The document discusses the evolution of evidence-based medicine (EBM) and Cochrane's role in EBM. It outlines how EBM began in the 1990s with an emphasis on controlled clinical observations and reliance on published literature rather than personal observations. It describes Cochrane's contributions to date, including systematic reviews and practice guidelines, as well as its potential future contributions through improving accessibility and usability of reviews for clinicians and guideline developers. The document also discusses the GRADE system for rating evidence quality and developing recommendations to guide clinical practice.

4. First principle: Hierarchy of Evidence Randomized Trials Observational studies patient-important outcomes Basic research test tube, animal, human physiology Clinical experience

8. 21 5 10 1 1 2 8 7 8 12 4 3 1 1 2 8 7 2 1 1 1 2 8 1 5 15 6 Not Mentioned Routine Experimental Rare/Never Specific M M M M M M Textbook/Review Recommendations Odds Ratio (Log Scale) 0.5 1.0 2.0 Favours Treatment Favours Control RCTs Pts 1 23 2 65 3 149 4 316 7 1793 10 2544 11 2651 15 3311 17 3929 22 5452 P<.01 23 5767 27 6125 30 6346 33 6571 43 21 059 54 22 051 67 47 531 65 47 185 70 48 154 P<.001 P<.00001 Cumulative Year 1960 1965 1970 1980 1985 1990 Thrombolytic Therapy

9. Prophylactic Lidocaine in MI 1970 2 304 1974 9 1451 1976 11 1686 1978 12 1986 1985 14 8412 1988 15 8745 9 1 1 8 0 2 5 0 2 8 0 3 14 4 6 4 2 1 1989 - 1st meta-analysis published Recommendations Yes No Not mentioned Favors treatment Favors placebo Outcome = death Relative risk (CI) 0.5 1 1.5 2 Cumulative Year # RCTs Subjects