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Classification/type
Incidence
Prevalence
Therapy
Screening
Diagnostic accuracy
Prognosis
Harm
Etiology
Prevention
2
Example
Incidence, prevalence
Therapy
Screening
Diagnostic accuracy
Prognosis
Harm
Etiology
One Size Does NOT Fit All! Use Your Question Classification to Seek the
Appropriate Type of Evidence
Question
Incidence, prevalence
Therapy
Clinical trials
Screening
Clinical trials
Diagnostic accuracy
Prognosis
Harm
Etiology
Hierarchy of
Evidence for
Intervention
Studies
(Treatment,
Prevention,
Screening, Harm)
Systematic
review of
randomized trials
Single randomized trial
Systematic review of observational
studies addressing patient-important
outcomes
Single observational study addressing
patient-important outcomes
Physiologic studies
Unsystematic clinical observations
Source: adapted from Guyatt et al for the EvidenceBased Medicine Working Group. JAMA.
2000;284:1290-1296.
Ways Similar
Studies May Differ
! Patient population
! Inclusion and exclusion criteria
! Exposure definition/intervention composition, dose, timing
! Comparison group/controls
! Management protocol (e.g., cointerventions) for trials
! Outcome definition (e.g., follow-up time, cause-specific
mortality)
! Quality of design and execution
! Analysis
7
! See Chapter 5 of Cochrane Handbook, Table 5.6.a, for comparison of pros and cons of
broad or narrow question
8
! See Chapter 5 of Cochrane Handbook, Table 5.6.a, for comparison of pros and cons of
broad or narrow question
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