Healthcare and Medicine Reference
− Were clinical aspects of the disease considered (subjects' characteris-
tics, comorbidity, outcomes, follow-up, and others)?
− How was the effect (impact) of a presumed cause (validity of results)
− Which criteria of causality are fulfilled by the study results?
− Was the broader balance between harm, benefits, costs, and control-
lability assessed and is it adequate?
− Is it the best evidence available?
− Are the results usable in the user's setting (caring for a specific
patient, groups of patients, community groups) and in which settings
are they not?
− If relevant, how much could and should such findings be
− Were possible competing causes considered and evaluated?
− If this problem was also a subject of other studies, should a system-
atic review and research synthesis of all these available experiences
be attempted and would such expanded research bring additional
4. Selection of the best evidence for clinical or community decision.
5. Linking evidence with clinical and community medicine (public health)
experience, knowledge, and practice and with patient and/or commu-
nity values and preferences.
6. Implementation of useful findings in clinical (clinical care) and com-
munity (public health policies and programs) medicines' decisions and
7. Evaluation of the implementations and the overall performance of the
8. Teaching others how to practice EBM/EBPH.
Physicians in their clinical practice should answer several questions before
choosing and using available evidence from the literature or from their own
experience and work for their decisions in clinical and community care:
1. What is the problem to be solved and is there a clearly formulated
question to be answered?
2. What kind of study or demonstration can we refer to in order to obtain
such an answer?
3. What are the results?
4. Are those results valid?