By Gordon Guyatt, Drummond Rennie, Maureen O. Meade, Deborah J. Cook

The major advisor to the rules and scientific purposes of evidence-based drugs.

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Investigators evaluate the diagnostic test by comparing its classification of patients with that of the reference standard (Figure 4-6). A final type of study examines a patient’s prog­ nosis and may identify factors that modify that prognosis. Here, investigators identify patients who When randomized trials are not available, we look to observational studies in which—rather than randomization—clinician or patient preference, or happenstance, determines whether patients receive an intervention or alternative (see Chapter 6, Why Study Results Mislead: Bias and Random Error).

The patient makes quantitative ratings of troublesome symptoms during each period, and the n-of-1 RCT continues until both the patient and the clinician conclude that the patient is or is not obtaining benefit from the target intervention. An n-of-1 RCT can provide definitive evidence of treatment effectiveness in individual patients5,6 and is thus at the top of the evidence hierarchy. Unfortunately, n-of-1 RCTs are restricted to chronic conditions with treatments that act and cease acting quickly and are subject to considerable logistic challenges.

Djulbegovic B, Guyatt GH, Ashcroft RE. Epistemologic inquiries in evidence-based medicine. Cancer Control. 2009;16(2): 158-168. Goldman AI. Toward a synthesis of reliabilism and evidentialism? or: evidentialism’s troubles, reliabialism’s rescue package. In: Dougherty T, ed. Evidentialism and Its Discontents. Oxford, UK: Oxford University Press; 2011:254-280. 3. Dougherty T. Introduction. In: Dougherty T, ed. Evidentialism and Its Discontents. Oxford, UK: Oxford University Press; 2011:1-14. Pirolli P, Card S.

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