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Muscle Nerve. 2018 Oct;58(4):486-496. doi: 10.1002/mus.26142. Epub 2018 May 18.

Evidence-based medicine for every day, everyone, and every therapeutic study.

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Department of Neurology, University of Missouri, Columbia, Missouri, USA.
Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Neurology TCC-8, 330 Brookline Avenue Boston, Massachusetts, 02215, USA.


The rapid growth in published medical literature makes it difficult for clinicians to keep up with advances in their fields. This may result in a cursory scan of the abstract and conclusion of a study without critically evaluating study quality. The application of evidence-based medicine (EBM) is the process of converting the abstract task of reading the literature into a practical method of using the literature to inform care in a specific clinical context while simultaneously expanding one's knowledge. EBM involves 4 steps: (1) stating the clinical problem in a defined question; (2) searching the literature for the evidence; (3) critically appraising the evidence for its validity; and (4) applying the evidence in the context of the patient's situation, preferences, and values. In this review, we use the recently published trial of thymectomy in myasthenia gravis as an example and systematically go through the steps of assessing internal validity, precision, and external validity. Muscle Nerve 58: 486-496, 2018.


effect size measures; evidence-based medicine; external validity; generalizability; internal validity; risk of bias


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