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Evidence-based medicine beyond the bedside: keeping an eye on context.

RATIONALE: Evidence-based medicine is being applied to decisions in a range of contexts beyond one-to-one patient care. Yet considerable disagreement persists regarding the defining components of evidence-based decision-making, particularly in institutional and public health contexts.

AIMS AND OBJECTIVES: This article reviews the key elements of evidence-based decision-making for clinical medicine, and adapts those key elements and argues for their broad applicability to a variety of decision-making contexts including institutional, public health, and self-care decision-making contexts.

METHODS: Conceptual Analysis. Results Evidence based decision-making involves research evidence, "social and institutional circumstances", and "values" of stakeholders. Furthermore, evidence-based decision-making includes "judgment" exercised by experts to appropriately weigh and integrate the various decision-making elements.

CONCLUSION: Asking critical questions about the purposes and context of a specific decision, basic principles of evidence-based reasoning can be appropriately applied beyond the bedside.

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