Table 1 Definitions of rating categories used in the modified RAM study [55]

'Appropriate'

In an average patient, the expected health benefit usually exceeds the expected negative consequences by a sufficiently wide margin that prescribing is worthwhile, irrespective of cost

'Inappropriate'

In an average patient, the expected negative consequences usually exceed the expected health benefits by a sufficiently wide margin that prescribing is not worthwhile, irrespective of cost

'Necessary to do'

In an average patient, it would be considered improper care NOT to prescribe as stated, because

(1) there is sufficient evidence, that the patient is likely to benefit AND

(2) the likely benefit to the patient is large enough to be clinically significant

'Necessary to avoid'

In an average patient, it would be considered improper care to prescribe as stated, because

(1) there is sufficient evidence, that the patient is likely to be harmed AND

(2) the likely harm to the patient is large enough to be clinically significant