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1a 31 32 II Principles of Clinical Research Research Design Clinical research can be experimental or observational. Observational studies can identify an association between two variables, but cannot establish a causal link. Experimental trials are used to address the question of causation. In experimental studies, the intervention is under the control of the researcher, whereas in observational studies the researcher observes patients at a point in time (cross-sectional studies) or over time (longitudinal studies).

How to use an article evaluating the clinical impact of a computer-based clinical decision support system. Evidence-Based Medicine Working Group. JAMA 1999;282:67–74. — Bucher HC, Guyatt GH, Cook, DJ, Holbrook A, McAlister FA. Users guide to medical literature. XIX. Applying clinical trial results. A. How to use an article measuring the effect of an intervention on surrogate end points. Evidence-Based Medicine Working Group. JAMA 1999; 282(8):771–778 — McAlister FA, Laupacis A, Wells GA, Sackett DL.

As mentioned previously, evidence-based medicine involves a hierarchy of evidence, from meta-analyses of high-quality randomized controlled trials showing definitive results directly applicable to an individual patient, to relying on a physiological rationale or previous experience with a small number of similar patients. The hallmark of the evidence-based surgeon is that for particular clinical decisions, the orthopaedic surgeons must know the strength of the evidence, and therefore the degree of uncertainty.

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