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Systematic Reviews: Critical Links in the Great Chain of Evidence

Cynthia D. Mulrow, MD, MSc; Deborah J. Cook, MD, MSc; and Frank Davidoff, MD, Editor
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Audie L. Murphy Memorial Veterans Hospital, San Antonio, TX 78284 St. Joseph's Hospital, Hamilton, Ontario L8N 4A6, Canada Annals of Internal Medicine, Philadelphia, PA 19106 Requests for Reprints: Cynthia D. Mulrow, MD, MSc, Audie L. Murphy Veterans Memorial Hospital, 7400 Merton Minter Boulevard, San Antonio, TX 78284. Current Author Addresses: Dr. Mulrow: Audie L. Murphy Veterans Memorial Hospital, 7400 Merton Minter Boulevard, San Antonio, TX 78284.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;126(5):389-391. doi:10.7326/0003-4819-126-5-199703010-00008
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Successful clinical decisions, like most human decisions, are complex creatures [1]. In making them, we draw on information from many sources: primary data and patient preferences, our own clinical and personal experience, external rules and constraints, and scientific evidence (Figure 1). The mix of inputs to clinical decisions varies from moment to moment and from day to day, depending on the decision and the decision makers. In general, however, the proportion of scientific evidence in the mix has grown progressively over the past 150 years or so.

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Grahic Jump Location
Figure 1.
Factors that enter into clinical decisions.
Grahic Jump Location




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