Foundations of Evidence-Based Medicine

by Jenicek, MD; Milos

• ISBN13: 9781842141939
• ISBN10: 1842141937
• Format: Hardcover
• Copyright: 2003-03-26
• Publisher: CRC Press

Summary

Presenting a cornucopia of topics seldom seen in a single resource, Foundations of Evidence-Based Medicine explores the principles of formal logic as applied to clinical problems and the uses of evidence in logical reasoning. Filled with definitions, formulae, outlines, flow charts, and checklists, the book contains accounts and references for almost anything you might want to know about the constantly growing roles of public health and clinical epidemiology in modern medicine. It describes the reasoning behind diagnosis, treatment, and prognosis in practical clinical medicine and discusses methods in quantitative analysis, especially meta-analysis and decision analysis. The innovative blend of informal logic and structured evidence-based reasoning makes this book stand out in a crowd.

Table of Contents

A Word from the Author	xiii
Section I How do we See Things in Medicine
How do we see medicine, health and disease? A basic set of rules and fundamental paradigms	3	(12)
Introductory comments	4	(1)
The art and science of medicine	5	(2)
The goals of medicine and its ensuing strategies: Health protection, disease prevention, and health promotion	7	(1)
How do we define and understand health and disease	8	(5)
Conclusions. Understanding the remaining chapters of this book	13	(2)
References	13	(2)
The work of physicians with individuals and communities. Epidemiology and other partners in evidence-based medicine	15	(30)
Common logic in dealing with individual patients and communities	16	(2)
Patterns of reasoning in practice and research and key ways to decisions	18	(4)
Related fields in research and practice	22	(16)
Conclusions. Fulfilling the Hippocratic oath	38	(7)
References	40	(5)
The logic of modern medicine. Reasoning and underlying concepts	45	(24)
Logic in medicine	46	(1)
Logic around us	46	(7)
Uncertainty and probability in medicine	53	(9)
Conclusions	62	(7)
References	63	(6)
Section II How do we Do Things in Medicine Gathering and evaluating evidence
Producing evidence. Classification, objectives and worthiness of medical research	69	(12)
Classification of studies of disease	70	(4)
General scope and quality of evidence	74	(5)
Conclusion	79	(2)
References	79	(2)
Assessing the health of individuals and communities. Health indicators, indexes, and scales	81	(26)
General considerations	82	(1)
Rates and ratios	82	(3)
Prevalence and incidence as measures of morbidity	85	(2)
Using observed rates as probabilities of health concerns	87	(1)
Relationship between various measures of morbidity and mortality	87	(2)
Using health indexes in describing disease spread	89	(4)
The most important health indicators and indexes	93	(7)
Mortality in the general population and its causes	100	(1)
Morbidity in the general population	100	(1)
Occurrence of common signs and symptoms in medical outpatients	100	(2)
Other health indicators	102	(1)
Conclusions	103	(4)
References	103	(4)
Identifying cases of disease. Clinimetrics and diagnosis	107	(40)
From clinical observation to diagnosis: Clinimetrics	109	(4)
Assembling a diagnostic entity (category)	113	(2)
Intellectual process involved in making a diagnosis	115	(3)
Qualitative diagnosis and its validity -- `Does the patient have the disease?'	118	(11)
Quantitative diagnosis and its clinimetric indexes. `How severe is this case?'	129	(2)
Comments on screening tests and screening programs	131	(2)
Studying the use of diagnostic tests in clinical practice	133	(1)
Major criteria of a valid diagnostic study	133	(5)
The question of differential diagnosis	138	(1)
Diagnosis as seen in fuzzy theory	139	(1)
Conclusions	140	(7)
References	142	(5)
Describing what happens. Clinical case reports, case series, occurrence studies	147	(36)
Three types of descriptive studies and their objectives	148	(1)
Drawing clinical pictures or describing disease in an individual. Case reports	149	(15)
Picturing disease as an entity. Describing disease occurrence in the community. Descriptive or occurrence studies	164	(14)
Conclusions	178	(5)
References	178	(5)
Search for causes of disease occurrence. Why does disease occur?	183	(46)
Concept of cause(s) in medicine	184	(1)
Basic concept and design of causal studies	185	(1)
Fundamental philosophy and criteria of the cause-effect relationship	186	(7)
Cohort study	193	(6)
Case-control study	199	(3)
`Hybrid' designs of analytical studies	202	(1)
Conclusions on causality	202	(2)
Major prerequisites for valid etiological studies	204	(5)
Advanced quantitative methods in etiological research. Multivariate and multivariable analysis	209	(4)
Investigation of disease outbreaks and their causes	213	(3)
Epidemiologic proof of causality in court. Contributions of physicians to decision-making in tort litigation	216	(2)
Conclusions	218	(11)
References	223	(6)
The impact of treatment and other clinical and community health interventions. A 'does it work?' evaluation	229	(40)
Basic paradigm and general consideration	230	(2)
Evaluation of treatment in disease cure	232	(27)
Evaluation of health promotion programs and interventions	259	(1)
Conclusions	260	(9)
References	262	(7)
Prognosis. Studies of disease course and outcomes	269	(28)
Conceptual considerations	270	(6)
General methodology of prognostic studies	276	(2)
Special methodology of prognostic studies. Survival or time-to-event analysis	278	(4)
Lessons for clinical research from experience gained in prognostic studies	282	(2)
Outcomes research	284	(1)
Clinical prediction rules	285	(1)
Prognostic studies as subject of systematic reviews	285	(1)
How to construct a study on prognosis	286	(3)
Conclusions. Considerations for further work in the area of prognosis	289	(8)
References	291	(6)
Section III Putting Experiences Together and Making Decisions in Medicine Structured uses of evidence
Analyzing and integrating a body of knowledge. Systematic reviews and meta-analysis of evidence	297	(30)
Definitions and objectives of meta-analysis, reviews and summaries of evidence	299	(1)
Original field of meta-analysis	299	(7)
Meta-analytic procedures, methods and techniques in medicine	306	(9)
Components and attributes of a good meta-analytic study	315	(3)
Conclusions and recommendations for the future	318	(2)
Advantages and disadvantages of meta-analysis	320	(1)
What next?	320	(7)
References	322	(5)
Using evidence and logic in everyday clinical reasoning, communication, and legal and scientific argumentation	327	(14)
Introducing evidence into the process of logic	328	(1)
Clinical rounds, reports, papers, testimonies, and health policies as arguments	328	(1)
Logical argumentation in medicine	329	(1)
Argument and argumentation the Aristotelian way	329	(7)
Possible uses of evidence and argumentation in the area of fuzzy logic applications	336	(2)
Conclusions	338	(3)
References	340	(1)
Decision analysis and decision-making in medicine. Beyond intuition, guts, and flair	341	(38)
How decisions in medicine are made. General concepts	343	(2)
Basic vocabulary and reference readings	345	(1)
Direction-searching tools in decision-making	346	(14)
Direction-giving tools in decision-making	360	(10)
Decisions and decision-making in community medicine and public health	370	(1)
Conclusions	371	(8)
References	374	(5)
Epilogue. Widening horizons, staying in touch	379	(3)
References	382	(3)
Index	385