Glossary

Authors: Katherine Law and Jeremy Howick

Welcome to the CEBM Glossary. This is not a comprehensive glossary but it outlines some of the key terms that
should be understood in relation to Evidence-Based practice.
Absolute risk contain detailed given disease or determination and
reduction information about other outcome. to its findings.
(ARR): The the individual The main feature Diagnostic Test:
difference in the patients. This of cohort study is Any medical test
event rate includes observation of performed to
between control demographic large numbers confirm, or
group (CER) and information (for over a long period determine the
treated group example, age, (commonly years) presence of
(EER): ARR = CER gender, ethnic with comparison disease in an
EER. origin) and of incidence rates individual
Bias: Any tendency information on in groups that suspected of
to influence the diagnosis, differ in exposure having the
results of a trial treatment, levels. disease, usually
(or their response to Confidence following the
interpretation) treatment, and interval (CI): The report of
other than the follow-up after range around a symptoms, or
experimental treatment. (NCI studys result based on the
intervention. Dictionary) within which we results of other
Blinding: A CER: Control event would expect the medical tests.
technique used in rate; see event true value to lie. Some examples of
research to rate. CIs account for the diagnostic tests
eliminate bias by Clinical practice sampling error include performing
hiding the guideline: A between the study a chest x-ray to
intervention from systematically population and the diagnose
the patient, developed wider population pneumonia, and
clinician, and/or statement the study is taking skin biopsy
other researchers designed to assist supposed to to detect
who are health care represent. See p11 cancerous cells.
interpreting professionals and Confounding (Harvard Guide to
results. patients make variable: A Diagnostic test)
Case-control study: decisions about variable which is EER: Experimental
The observational appropriate health not the one you event rate; see
epidemiologic care for specific are interested in Event rate.
study of persons clinical but which may Effectiveness: A
with the disease circumstances. affect the results measure of the
(or other outcome Cochrane of trial. benefit resulting
variable) of collaboration: A Critically appraised from an
interest and a worldwide topic (CAT): A intervention for a
suitable control association of short summary of given health
(comparison, groups who create an article from the problem under
reference) group and maintain literature, created usual conditions of
of persons without systematic to answer a clinical care for a
the disease. The reviews of the specific clinical particular group.
relationship of an literature for question. Efficacy: A measure
attribute to the specific topic Decision of the benefit
disease is areas. analysis: The resulting from an
examined by Cohort study: The application of intervention for a
comparing the analytic method of explicit, given health
diseased and epidemiologic quantitative problem under the
nondiseased with study in which methods to ideal conditions of
regard to how subsets of a analyse decisions an investigation.
frequently the defined population under conditions Event rate: The
attribute is can be identified of uncertainty. proportion of
present or, if who are, have Diagnosis: The patients in a group
quantitative, the been, or in the process of in whom an event
levels of the future may be determining is observed..
attribute, in each exposed or not health status and Forrest plot: A
of the groups. exposed, or the factors diagrammatic
Case-series: A exposed in responsible for representation of
group or series of different degrees, producing it; may the results of
case reports to a factor or be applied to an individual trials in
involving patients factors individual, family, a meta-analysis.
who were given hypothesized to group or Funnel plot: A
similar treatment. influence the community. The method of
Reports of case probability of term applied both graphing the
series usually occurrence of a to the process of results of trials in
 a meta-analysis to for clinical date, sex, have no chance
show if the results reasons. occupation, of selection.
have been Likelihood national origin, For example, a
affected by ratio: The language, scheme
publication bias. likelihood that a marital status, whereby units
Heterogeneity: In given test result income, and are selected
systematic would be expected relationship to purposively
reviews, the in a patient with head of would yield a
amount of the target disorder household in non-random
incompatibility compared to the addition to sample. Again,
between trials likelihood that the information on a sample
included in the same result would the dwelling obtained by
review, whether be expected in a place. taking
clinical (ie the patient without Local and current members at
studies are that disorder. random sample fixed intervals
clinically different) for a positive test survey on a list is a
or statistical (ie result = LR+ = Local: Of or non-random
the results are sensitivity/(1- belonging to or sample unless
different from one specificity) characteristic the list was
another). for a negative test of a particular arranged in a
Historically result = LR- = (1- locality or random order.
Controlled sensitivity)/specifi neighbourhood (OECD)
Study: A control city Current: Mechanism-based
study recruiting Local and current Occurring in or reasoning:
control subject(s) random census belonging to Involves an
for whom data Local: Of or the present inference from
were collected at a belonging to or time mechanisms to
time preceding characteristic Random claims that an
that at which the of a particular sample: A intervention
data are gathered locality or sample that is produces a
on the group neighbourhood arrived at by patient-relevant
being studied. Current: selecting outcome. Such
Inception cohort Occurring in or sample units reasoning will
study: A group of belonging to such that each involve an
individuals the present possible unit inferential chain
identified for time has a fixed and linking the
subsequent study Random determinate intervention (such
at an early, sample: A probability of as antiarrhythmic
uniform point in sample that is selection. drugs) with a
the course of the arrived at by Survey: An clinical outcome
specified health selecting investigation in (such as
condition, or sample units which mortality).
before the such that each information is (Howick)
condition possible unit systematically MeSH: Medical
develops. has a fixed and collected but in Subject Headings:
Incidence: The determinate which the a thesaurus of
number of new probability of experimental medical terms
cases of illness selection. method is not used by many
commencing, or of Census: An used. databases and
persons falling ill, enumeration of Local non-random libraries to index
during a specified a population, sample and classify
time period in a originally Local: Of or medical
given population. intended for belonging to or information.
Intention-to-treat: purposes of characteristic Monitoring Test:
Characteristic of a taxation and of a particular Any medical test
study where military locality or performed to
patients are service. Census neighbourhood confirm, or
analysed in the enumeration of Non-random determine the
groups to which a population of sample: A presence of
they were a population sample disease in an
originally usually records selected by a individual
assigned, even identities of all non-random suspected of
though they may persons in method, and as having the
have switched every place of a result, some disease, usually
treatment arms residence, with elements of the following the
during the study age, or birth population report of
 symptoms, or Negative controlled studies. society to prevent
based on the predictive value (Howick) disease happening or
results of other (-PV): The Odds: A ratio of its consequences. In
medical tests. proportion of events to non- general, prevention
Some examples of people with a events. If the includes a wide
diagnostic tests negative test who event rate for a range of
include performing are free of disease is 0.2 interventions, aimed
a chest x-ray to disease. (20%), its non- at reducing risks to
diagnose Number needed to event rate is 0.8 health. These are
pneumonia, and treat (NNT): The and therefore its grouped into three
taking skin biopsy number of odds are 2/8. categories:
to detect patients who need p value: The Primary
cancerous cells. to be treated to probability that a prevention:
(Harvard Guide to prevent one bad particular result
refers to
Diagnostic test) outcome. It is the would have
Nested Case- inverse of the happened by strategies
control study: A ARR: NNT=1/ARR. chance. used to
case control study Numbers needed Positive predictive prevent a
in which cases and to harm (NNH)-the value (+PV): The disease
controls are drawn number of proportion of happening in
from the patients who, if people with a the first
population in a they received the positive test who
cohort study. As experimental have disease. place. An
some data are treatment, would Post-test example may
already available lead to one probability: The be salt
about both cases additional person probability that a reduction to
and controls, the being harmed patient has the prevent an
effects of some compared with disorder of interest individual
potential patients who after the test
becoming
confounding receive the control result is known.
variables are treatment; Pre-test hypertensive.
reduced or calculated as probability: The Medication
eliminated. In this 1/ARI. probability that a can be used
type of case Observational patient has the in primary
control study, a study: A family of disorder of interest prevention
set of controls is studies in which prior to
such as the
selected from investigators administering a
subjects, i.e. non- compare people test. use of blood
cases, at risk at who take an Post-marketing lowering or
the time of intervention with surveillance: A cholesterol
occurrence of those who do not. procedure lowering
each case that The investigators implemented after drugs to
arises in a cohort, neither allocate a drug has been
lower the risk
thus allowing for patients to receive licensed for public
the confounding the intervention use, designed to of a stroke or
effect of time in not administer the provide heart attack.
the analysis. intervention. information on the Secondary
n-of-1 trial: A Instead, they actual use of the prevention:
variation of a compare records drug for a given refers to
randomized of patients who indication and on strategies
controlled trial in had taken an the occurrence of
used in those
which a sequence intervention and side effects,
of alternative been treated in adverse reactions, with an
treatment routine practice etc. A method for existing
regimens is with similar epidemiologic disease which
randomly patients who had study of adverse prevent
allocated to a not taken the drug reactions. recurrence, or
patient. The intervention. The Prevalence: The
significant
outcomes of most common baseline risk of a
regimens are observational disorder in the morbidity. For
compared, with designs are case- population of example, in
the aim of studies, case- interest. someone who
deciding on the series, case- Prevention: Prevent has a heart
optimum regimen control studies, ion refers to attack
for the patient. cohort studies, measures taken by
cholesterol
and historically an individual or a
 lowering (inconclusive trials disease who have validity of a study
drugs are are less likely to a positive test. refers to the
be published than Specificity: The appropriateness
used to lower
conclusive ones, proportion of by which its
the risk of but are not people free of a results can be
subsequent necessarily less disease who have applied to non-
heart attack valid). a negative test. study patients or
and death. Randomized trial: Systematic review: populations.
Tertiary An epidemiological The application of
experiment in strategies that
prevention:
which subjects in a limit bias in the All definitions in the
refers to the population are assembly, critical glossary are from:
prevention of randomly appraisal, and Last, J. M. (2001) A
Dictionary of Epidemiology
long term allocated into synthesis of all Fourth Edition. Oxford
chronic groups, usually relevant studies University Press
disease called study and on a specific topic.
control groups, to Systematic Harvard Health Publication
progression, (2010) A Guide to
receive or not reviews focus on Diagnostic Tests, viewed
physical
receive an peer-reviewed 23 November 2010
deterioration experimental publications about http://www.health.harvard.
and preventive or a specific health edu/diagnostic-tests-and-
medical-procedures
attendant therapeutic problem and use
suffering. For procedure, rigorous, Howick, J.
example, maneuver, or standardized (Forthcoming) Resolving
intervention. The methods for the paradoxes in
removing Evidence-Based Medicine.
results are selecting and A philosophical
allergens assessed by assessing articles. inquiry. Blackwell/Wiley
which may rigorous A systematic
aggravate comparison of review may or Organisation for Economic
Co-operation and
asthmatic rates of disease, may not include Development (OECD)
patients; death, recovery, a meta-analysis, (2010) Glossary of
or other which is a Statistical Terms, viewed
screening for 25 November 2010
appropriate quantitative
eye, renal, outcome in the summary of the
http://stats.oecd.org/glossa
ry/
eye, and foot study and control results. National Cancer Institute
problems groups. Treatment (NCI) (2010) NCI
Relative risk (RR) benefits: Positive Dictionary of Cancer
among Term, viewed 23
diabetics to (or risk patient-relevant November 2010
reduce the ratio): The ratio outcome http://www.cancer.gov/dicti
of the risk of an associated with an onary/?CdrID=44006
risks of
event in the intervention,
complications experimental quantifiable by
. group compared epidemiological
Prognosis: The to that of the measures such as
prospect of control group absolute risk
survival and (RR=EER / CER). reduction (ARR)
recovery from a Not to be confused and number
disease as with relative risk needed to treat
anticipated from reduction (see (NNT).
the usual course below). Validity: The extent
of that disease or Relative risk to which a variable
indicated by reduction or intervention
special features of (RRR): The measures what it
the case. percentage is supposed to
Prognostic cohort reduction in measure or
study: events in the accomplishes
Publication bias: A treated group what it is
bias in a event rate (EER) supposed to
systematic review compared to the accomplish.
caused by control group The internal
incompleteness of event rate (CER): validity of a study
the search, such RRR = (CER-EER) / refers to the
as omitting non- CER. integrity of the
English language Sensitivity: The experimental
sources, or proportion of design.
unpublished trials people with The external