words, the probability is very low that further research will completely change the presented conclusions.</li> <li>Moderate Quality Evidence: The authors are confident that the presented estimate lies close to the true value, but it is also possible that it may be substantially different. In other words, further research may completely change the conclusions.</li> <li>Low Quality Evidence: The authors are not confident in the effect estimate, and the true value may be substantially different. In other words, further research is likely to change the presented conclusions completely.</li> <li>Very Low Quality Evidence: The authors do not have any confidence in the estimate and it is likely that the true value is substantially different from it. In other words, new research will probably change the presented conclusions completely.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Categories_of_recommendations">Categories of recommendations</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=11" title="Edit section: Categories of recommendations">edit</a>]</div> In guidelines and other publications, recommendation for a clinical service is classified by the balance of risk versus benefit and the level of evidence on which this information is based. The U.S. Preventive Services Task Force uses the following system:<a href="#cite_note-73">[73]</a> <ul><li>Level A: Good <a href="/wiki/Scientific_evidence" title="Scientific evidence">scientific evidence</a> suggests that the benefits of the clinical service substantially outweigh the potential risks. Clinicians should discuss the service with eligible patients.</li> <li>Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients.</li> <li>Level C: At least fair scientific evidence suggests that the clinical service provides benefits, but the balance between benefits and risks is too close for general recommendations. Clinicians need not offer it unless individual considerations apply.</li> <li>Level D: At least fair scientific evidence suggests that the risks of the clinical service outweigh potential benefits. Clinicians should not routinely offer the service to asymptomatic patients.</li> <li>Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.</li></ul> GRADE guideline panelists may make strong or weak recommendations on the basis of further criteria. Some of the important criteria are the balance between desirable and undesirable effects (not considering cost), the quality of the evidence, values and preferences and costs (resource utilization).<a href="#cite_note-GRADE_Handbook-71">[71]</a> Despite the differences between systems, the purposes are the same: to guide users of clinical research information on which studies are likely to be most valid. However, the individual studies still require careful critical appraisal.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Statistical_measures">Statistical measures</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=12" title="Edit section: Statistical measures">edit</a>]</div> Evidence-based medicine attempts to express clinical benefits of tests and treatments using mathematical methods. Tools used by practitioners of evidence-based medicine include: <ul><li>Likelihood ratio <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Likelihood_ratios_in_diagnostic_testing" title="Likelihood ratios in diagnostic testing">Likelihood ratios in diagnostic testing</a></div> The <a href="/wiki/Pre-test_odds" class="mw-redirect" title="Pre-test odds">pre-test odds</a> of a particular diagnosis, multiplied by the likelihood ratio, determines the <a href="/wiki/Pre-_and_post-test_probability" title="Pre- and post-test probability">post-test odds</a>. (Odds can be calculated from, and then converted to, the [more familiar] probability.) This reflects <a href="/wiki/Bayes%27_theorem" title="Bayes' theorem">Bayes' theorem</a>. The differences in likelihood ratio between clinical tests can be used to prioritize clinical tests according to their usefulness in a given clinical situation.</li> <li>AUC-ROC The area under the <a href="/wiki/Receiver_operating_characteristic" title="Receiver operating characteristic">receiver operating characteristic</a> curve (AUC-ROC) reflects the relationship between <a href="/wiki/Sensitivity_and_specificity" title="Sensitivity and specificity">sensitivity and specificity</a> for a given test. High-quality tests will have an AUC-ROC approaching 1, and high-quality publications about clinical tests will provide information about the AUC-ROC. Cutoff values for positive and negative tests can influence specificity and sensitivity, but they do not affect AUC-ROC.</li> <li><a href="/wiki/Number_needed_to_treat" title="Number needed to treat">Number needed to treat</a> (NNT)/<a href="/wiki/Number_needed_to_harm" title="Number needed to harm">Number needed to harm</a> (NNH). NNT and NNH are ways of expressing the effectiveness and safety, respectively, of interventions in a way that is clinically meaningful. NNT is the number of people who need to be treated in order to achieve the desired outcome (e.g. survival from cancer) in one patient. For example, if a treatment increases the chance of survival by 5%, then 20 people need to be treated in order for 1 additional patient to survive because of the treatment. The concept can also be applied to diagnostic tests. For example, if 1,339 women age 50–59 need to be invited for breast cancer screening over a ten-year period in order to prevent one woman from dying of breast cancer,<a href="#cite_note-BandolierStatins2004-74">[74]</a> then the NNT for being invited to breast cancer screening is 1339.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Quality_of_clinical_trials">Quality of clinical trials</h3>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=13" title="Edit section: Quality of clinical trials">edit</a>]</div> Evidence-based medicine attempts to objectively evaluate the quality of clinical research by critically assessing techniques reported by researchers in their publications. <ul><li>Trial design considerations: High-quality studies have clearly defined eligibility criteria and have minimal missing data.<a href="#cite_note-:03-75">[75]</a><a href="#cite_note-76">[76]</a></li> <li>Generalizability considerations: Studies may only be applicable to narrowly defined patient populations and may not be generalizable to other clinical contexts.<a href="#cite_note-:03-75">[75]</a></li> <li>Follow-up: Sufficient time for defined outcomes to occur can influence the prospective study outcomes and the <a href="/wiki/Statistical_power" class="mw-redirect" title="Statistical power">statistical power</a> of a study to detect differences between a treatment and control arm.<a href="#cite_note-:2-77">[77]</a></li> <li>Power: A mathematical calculation can determine whether the number of patients is sufficient to detect a difference between treatment arms. A negative study may reflect a lack of benefit, or simply a lack of sufficient quantities of patients to detect a difference.<a href="#cite_note-:2-77">[77]</a><a href="#cite_note-:03-75">[75]</a><a href="#cite_note-:1-78">[78]</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Limitations_and_criticism">Limitations and criticism</h2>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=14" title="Edit section: Limitations and criticism">edit</a>]</div> There are a number of limitations and criticisms of evidence-based medicine.<a href="#cite_note-Krauss,_Alexander._2018-79">[79]</a><a href="#cite_note-Timmermans2005-80">[80]</a><a href="#cite_note-81">[81]</a> Two widely cited categorization schemes for the various published critiques of EBM include the three-fold division of Straus and McAlister ("limitations universal to the practice of medicine, limitations unique to evidence-based medicine and misperceptions of evidence-based-medicine")<a href="#cite_note-Straus-McAlister-2000-82">[82]</a> and the five-point categorization of Cohen, Stavri and Hersh (EBM is a poor philosophic basis for medicine, defines evidence too narrowly, is not evidence-based, is limited in usefulness when applied to individual patients, or reduces the autonomy of the doctor/patient relationship).<a href="#cite_note-Cohen-2004-83">[83]</a> In no particular order, some published objections include: <ul><li>Research produced by EBM, such as from <a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">randomized controlled trials</a> (RCTs), may not be relevant for all treatment situations.<a href="#cite_note-pmid11489034-84">[84]</a> Research tends to focus on specific populations, but individual persons can vary substantially from population norms. Because certain population segments have been historically under-researched (due to reasons such as race, gender, age, and co-morbid diseases), evidence from RCTs may not be generalizable to those populations.<a href="#cite_note-orvyhi-85">[85]</a> Thus, EBM applies to groups of people, but this should not preclude clinicians from using their personal experience in deciding how to treat each patient. One author advises that "the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand" and suggests that evidence-based medicine should not discount the value of clinical experience.<a href="#cite_note-Tonelli99-65">[65]</a> Another author stated that "the practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."<a href="#cite_note-sackett2-1">[1]</a></li> <li>Use of evidence-based guidelines often fits poorly for complex, multimorbid patients. This is because the guidelines are usually based on clinical studies focused on single diseases. In reality, the recommended treatments in such circumstances may interact unfavorably with each other and often lead to polypharmacy.<a href="#cite_note-86">[86]</a><a href="#cite_note-87">[87]</a></li> <li>The theoretical ideal of EBM (that every narrow clinical question, of which hundreds of thousands can exist, would be answered by <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> and systematic reviews of multiple RCTs) faces the limitation that research (especially the RCTs themselves) is expensive; thus, in reality, for the foreseeable future, the demand for EBM will always be much higher than the supply, and the best humanity can do is to triage the application of scarce resources.</li> <li>Research can be influenced by biases such as political or <a href="/wiki/Religious_bias" class="mw-redirect" title="Religious bias">belief bias</a>,<a href="#cite_note-88">[88]</a><a href="#cite_note-89">[89]</a> <a href="/wiki/Publication_bias" title="Publication bias">publication bias</a> and <a href="/wiki/Conflict_of_interest_in_academic_publishing" class="mw-redirect" title="Conflict of interest in academic publishing">conflict of interest in academic publishing</a>. For example, studies with conflicts due to industry funding are more likely to favor their product.<a href="#cite_note-90">[90]</a><a href="#cite_note-91">[91]</a> It has been argued that contemporary evidence based medicine is an illusion, since evidence based medicine has been corrupted by corporate interests, failed regulation, and commercialisation of academia.<a href="#cite_note-92">[92]</a></li> <li>Systematic Reviews methodologies are capable of bias and abuse in respect of (i) choice of inclusion criteria (ii) choice of outcome measures, comparisons and analyses (iii) the subjectivity inevitable in Risk of Bias assessments, even when codified procedures and criteria are observed.<a href="#cite_note-Bias-93">[93]</a><a href="#cite_note-Bias2-94">[94]</a><a href="#cite_note-Bias3-95">[95]</a> An example of all these problems can be seen in a Cochrane Review,<a href="#cite_note-Bias4-96">[96]</a> as analyzed by Edmund J. Fordham, et al. in their relevant review.<a href="#cite_note-Bias-93">[93]</a></li> <li>A lag exists between when the RCT is conducted and when its results are published.<a href="#cite_note-CaseReport-97">[97]</a></li> <li>A lag exists between when results are published and when they are properly applied.<a href="#cite_note-98">[98]</a></li> <li><a href="/wiki/Hypocognition" title="Hypocognition">Hypocognition</a> (the absence of a simple, consolidated mental framework into which new information can be placed) can hinder the application of EBM.<a href="#cite_note-99">[99]</a></li> <li><a href="/wiki/Value_(personal_and_cultural)" class="mw-redirect" title="Value (personal and cultural)">Values</a>: while patient values are considered in the original definition of EBM, the importance of values is not commonly emphasized in EBM training, a potential problem under current study.<a href="#cite_note-100">[100]</a><a href="#cite_note-101">[101]</a><a href="#cite_note-102">[102]</a></li></ul> A 2018 study, "Why all randomised controlled trials produce biased results", assessed the 10 most cited RCTs and argued that trials face a wide range of biases and constraints, from trials only being able to study a small set of questions amenable to randomisation and generally only being able to assess the average treatment effect of a sample, to limitations in extrapolating results to another context, among many others outlined in the study.<a href="#cite_note-Krauss,_Alexander._2018-79">[79]</a> <div class="mw-heading mw-heading2"><h2 id="Application_of_evidence_in_clinical_settings">Application of evidence in clinical settings</h2>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=15" title="Edit section: Application of evidence in clinical settings">edit</a>]</div> Despite the emphasis on evidence-based medicine, unsafe or ineffective medical practices continue to be applied, because of patient demand for tests or treatments, because of failure to access information about the evidence, or because of the rapid pace of change in the scientific evidence.<a href="#cite_note-Epstein-103">[103]</a> For example, between 2003 and 2017, the evidence shifted on hundreds of medical practices, including whether <a href="/wiki/Hormone_replacement_therapy" title="Hormone replacement therapy">hormone replacement therapy</a> was safe, whether babies should be given certain vitamins, and whether <a href="/wiki/Antidepressant_drugs" class="mw-redirect" title="Antidepressant drugs">antidepressant drugs</a> are effective in people with <a href="/wiki/Alzheimer%27s_disease" title="Alzheimer's disease">Alzheimer's disease</a>.<a href="#cite_note-104">[104]</a> Even when the evidence unequivocally shows that a treatment is either not safe or not effective, it may take many years for other treatments to be adopted.<a href="#cite_note-Epstein-103">[103]</a> There are many factors that contribute to lack of uptake or implementation of evidence-based recommendations.<a href="#cite_note-105">[105]</a> These include lack of awareness at the individual clinician or patient (micro) level, lack of institutional support at the organisation level (meso) level or higher at the policy (macro) level.<a href="#cite_note-106">[106]</a><a href="#cite_note-107">[107]</a> In other cases, significant change can require a generation of physicians to <a href="/wiki/Retirement" title="Retirement">retire</a> or die and be replaced by physicians who were trained with more recent evidence.<a href="#cite_note-Epstein-103">[103]</a> Physicians may also reject evidence that conflicts with their anecdotal experience or because of cognitive biases – for example, a vivid memory of a rare but shocking outcome (the <a href="/wiki/Availability_heuristic" title="Availability heuristic">availability heuristic</a>), such as a patient dying after refusing treatment.<a href="#cite_note-Epstein-103">[103]</a> They may overtreat to "do something" or to address a patient's emotional needs.<a href="#cite_note-Epstein-103">[103]</a> They may worry about malpractice charges based on a discrepancy between what the patient expects and what the evidence recommends.<a href="#cite_note-Epstein-103">[103]</a> They may also overtreat or provide ineffective treatments because the treatment feels biologically plausible.<a href="#cite_note-Epstein-103">[103]</a> It is the responsibility of those developing clinical guidelines to include an implementation plan to facilitate uptake.<a href="#cite_note-Loza_2022-108">[108]</a> The implementation process will include an implementation plan, analysis of the context, identifying barriers and facilitators and designing the strategies to address them.<a href="#cite_note-Loza_2022-108">[108]</a> <div class="mw-heading mw-heading2"><h2 id="Education">Education</h2>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=16" title="Edit section: Education">edit</a>]</div> Training in evidence based medicine is offered across the continuum of medical education.<a href="#cite_note-Sicily_statement_on_evidence-based-56">[56]</a> Educational competencies have been created for the education of health care professionals.<a href="#cite_note-109">[109]</a><a href="#cite_note-Sicily_statement_on_evidence-based-56">[56]</a><a href="#cite_note-110">[110]</a> The Berlin questionnaire and the Fresno Test<a href="#cite_note-pmid12468485-111">[111]</a><a href="#cite_note-pmid143529-112">[112]</a> are validated instruments for assessing the effectiveness of education in evidence-based medicine.<a href="#cite_note-pmid16954491-113">[113]</a><a href="#cite_note-pmid15514352-114">[114]</a> These questionnaires have been used in diverse settings.<a href="#cite_note-pmid21686291-115">[115]</a><a href="#cite_note-pmid21286836-116">[116]</a> A Campbell systematic review that included 24 trials examined the effectiveness of <a href="/wiki/E-learning" class="mw-redirect" title="E-learning">e-learning</a> in improving evidence-based health care knowledge and practice. It was found that e-learning, compared to no learning, improves evidence-based health care knowledge and skills but not attitudes and behaviour. No difference in outcomes is present when comparing e-learning with face-to-face learning. Combining e-learning and face-to-face learning (blended learning) has a positive impact on evidence-based knowledge, skills, attitude and behavior.<a href="#cite_note-117">[117]</a> As a form of e-learning, some medical school students engage in editing Wikipedia to increase their EBM skills,<a href="#cite_note-118">[118]</a> and some students construct EBM materials to develop their skills in communicating medical knowledge.<a href="#cite_note-119">[119]</a> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=17" title="Edit section: See also">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239009302">.mw-parser-output .portalbox{padding:0;margin:0.5em 0;display:table;box-sizing:border-box;max-width:175px;list-style:none}.mw-parser-output .portalborder{border:1px solid var(--border-color-base,#a2a9b1);padding:0.1em;background:var(--background-color-neutral-subtle,#f8f9fa)}.mw-parser-output .portalbox-entry{display:table-row;font-size:85%;line-height:110%;height:1.9em;font-style:italic;font-weight:bold}.mw-parser-output .portalbox-image{display:table-cell;padding:0.2em;vertical-align:middle;text-align:center}.mw-parser-output .portalbox-link{display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle}@media(min-width:720px){.mw-parser-output .portalleft{clear:left;float:left;margin:0.5em 1em 0.5em 0}.mw-parser-output .portalright{clear:right;float:right;margin:0.5em 0 0.5em 1em}}</style><ul role="navigation" aria-label="Portals" class="noprint portalbox portalborder portalright"> <li class="portalbox-entry"><img alt="icon" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/12px-WHO_Rod.svg.png" decoding="async" width="12" height="28" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/18px-WHO_Rod.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/24px-WHO_Rod.svg.png 2x" data-file-width="107" data-file-height="250" /><a href="/wiki/Portal:Medicine" title="Portal:Medicine">Medicine portal</a></li></ul> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/Anecdotal_evidence" title="Anecdotal evidence">Anecdotal evidence</a></li> <li><a href="/wiki/Clinical_decision_support_system" title="Clinical decision support system">Clinical decision support system</a> (CDSS)</li> <li><a href="/wiki/Clinical_epidemiology" title="Clinical epidemiology">Clinical epidemiology</a></li> <li><a href="/wiki/Consensus_(medical)" class="mw-redirect" title="Consensus (medical)">Consensus (medical)</a></li> <li><a href="/wiki/Epidemiology" title="Epidemiology">Epidemiology</a></li> <li><a href="/wiki/Evidence-based_dentistry" title="Evidence-based dentistry">Evidence-based dentistry</a></li> <li><a href="/wiki/Evidence-based_design" title="Evidence-based design">Evidence-based design</a></li> <li><a href="/wiki/Evidence-based_nursing" title="Evidence-based nursing">Evidence-based nursing</a></li> <li><a href="/wiki/Evidence-based_policy" title="Evidence-based policy">Evidence-based policy</a></li> <li><a href="/wiki/Evidence-based_practices" class="mw-redirect" title="Evidence-based practices">Evidence-based practices</a></li> <li><a href="/wiki/Evidence-based_management" title="Evidence-based management">Evidence-based management</a></li> <li><a href="/wiki/Evidence-based_research" class="mw-redirect" title="Evidence-based research">Evidence-based research</a> (Metascience)</li> <li><a href="/wiki/Hierarchy_of_evidence" title="Hierarchy of evidence">Hierarchy of evidence</a></li> <li><a href="/wiki/Medical_algorithm" title="Medical algorithm">Medical algorithm</a></li> <li><a href="/wiki/Paradigm_shift" title="Paradigm shift">Paradigm shift</a> – the social process by which scientific evidence is eventually adopted</li> <li><a href="/wiki/Personalized_medicine" title="Personalized medicine">Personalized medicine</a></li> <li><a href="/wiki/Policy-based_evidence_making" title="Policy-based evidence making">Policy-based evidence making</a></li> <li><a href="/wiki/Precision_medicine" class="mw-redirect" title="Precision medicine">Precision medicine</a></li> <li><a href="/wiki/Scientific_evidence" title="Scientific evidence">Scientific evidence</a></li></ul></div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=18" title="Edit section: References">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-sackett2-1">^ <a href="#cite_ref-sackett2_1-0">a</a> <a href="#cite_ref-sackett2_1-1">b</a> <a href="#cite_ref-sackett2_1-2">c</a> <a href="#cite_ref-sackett2_1-3">d</a> <a href="#cite_ref-sackett2_1-4">e</a> <a href="#cite_ref-sackett2_1-5">f</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output 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Academic Medicine. 92 (2): 194–200. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2FACM.0000000000001381">10.1097/ACM.0000000000001381</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265689">5265689</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/27627633">27627633</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Academic+Medicine&rft.atitle=Why+Medical+Schools+Should+Embrace+Wikipedia%3A+Final-Year+Medical+Student+Contributions+to+Wikipedia+Articles+for+Academic+Credit+at+One+School&rft.volume=92&rft.issue=2&rft.pages=194-200&rft.date=2017-02&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5265689%23id-name%3DPMC&rft_id=info%3Apmid%2F27627633&rft_id=info%3Adoi%2F10.1097%2FACM.0000000000001381&rft.aulast=Azzam&rft.aufirst=A&rft.au=Bresler%2C+D&rft.au=Leon%2C+A&rft.au=Maggio%2C+L&rft.au=Whitaker%2C+E&rft.au=Heilman%2C+J&rft.au=Orlowitz%2C+J&rft.au=Swisher%2C+V&rft.au=Rasberry%2C+L&rft.au=Otoide%2C+K&rft.au=Trotter%2C+F&rft.au=Ross%2C+W&rft.au=McCue%2C+JD&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5265689&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEvidence-based+medicine" class="Z3988"> </li> <li id="cite_note-119"><a href="#cite_ref-119">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMaggioWillinskyCostelloSkinner2020" class="citation journal cs1">Maggio LA, Willinsky JM, Costello JA, Skinner NA, Martin PC, Dawson JE (December 2020). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718341">"Integrating Wikipedia editing into health professions education: a curricular inventory and review of the literature"</a>. Perspectives on Medical Education. 9 (6): 333–342. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs40037-020-00620-1">10.1007/s40037-020-00620-1</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718341">7718341</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/33030643">33030643</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Perspectives+on+Medical+Education&rft.atitle=Integrating+Wikipedia+editing+into+health+professions+education%3A+a+curricular+inventory+and+review+of+the+literature&rft.volume=9&rft.issue=6&rft.pages=333-342&rft.date=2020-12&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC7718341%23id-name%3DPMC&rft_id=info%3Apmid%2F33030643&rft_id=info%3Adoi%2F10.1007%2Fs40037-020-00620-1&rft.aulast=Maggio&rft.aufirst=LA&rft.au=Willinsky%2C+JM&rft.au=Costello%2C+JA&rft.au=Skinner%2C+NA&rft.au=Martin%2C+PC&rft.au=Dawson%2C+JE&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC7718341&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEvidence-based+medicine" class="Z3988"> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Bibliography">Bibliography</h2>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=19" title="Edit section: Bibliography">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin" style=""> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFDoi2012" class="citation book cs1">Doi SA (2012). Understanding evidence in health care: Using clinical epidemiology. South Yarra, VIC, Australia: Palgrave Macmillan. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4202-5669-7" title="Special:BookSources/978-1-4202-5669-7"><bdi>978-1-4202-5669-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Understanding+evidence+in+health+care%3A+Using+clinical+epidemiology&rft.place=South+Yarra%2C+VIC%2C+Australia&rft.pub=Palgrave+Macmillan&rft.date=2012&rft.isbn=978-1-4202-5669-7&rft.aulast=Doi&rft.aufirst=SA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEvidence-based+medicine" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGrobbeeHoes2009" class="citation book cs1">Grobbee DE, Hoes AW (2009). Clinical Epidemiology: Principles, Methods, and Applications for Clinical Research. Jones & Bartlett Learning. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7637-5315-3" title="Special:BookSources/978-0-7637-5315-3"><bdi>978-0-7637-5315-3</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Clinical+Epidemiology%3A+Principles%2C+Methods%2C+and+Applications+for+Clinical+Research&rft.pub=Jones+%26+Bartlett+Learning&rft.date=2009&rft.isbn=978-0-7637-5315-3&rft.aulast=Grobbee&rft.aufirst=DE&rft.au=Hoes%2C+AW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEvidence-based+medicine" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHowick2011" class="citation book cs1">Howick JH (2011). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=O8djbHBva5IC">The Philosophy of Evidence-based Medicine</a>. 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Sage. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7619-1939-1" title="Special:BookSources/978-0-7619-1939-1"><bdi>978-0-7619-1939-1</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Clinical+Epidemiology+%26+Evidence-Based+Medicine%3A+Fundamental+Principles+of+Clinical+Reasoning+%26+Research&rft.pub=Sage&rft.date=2001&rft.isbn=978-0-7619-1939-1&rft.aulast=Katz&rft.aufirst=DL&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fclinicalepidemio0000katz&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEvidence-based+medicine" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFStegenga2018" class="citation book cs1">Stegenga J (2018). <a rel="nofollow" class="external text" href="https://www.press.uchicago.edu/ucp/books/book/chicago/C/bo29193227.html">Care and Cure: An Introduction To Philosophy of Medicine</a>. University of Chicago Press. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-226-59517-7" title="Special:BookSources/978-0-226-59517-7"><bdi>978-0-226-59517-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Care+and+Cure%3A+An+Introduction+To+Philosophy+of+Medicine&rft.pub=University+of+Chicago+Press&rft.date=2018&rft.isbn=978-0-226-59517-7&rft.aulast=Stegenga&rft.aufirst=J&rft_id=https%3A%2F%2Fwww.press.uchicago.edu%2Fucp%2Fbooks%2Fbook%2Fchicago%2FC%2Fbo29193227.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEvidence-based+medicine" class="Z3988"></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2>[<a href="/w/index.php?title=Evidence-based_medicine&action=edit&section=20" title="Edit section: External links">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 0 2px 0.9em;text-align:center}.mw-parser-output .side-box-imageright{padding:2px 0.9em 2px 0;text-align:center}@media(min-width:500px){.mw-parser-output .side-box-flex{display:flex;align-items:center}.mw-parser-output .side-box-text{flex:1;min-width:0}}@media(min-width:720px){.mw-parser-output .side-box{width:238px}.mw-parser-output .side-box-right{clear:right;float:right;margin-left:1em}.mw-parser-output .side-box-left{margin-right:1em}}</style><style data-mw-deduplicate="TemplateStyles:r1237033735">@media print{body.ns-0 .mw-parser-output .sistersitebox{display:none!important}}@media 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srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Wiktionary-logo-en-v2.svg/60px-Wiktionary-logo-en-v2.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/99/Wiktionary-logo-en-v2.svg/80px-Wiktionary-logo-en-v2.svg.png 2x" data-file-width="512" data-file-height="512" /></div> <div class="side-box-text plainlist">Look up <a href="https://en.wiktionary.org/wiki/Special:Search/evidence-based_medicine" class="extiw" title="wiktionary:Special:Search/evidence-based medicine">evidence-based medicine</a> in Wiktionary, the free dictionary.</div></div> </div> <ul><li><a rel="nofollow" class="external text" href="https://files.jamanetwork.com/sdebm/">Evidence-Based Medicine – An Oral History</a>, <a href="/wiki/JAMA_(journal)" class="mw-redirect" title="JAMA (journal)">JAMA</a> and the <a href="/wiki/BMJ" class="mw-redirect" title="BMJ">BMJ</a>, 2014. <a href="/wiki/Open_access" title="open access publication – free to read"><img alt="Open access icon" src="//upload.wikimedia.org/wikipedia/commons/thumb/7/77/Open_Access_logo_PLoS_transparent.svg/9px-Open_Access_logo_PLoS_transparent.svg.png" decoding="async" width="9" height="14" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/77/Open_Access_logo_PLoS_transparent.svg/14px-Open_Access_logo_PLoS_transparent.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/77/Open_Access_logo_PLoS_transparent.svg/18px-Open_Access_logo_PLoS_transparent.svg.png 2x" data-file-width="640" data-file-height="1000" /></a></li> <li><a rel="nofollow" class="external text" href="https://www.cebm.net/">Centre for Evidence-based Medicine at the University of Oxford.</a></li></ul> <div style="clear:both;" class=""></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid 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.navbox{display:none!important}}</style></div><div role="navigation" class="navbox" aria-labelledby="Evidence-based_practice" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Evidence-based_practice" title="Template:Evidence-based practice"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Evidence-based_practice" title="Template talk:Evidence-based practice"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Evidence-based_practice" title="Special:EditPage/Template:Evidence-based practice"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Evidence-based_practice" style="font-size:114%;margin:0 4em"><a href="/wiki/Evidence-based_practice" title="Evidence-based practice">Evidence-based practice</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Key terms</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Evidence-based_practice" title="Evidence-based practice">Evidence-based practice</a></li> <li><a href="/wiki/Hierarchy_of_evidence" title="Hierarchy of evidence">Hierarchy of evidence</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Applications</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Effective_altruism" title="Effective altruism">Effective altruism</a></li> <li><a href="/wiki/Evidence-based_assessment" title="Evidence-based assessment">Evidence-based assessment</a></li> <li><a href="/wiki/Evidence-based_conservation" title="Evidence-based conservation">Evidence-based conservation</a></li> <li><a href="/wiki/Evidence-based_dentistry" title="Evidence-based dentistry">Evidence-based dentistry</a></li> <li><a href="/wiki/Evidence-based_design" title="Evidence-based design">Evidence-based design</a></li> <li><a href="/wiki/Evidence-based_education" title="Evidence-based education">Evidence-based education</a></li> <li><a href="/wiki/Evidence-based_legislation" title="Evidence-based legislation">Evidence-based legislation</a></li> <li><a href="/wiki/Evidence-based_library_and_information_practice" title="Evidence-based library and information practice">Evidence-based library and information practice</a></li> <li><a href="/wiki/Evidence-based_management" title="Evidence-based management">Evidence-based management</a></li> <li><a href="/wiki/Evidence-based_medical_ethics" title="Evidence-based medical ethics">Evidence-based medical ethics</a></li> <li><a class="mw-selflink selflink">Evidence-based medicine</a></li> <li><a href="/wiki/Evidence-based_nursing" title="Evidence-based nursing">Evidence-based nursing</a></li> <li><a href="/wiki/Evidence-based_pharmacy_in_developing_countries" title="Evidence-based pharmacy in developing countries">Evidence-based pharmacy in developing countries</a></li> <li><a href="/wiki/Evidence-based_policing" title="Evidence-based policing">Evidence-based policing</a></li> <li><a href="/wiki/Evidence-based_prosecution" title="Evidence-based prosecution">Evidence-based prosecution</a></li> <li><a href="/wiki/Evidence-based_policy" title="Evidence-based policy">Evidence-based policy</a></li> <li><a href="/wiki/Evidence-based_scheduling" title="Evidence-based scheduling">Evidence-based scheduling</a></li> <li><a href="/wiki/Evidence-based_toxicology" title="Evidence-based toxicology">Evidence-based toxicology</a></li> <li><a href="/wiki/Journalology" title="Journalology">Journalology</a></li> <li><a href="/wiki/Metascience" title="Metascience">Metascience</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Clinical_study_design" title="Clinical study design">Methods</a> and concepts</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trial</a></li> <li><a href="/wiki/Systematic_review" title="Systematic review">Systematic review</a></li> <li><a href="/wiki/Meta-analysis" title="Meta-analysis">Meta-analysis</a></li> <li><a href="/wiki/Umbrella_review" title="Umbrella review">Umbrella review</a></li> <li><a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">Randomized controlled trial</a></li> <li><a href="/wiki/Health_technology_assessment" title="Health technology assessment">Health technology assessment</a></li> <li><a href="/wiki/PICO_process" title="PICO process">PICO process</a></li> <li><a href="/wiki/GRADE_approach" title="GRADE approach">GRADE approach</a></li> <li><a href="/wiki/Pragmatic_clinical_trial" title="Pragmatic clinical trial">Pragmatic clinical trial</a></li> <li><a href="/wiki/Spaced_repetition" title="Spaced repetition">Spaced repetition</a></li> <li><a href="/wiki/Risk_assessment" title="Risk assessment">Risk assessment</a></li> <li>Scientific <a href="/wiki/Uncertainty" title="Uncertainty">uncertainty</a></li> <li><a href="/wiki/Policy-based_evidence_making" title="Policy-based evidence making">Policy-based evidence making</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">People</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Archie_Cochrane" title="Archie Cochrane">Archie Cochrane</a></li> <li><a href="/wiki/David_Sackett" title="David Sackett">David Sackett</a></li> <li><a href="/wiki/Iain_Chalmers" title="Iain Chalmers">Iain Chalmers</a></li> <li><a href="/wiki/Ken_Harvey_(professor)" title="Ken Harvey (professor)">Ken Harvey</a></li> <li><a href="/wiki/John_Ioannidis" title="John Ioannidis">John Ioannidis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Groups</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Non-profit</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/James_Lind_Alliance" title="James Lind Alliance">James Lind Alliance</a></li> <li><a href="/wiki/Cochrane_(organisation)" title="Cochrane (organisation)">Cochrane Collaboration</a></li> <li><a href="/wiki/Campbell_Collaboration" title="Campbell Collaboration">Campbell Collaboration</a></li> <li><a href="/wiki/Science-Based_Medicine" title="Science-Based Medicine">Science-Based Medicine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Governmental</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Agency_for_Healthcare_Research_and_Quality" title="Agency for Healthcare Research and Quality">Agency for Healthcare Research and Quality (AHRQ)</a></li> <li><a href="/wiki/Canadian_Agency_for_Drugs_and_Technologies_in_Health" class="mw-redirect" title="Canadian Agency for Drugs and Technologies in Health">Canadian Agency for Drugs and Technologies in Health (CADTH)</a></li> <li><a href="/wiki/European_Network_for_Health_Technology_Assessment" title="European Network for Health Technology Assessment">EUnetHTA</a></li> <li><a href="/wiki/German_Agency_for_Quality_in_Medicine" title="German Agency for Quality in Medicine">German Agency for Quality in Medicine (AEZQ)</a></li> <li><a href="/wiki/National_Institute_for_Health_and_Care_Excellence" title="National Institute for Health and Care Excellence">National Institute for Health and Care Excellence (NICE)</a></li> <li><a href="/wiki/Swedish_Agency_for_Health_Technology_Assessment_and_Assessment_of_Social_Services" title="Swedish Agency for Health Technology Assessment and Assessment of Social Services">Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)</a></li> <li><a href="/wiki/Evidence-Informed_Policy_Network" title="Evidence-Informed Policy Network">WHO Evidence-Informed Policy Network (EVIPNet)</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Academic</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Centre_for_Reviews_and_Dissemination" title="Centre for Reviews and Dissemination">Centre for Reviews and Dissemination</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Examine.com" title="Examine.com">Examine.com</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Health_care_quality" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Health_care_quality" title="Template:Health care quality"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Health_care_quality" title="Template talk:Health care quality"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Health_care_quality" title="Special:EditPage/Template:Health care quality"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Health_care_quality" style="font-size:114%;margin:0 4em"><a href="/wiki/Health_care_quality" title="Health care quality">Health care quality</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Concepts of quality</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Evidence-based medicine</a></li> <li><a href="/wiki/Medical_consensus" title="Medical consensus">Medical consensus</a></li> <li><a href="/wiki/Medical_guideline" title="Medical guideline">Medical guideline</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Health care evaluations</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Clinical_audit" title="Clinical audit">Clinical audit</a></li> <li><a href="/wiki/Clinical_peer_review" title="Clinical peer review">Clinical peer review</a></li> <li><a href="/wiki/Independent_medical_review" title="Independent medical review">Independent medical review</a></li> <li><a href="/wiki/Health_care_ratings" title="Health care ratings">Health care ratings</a></li> <li><a href="/wiki/Health_impact_assessment" title="Health impact assessment">Health impact assessment</a></li> <li><a href="/wiki/Health_services_research" title="Health services research">Health services research</a></li> <li><a href="/wiki/Routine_health_outcomes_measurement" title="Routine health outcomes measurement">Routine health outcomes measurement</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Accreditation</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hospital_accreditation" title="Hospital accreditation">Hospital accreditation</a></li> <li><a href="/wiki/International_healthcare_accreditation" title="International healthcare accreditation">International healthcare accreditation</a></li> <li><a href="/wiki/List_of_international_healthcare_accreditation_organizations" title="List of international healthcare accreditation organizations">List of international healthcare accreditation organizations</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Costs and benefits</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Incremental_cost-effectiveness_ratio" title="Incremental cost-effectiveness ratio">Incremental cost-effectiveness ratio</a></li> <li><a href="/wiki/Cost-effectiveness_analysis" title="Cost-effectiveness analysis">Cost-effectiveness analysis</a></li> <li><a href="/wiki/Cost-minimization_analysis" title="Cost-minimization analysis">Cost-minimization analysis</a></li> <li><a href="/wiki/Cost_per_procedure" title="Cost per procedure">Cost per procedure</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Tools</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Clinical_Quality_Management_System" class="mw-redirect" title="Clinical Quality Management System">Clinical Quality Management System</a></li> <li><a href="/wiki/Disability-adjusted_life_year" title="Disability-adjusted life year">Disability-adjusted life year</a></li> <li><a href="/wiki/Incremental_cost-effectiveness_ratio" title="Incremental cost-effectiveness ratio">Incremental cost-effectiveness ratio</a></li> <li><a href="/wiki/Quality-adjusted_life_year" title="Quality-adjusted life year">Quality-adjusted life year</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Medicine" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Medicine" title="Template:Medicine"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Medicine" title="Template talk:Medicine"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Medicine" title="Special:EditPage/Template:Medicine"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Medicine" style="font-size:114%;margin:0 4em"><a href="/wiki/Medicine" title="Medicine">Medicine</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialties</a> and <a href="/wiki/Subspecialty" title="Subspecialty">subspecialties</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Surgery" title="Surgery">Surgery</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiac_surgery" title="Cardiac surgery">Cardiac surgery</a></li> <li><a href="/wiki/Cardiothoracic_surgery" title="Cardiothoracic surgery">Cardiothoracic surgery</a></li> <li><a href="/wiki/Endocrine_surgery" title="Endocrine surgery">Endocrine surgery</a></li> <li><a href="/wiki/Eye_surgery" title="Eye surgery">Eye surgery</a></li> <li><a href="/wiki/General_surgery" title="General surgery">General surgery</a> <ul><li><a href="/wiki/Colorectal_surgery" title="Colorectal surgery">Colorectal surgery</a></li> <li><a href="/wiki/Digestive_system_surgery" title="Digestive system surgery">Digestive system surgery</a></li></ul></li> <li><a href="/wiki/Neurosurgery" title="Neurosurgery">Neurosurgery</a></li> <li><a href="/wiki/Oral_and_maxillofacial_surgery" title="Oral and maxillofacial surgery">Oral and maxillofacial surgery</a></li> <li><a href="/wiki/Orthopedic_surgery" title="Orthopedic surgery">Orthopedic surgery</a></li> <li><a href="/wiki/Hand_surgery" title="Hand surgery">Hand surgery</a></li> <li><a href="/wiki/Otorhinolaryngology" title="Otorhinolaryngology">Otolaryngology</a> <ul><li>ENT</li></ul></li> <li><a href="/wiki/Pediatric_surgery" title="Pediatric surgery">Pediatric surgery</a></li> <li><a href="/wiki/Plastic_surgery" title="Plastic surgery">Plastic surgery</a></li> <li><a href="/wiki/Reproductive_surgery" title="Reproductive surgery">Reproductive surgery</a></li> <li><a href="/wiki/Surgical_oncology" title="Surgical oncology">Surgical oncology</a></li> <li><a href="/wiki/Organ_transplantation" title="Organ transplantation">Transplant surgery</a></li> <li><a href="/wiki/Trauma_surgery" title="Trauma surgery">Trauma surgery</a></li> <li><a href="/wiki/Urology" title="Urology">Urology</a> <ul><li><a href="/wiki/Andrology" title="Andrology">Andrology</a></li></ul></li> <li><a href="/wiki/Vascular_surgery" title="Vascular surgery">Vascular surgery</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Internal_medicine" title="Internal medicine">Internal medicine</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Allergy" title="Allergy">Allergy</a> / <a href="/wiki/Immunology" title="Immunology">Immunology</a></li> <li><a href="/wiki/Angiology" title="Angiology">Angiology</a></li> <li><a href="/wiki/Cardiology" title="Cardiology">Cardiology</a></li> <li><a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a></li> <li><a href="/wiki/Gastroenterology" title="Gastroenterology">Gastroenterology</a> <ul><li><a href="/wiki/Hepatology" title="Hepatology">Hepatology</a></li></ul></li> <li><a href="/wiki/Geriatrics" title="Geriatrics">Geriatrics</a></li> <li><a href="/wiki/Hematology" title="Hematology">Hematology</a></li> <li><a href="/wiki/Hospital_medicine" title="Hospital medicine">Hospital medicine</a></li> <li><a href="/wiki/Infectious_diseases_(medical_specialty)" title="Infectious diseases (medical specialty)">Infectious diseases</a></li> <li><a href="/wiki/Nephrology" title="Nephrology">Nephrology</a></li> <li><a href="/wiki/Oncology" title="Oncology">Oncology</a></li> <li><a href="/wiki/Pulmonology" title="Pulmonology">Pulmonology</a></li> <li><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Obstetrics_and_gynaecology" title="Obstetrics and gynaecology">Obstetrics and gynaecology</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gynaecology" title="Gynaecology">Gynaecology</a></li> <li><a href="/wiki/Gynecologic_oncology" title="Gynecologic oncology">Gynecologic oncology</a></li> <li><a href="/wiki/Maternal%E2%80%93fetal_medicine" title="Maternal–fetal medicine">Maternal–fetal medicine</a></li> <li><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></li> <li><a href="/wiki/Reproductive_endocrinology_and_infertility" title="Reproductive endocrinology and infertility">Reproductive endocrinology and infertility</a></li> <li><a href="/wiki/Urogynecology" title="Urogynecology">Urogynecology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Radiology" title="Radiology">Radiology</a> <ul><li><a href="/wiki/Interventional_radiology" title="Interventional radiology">Interventional radiology</a></li> <li><a href="/wiki/Neuroradiology" title="Neuroradiology">Neuroradiology</a></li> <li><a href="/wiki/Nuclear_medicine" title="Nuclear medicine">Nuclear medicine</a></li></ul></li> <li><a href="/wiki/Pathology" title="Pathology">Pathology</a> <ul><li><a href="/wiki/Anatomical_pathology" title="Anatomical pathology">Anatomical</a></li> <li><a href="/wiki/Clinical_pathology" title="Clinical pathology">Clinical pathology</a></li> <li><a href="/wiki/Clinical_chemistry" title="Clinical chemistry">Clinical chemistry</a></li> <li><a href="/wiki/Cytopathology" title="Cytopathology">Cytopathology</a></li> <li><a href="/wiki/Medical_microbiology" title="Medical microbiology">Medical microbiology</a></li> <li><a href="/wiki/Transfusion_medicine" title="Transfusion medicine">Transfusion medicine</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Addiction_medicine" title="Addiction medicine">Addiction medicine</a></li> <li><a href="/wiki/Adolescent_medicine" title="Adolescent medicine">Adolescent medicine</a></li> <li><a href="/wiki/Anesthesiology" title="Anesthesiology">Anesthesiology</a> <ul><li><a href="/wiki/Obstetric_anesthesiology" title="Obstetric anesthesiology">Obstetric anesthesiology</a></li> <li><a href="/wiki/Neurosurgical_anesthesia" title="Neurosurgical anesthesia">Neurosurgical anesthesiology</a></li></ul></li> <li><a href="/wiki/Aviation_medicine" title="Aviation medicine">Aviation medicine</a></li> <li><a href="/wiki/Dermatology" title="Dermatology">Dermatology</a></li> <li><a href="/wiki/Disaster_medicine" title="Disaster medicine">Disaster medicine</a></li> <li><a href="/wiki/Diving_medicine" title="Diving medicine">Diving medicine</a></li> <li><a href="/wiki/Emergency_medicine" title="Emergency medicine">Emergency medicine</a> <ul><li><a href="/wiki/Mass_gathering_medicine" title="Mass gathering medicine">Mass gathering medicine</a></li></ul></li> <li><a href="/wiki/Evolutionary_medicine" title="Evolutionary medicine">Evolutionary medicine</a></li> <li><a href="/wiki/Family_medicine" title="Family medicine">Family medicine</a> / <a href="/wiki/General_practice" title="General practice">General practice</a></li> <li><a href="/wiki/Hospital_medicine" title="Hospital medicine">Hospital medicine</a></li> <li><a href="/wiki/Intensive_care_medicine" title="Intensive care medicine">Intensive care medicine</a></li> <li><a href="/wiki/Medical_genetics" title="Medical genetics">Medical genetics</a></li> <li><a href="/wiki/Narcology" title="Narcology">Narcology</a></li> <li><a href="/wiki/Neurology" title="Neurology">Neurology</a> <ul><li><a href="/wiki/Clinical_neurophysiology" title="Clinical neurophysiology">Clinical neurophysiology</a></li></ul></li> <li><a href="/wiki/Occupational_medicine" title="Occupational medicine">Occupational medicine</a></li> <li><a href="/wiki/Ophthalmology" title="Ophthalmology">Ophthalmology</a></li> <li><a href="/wiki/Oral_medicine" title="Oral medicine">Oral medicine</a></li> <li><a href="/wiki/Pain_management" title="Pain management">Pain management</a></li> <li><a href="/wiki/Palliative_care" title="Palliative care">Palliative care</a></li> <li><a href="/wiki/Pediatrics" title="Pediatrics">Pediatrics</a> <ul><li><a href="/wiki/Neonatology" title="Neonatology">Neonatology</a></li></ul></li> <li><a href="/wiki/Phlebologist" class="mw-redirect" title="Phlebologist">Phlebology</a></li> <li><a href="/wiki/Physical_medicine_and_rehabilitation" title="Physical medicine and rehabilitation">Physical medicine and rehabilitation</a> (PM&R)</li> <li><a href="/wiki/Preventive_healthcare" title="Preventive healthcare">Preventive medicine</a></li> <li><a href="/wiki/Prison_healthcare" title="Prison healthcare">Prison healthcare</a></li> <li><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a> <ul><li><a href="/wiki/Addiction_psychiatry" title="Addiction psychiatry">Addiction psychiatry</a></li></ul></li> <li><a href="/wiki/Radiation_therapy" title="Radiation therapy">Radiation oncology</a></li> <li><a href="/wiki/Reproductive_medicine" title="Reproductive medicine">Reproductive medicine</a></li> <li><a href="/wiki/Sexual_medicine" title="Sexual medicine">Sexual medicine</a> <ul><li><a href="/wiki/Venereology" title="Venereology">Venereology</a></li></ul></li> <li><a href="/wiki/Sleep_medicine" title="Sleep medicine">Sleep medicine</a></li> <li><a href="/wiki/Sports_medicine" title="Sports medicine">Sports medicine</a></li> <li><a href="/wiki/Organ_transplantation" title="Organ transplantation">Transplantation medicine</a></li> <li><a href="/wiki/Tropical_medicine" title="Tropical medicine">Tropical medicine</a> <ul><li><a href="/wiki/Travel_medicine" title="Travel medicine">Travel medicine</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_education" title="Medical education">Medical education</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Medical_school" title="Medical school">Medical school</a></li> <li><a href="/wiki/Bachelor_of_Medicine,_Bachelor_of_Surgery" title="Bachelor of Medicine, Bachelor of Surgery">Bachelor of Medicine, Bachelor of Surgery</a></li> <li><a href="/wiki/Bachelor_of_Medical_Sciences" title="Bachelor of Medical Sciences">Bachelor of Medical Sciences</a></li> <li><a href="/wiki/Master_of_Medicine" title="Master of Medicine">Master of Medicine</a></li> <li><a href="/wiki/Master_of_Surgery" title="Master of Surgery">Master of Surgery</a></li> <li><a href="/wiki/Doctor_of_Medicine" title="Doctor of Medicine">Doctor of Medicine</a></li> <li><a href="/wiki/Doctor_of_Osteopathic_Medicine" title="Doctor of Osteopathic Medicine">Doctor of Osteopathic Medicine</a></li> <li><a href="/wiki/MD%E2%80%93PhD" title="MD–PhD">MD–PhD</a> <ul><li><a href="/wiki/Medical_Scientist_Training_Program" title="Medical Scientist Training Program">Medical Scientist Training Program</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related topics</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alternative_medicine" title="Alternative medicine">Alternative medicine</a></li> <li><a href="/wiki/Allied_health_professions" title="Allied health professions">Allied health</a></li> <li><a href="/wiki/Molecular_oncology" title="Molecular oncology">Molecular oncology</a></li> <li><a href="/wiki/Nanomedicine" title="Nanomedicine">Nanomedicine</a></li> <li><a href="/wiki/Personalized_medicine" title="Personalized medicine">Personalized medicine</a></li> <li><a href="/wiki/Public_health" title="Public health">Public health</a></li> <li><a href="/wiki/Rural_health" title="Rural health">Rural health</a></li> <li><a href="/wiki/Therapy" title="Therapy">Therapy</a></li> <li><a href="/wiki/Traditional_medicine" title="Traditional medicine">Traditional medicine</a></li> <li><a href="/wiki/Veterinary_medicine" title="Veterinary medicine">Veterinary medicine</a></li> <li><a href="/wiki/Physician" title="Physician">Physician</a> <ul><li><a href="/wiki/Chief_physician" title="Chief physician">Chief physician</a></li></ul></li> <li><a href="/wiki/History_of_medicine" title="History of medicine">History of medicine</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /> <a href="/wiki/Category:Medicine" title="Category:Medicine">Category</a></li> <li><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/12px-Commons-logo.svg.png" decoding="async" width="12" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/18px-Commons-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/24px-Commons-logo.svg.png 2x" data-file-width="1024" data-file-height="1376" /> <a href="https://commons.wikimedia.org/wiki/Medicine" class="extiw" title="commons:Medicine">Commons</a></li> <li><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/16px-People_icon.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/24px-People_icon.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/32px-People_icon.svg.png 2x" data-file-width="100" data-file-height="100" /> <a href="/wiki/Wikipedia:WikiProject_Medicine" title="Wikipedia:WikiProject Medicine">Wikiproject</a></li> <li><a href="/wiki/File:Symbol_portal_class.svg" class="mw-file-description" title="Portal"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/16px-Symbol_portal_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/23px-Symbol_portal_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/31px-Symbol_portal_class.svg.png 2x" data-file-width="180" data-file-height="185" /></a> <a href="/wiki/Portal:Medicine" title="Portal:Medicine">Portal</a></li> <li><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Global_thinking.svg/10px-Global_thinking.svg.png" decoding="async" width="10" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Global_thinking.svg/15px-Global_thinking.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/41/Global_thinking.svg/21px-Global_thinking.svg.png 2x" data-file-width="130" data-file-height="200" /> <a href="/wiki/Outline_of_medicine" title="Outline of medicine">Outline</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Clinical_research_and_experimental_design" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Medical_research_studies" title="Template:Medical research studies"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Medical_research_studies" title="Template talk:Medical research studies"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Medical_research_studies" title="Special:EditPage/Template:Medical research studies"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Clinical_research_and_experimental_design" style="font-size:114%;margin:0 4em"><a href="/wiki/Clinical_research" title="Clinical research">Clinical research</a> and <a href="/wiki/Design_of_experiments" title="Design of experiments">experimental design</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Overview</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trial</a> <ul><li><a href="/wiki/Protocol_(science)" title="Protocol (science)">Trial protocols</a></li> <li><a href="/wiki/Adaptive_clinical_trial" class="mw-redirect" title="Adaptive clinical trial">Adaptive clinical trial</a></li></ul></li> <li><a href="/wiki/Academic_clinical_trials" class="mw-redirect" title="Academic clinical trials">Academic clinical trials</a></li> <li><a href="/wiki/Clinical_study_design" title="Clinical study design">Clinical study design</a></li> <li><a class="mw-selflink selflink">Evidence-based medicine</a></li> <li><a href="/wiki/Real_world_evidence" title="Real world evidence">Real world evidence</a></li> <li><a href="/wiki/Patient_and_public_involvement" title="Patient and public involvement">Patient and public involvement</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Scientific_control" title="Scientific control">Controlled study</a> (<a href="/wiki/Hierarchy_of_evidence#USA" title="Hierarchy of evidence">EBM I to II-1</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">Randomized controlled trial</a> <ul><li><a href="/wiki/Experiment" title="Experiment">Scientific experiment</a></li> <li><a href="/wiki/Blind_experiment" class="mw-redirect" title="Blind experiment">Blind experiment</a></li> <li><a href="/wiki/Open-label_trial" title="Open-label trial">Open-label trial</a></li></ul></li> <li><a href="/wiki/Adaptive_clinical_trial" class="mw-redirect" title="Adaptive clinical trial">Adaptive clinical trial</a> <ul><li><a href="/wiki/Platform_trial" title="Platform trial">Platform trial</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Observational_study" title="Observational study">Observational study</a> (<a href="/wiki/Hierarchy_of_evidence#USA" title="Hierarchy of evidence">EBM II-2 to II-3</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cross-sectional_study" title="Cross-sectional study">Cross-sectional study</a> vs. <a href="/wiki/Longitudinal_study" title="Longitudinal study">Longitudinal study</a>, <a href="/wiki/Ecological_study" title="Ecological study">Ecological study</a></li> <li><a href="/wiki/Cohort_study" title="Cohort study">Cohort study</a> <ul><li><a href="/wiki/Retrospective_cohort_study" title="Retrospective cohort study">Retrospective</a></li> <li><a href="/wiki/Prospective_cohort_study" title="Prospective cohort study">Prospective</a></li></ul></li> <li><a href="/wiki/Case%E2%80%93control_study" title="Case–control study">Case–control study</a> (<a href="/wiki/Nested_case%E2%80%93control_study" title="Nested case–control study">Nested case–control study</a>)</li> <li><a href="/wiki/Case_series" title="Case series">Case series</a></li> <li><a href="/wiki/Case_study" title="Case study">Case study</a></li> <li><a href="/wiki/Case_report" title="Case report">Case report</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Outcome_measure" title="Outcome measure">Measures</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiological_methods#Measures_of_occurrence" class="mw-redirect" title="Epidemiological methods">Occurrence</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Incidence_(epidemiology)" title="Incidence (epidemiology)">Incidence</a>, <a href="/wiki/Cumulative_incidence" class="mw-redirect" title="Cumulative incidence">Cumulative incidence</a>, <a href="/wiki/Prevalence" title="Prevalence">Prevalence</a>, <a href="/wiki/Point_prevalence" class="mw-redirect" title="Point prevalence">Point prevalence</a>, <a href="/wiki/Period_prevalence" class="mw-redirect" title="Period prevalence">Period prevalence</a></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiological_methods#Measures_of_association" class="mw-redirect" title="Epidemiological methods">Association</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Risk_difference" title="Risk difference">Risk difference</a>, <a href="/wiki/Number_needed_to_treat" title="Number needed to treat">Number needed to treat</a>, <a href="/wiki/Number_needed_to_harm" title="Number needed to harm">Number needed to harm</a>, <a href="/wiki/Risk_ratio" class="mw-redirect" title="Risk ratio">Risk ratio</a>, <a href="/wiki/Relative_risk_reduction" title="Relative risk reduction">Relative risk reduction</a>, <a href="/wiki/Odds_ratio" title="Odds ratio">Odds ratio</a>, <a href="/wiki/Hazard_ratio" title="Hazard ratio">Hazard ratio</a></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Population_impact_measure" title="Population impact measure">Population impact</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Attributable_fraction_among_the_exposed" title="Attributable fraction among the exposed">Attributable fraction among the exposed</a>, <a href="/wiki/Attributable_fraction_for_the_population" title="Attributable fraction for the population">Attributable fraction for the population</a>, <a href="/wiki/Preventable_fraction_among_the_unexposed" title="Preventable fraction among the unexposed">Preventable fraction among the unexposed</a>, <a href="/wiki/Preventable_fraction_for_the_population" title="Preventable fraction for the population">Preventable fraction for the population</a></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiological_methods#Other_measures" class="mw-redirect" title="Epidemiological methods">Other</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><a href="/wiki/Clinical_endpoint" title="Clinical endpoint">Clinical endpoint</a>, <a href="/wiki/Virulence" title="Virulence">Virulence</a>, <a href="/wiki/Infectivity" title="Infectivity">Infectivity</a>, <a href="/wiki/Mortality_rate" title="Mortality rate">Mortality rate</a>, <a href="/wiki/Morbidity" class="mw-redirect" title="Morbidity">Morbidity</a>, <a href="/wiki/Case_fatality_rate" title="Case fatality rate">Case fatality rate</a>, <a href="/wiki/Specificity_and_sensitivity" class="mw-redirect" title="Specificity and sensitivity">Specificity and sensitivity</a>, <a href="/wiki/Likelihood_ratios_in_diagnostic_testing" title="Likelihood ratios in diagnostic testing">Likelihood-ratios</a>, <a href="/wiki/Pre-_and_post-test_probability" title="Pre- and post-test probability">Pre- and post-test probability</a></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Trial/test types</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/In_vitro" title="In vitro">In vitro</a></li> <li><a href="/wiki/In_vivo" title="In vivo">In vivo</a></li> <li><a href="/wiki/Animal_testing" title="Animal testing">Animal testing</a></li> <li><a href="/wiki/Animal_testing_on_non-human_primates" title="Animal testing on non-human primates">Animal testing on non-human primates</a></li> <li><a href="/wiki/First-in-man_study" class="mw-redirect" title="First-in-man study">First-in-man study</a></li> <li><a href="/wiki/Multicenter_trial" title="Multicenter trial">Multicenter trial</a></li> <li><a href="/wiki/Seeding_trial" title="Seeding trial">Seeding trial</a></li> <li><a href="/wiki/Vaccine_trial" title="Vaccine trial">Vaccine trial</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Analysis_of_clinical_trials" title="Analysis of clinical trials">Analysis of clinical trials</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Risk%E2%80%93benefit_ratio" title="Risk–benefit ratio">Risk–benefit ratio</a></li> <li><a href="/wiki/Systematic_review" title="Systematic review">Systematic review</a></li> <li><a href="/wiki/Reproducibility" title="Reproducibility">Replication</a></li> <li><a href="/wiki/Meta-analysis" title="Meta-analysis">Meta-analysis</a></li> <li><a href="/wiki/Intention-to-treat_analysis" title="Intention-to-treat analysis">Intention-to-treat analysis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Interpretation of results</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Selection_bias" title="Selection bias">Selection bias</a></li> <li><a href="/wiki/Survivorship_bias" title="Survivorship bias">Survivorship bias</a></li> <li><a href="/wiki/Correlation_does_not_imply_causation" title="Correlation does not imply causation">Correlation does not imply causation</a></li> <li><a href="/wiki/Null_result" title="Null result">Null result</a></li> <li><a href="/wiki/Sex_as_a_biological_variable" title="Sex as a biological variable">Sex as a biological variable</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><a href="/wiki/Category:Clinical_research" 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