Clinical epidemiology: the essentials
Gespeichert in:
| Hauptverfasser: | , |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Lippincott Williams & Wilkins
2005
|
| Ausgabe: | 4. ed. |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XV, 252 S. Ill., graph. Darst. |
| ISBN: | 0781752159 |
Internformat
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| 100 | 1 | |a Fletcher, Robert H. |e Verfasser |0 (DE-588)137930178 |4 aut | |
| 245 | 1 | 0 | |a Clinical epidemiology |b the essentials |c Robert H. Fletcher ; Suzanne W. Fletcher |
| 250 | |a 4. ed. | ||
| 264 | 1 | |a Philadelphia [u.a.] |b Lippincott Williams & Wilkins |c 2005 | |
| 300 | |a XV, 252 S. |b Ill., graph. Darst. | ||
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Datensatz im Suchindex
| _version_ | 1804135662813708288 |
|---|---|
| adam_text | 1 Introduction 1
2 Abnormality 17
3 Diagnosis 35
4 Frequency 59
5 Risk: Looking Forward 75
6 Risk: Looking Backward 91
7 Prognosis 105
8 Treatment 125
9 Prevention 147
10 Chance 169
11 Cause 187
12 Systematic Reviews 205
13 Knowledge Management 221
Appendix A—Answers to Review
Questions 233
Appendix B Additional Readings 241
ix
CHAPTER I
Introduction 1
THE SCIENTIFIC BASIS FOR CLINICAL
MEDICINE 2
CLINICAL EPIDEMIOLOGY 3
BASIC PRINCIPLES 4
Clinical Questions 4
Variables 5
Health Outcomes 5
Numbers and Probability 5
Populations and Samples 6
Bias (Systematic Error) 7
Chance 9
The Effects of Bias and Chance Are Cumulative 9
Internal and External Validity 10
INFORMATION AND DECISIONS 12
ORGANIZATION OF THIS BOOK 12
CHAPTER 2
Abnormality 17
TYPES OF DATA 18
Nominal Data 18
Ordinal Data 18
Interval Data 19
PERFORMANCE OF MEASUREMENTS 19
Validity 19
Content Validity 20
Construct Validity 20
Criterion Validity 20
Reliability 20
Range 21
Responsiveness 21
Interpretability 21
VARIATION 21
Variation Resulting from Measure lent 22
Variation Resulting from Biologic Differences 23
Total Variation 24
Effects of Variation 24
DISTRIBUTIONS 25
Describing Distributions 25
Actual Distributions 25
The Normal Distribution 27
CRITERIA FOR ABNORMALITY 28
Abnormal = Unusual 29
Abnormal = Associated with Disease 31
Abnormal = Treatable 31
REGRESSION TO THE MEAN 32
CHAPTER 3
Diagnosis 35
SIMPLIFYING DATA 35
THE ACCURACY OF A TEST RESULT 36
The Gold Standard 36
Lack of Information on Negative Tests 37
Lack of Information on Test Results in the
Nondiseased 37
Lack of Objective Standards for Disease 37
Consequences of Imperfect Standards 38
SENSITIVITY AND SPECIFICITY 38
Definitions 40
Use of Sensitive Tests 40
Use of Specific Tests 40
Trade Offs Between Sensitivity and Specificity 40
The ROC Curve 40
ESTABLISHING SENSITIVITY AND SPECIFICITY 42
Spectrum of Patients 42
Bias 43
Chance 44
PREDICTIVE VALUE 45
Definitions 45
Determinants of Predictive Value 45
Estimating Prevalence 47
xi
All uun i cm i j
Increasing the Prevalence of Disease Before
Testing 47
Referral Process 47
Selected Demographic Croups 47
Specifics of the Clinical Situation 47
Implications for Interpreting the Medical
Literature 48
LIKELIHOOD RATIOS 49
Odds 49
Definitions 49
Use of Likelihood Ratios 49
Techniques for Using Likelihood Ratios 50
MULTIPLE TESTS 51
Parallel Testing 52
Clinical Prediction Rules 55
Serial Testing 55
Serial Likelihood Ratios 56
Assumption of Independence 56
CHAPTER 4
Frequency 59
ARE WORDS SUITABLE SUBSTITUTES FOR
NUMBERS? 60
PREVALENCE AND INCIDENCE 60
Prevalence 60
Incidence 60
Prevalence and Incidence in Relation to Time 61
Distinguishing Prevalence and Incidence 62
RELATIONSHIPS AMONG PREVALENCE, INCIDENCE,
AND DURATION OF DISEASE 62
SOME OTHER RATES 63
STUDIES OF PREVALENCE AND INCIDENCE 63
Prevalence Studies 64
Incidence Studies 64
Cumulative Incidence 64
Incidence Density (Person Years) 65
INTERPRETING MEASURES OF FREQUENCY 65
What Is a Case?: Defining the Numerator 65
What Is the Population?: Defining the
Denominator 66
Sampling 67
DISTRIBUTION OF DISEASE BY TIME, PLACE, AND
PERSON 68
Time 68
Place 69
Person 69
VALUE AND LIMITATIONS OF PREVALENCE
STUDIES 69
What Are Prevalence Studies Good For? 70
When Are Prevalence Studies Not Particularly
Good? 71
POSTSCRIPT 71
CHAPTER 5
Risk: Looking Forward 75
RISK FACTORS 76
RECOGNIZING RISK 76
Long Latency 76
Common. Exposure to Risk Factors 76
Low Incidence of Disease 77
Small Risk 77
Common Risk 77
Multiple Causes and Effects 78
USES OF RISK 79
Risk Factors Predict Future Disease 79
Risk Factors May or May Not Be Causal 79
Risk Factors Help Establish Pretest Disease
Probability for Diagnostic Testing 80
Risk Stratification for Screening Programs 80
Removing Risk Factors May Prevent Disease 80
STUDIES OF RISK 80
When Experiments Are Not Possible 81
Cohorts 81
Cohort Studies 81
Prospective and Historical Cohort Studies 82
Case Cohort Studies 83
Advantages and Disadvantages of Cohort
Studies 83
WAYS TO EXPRESS AND COMPARE RISK 85
Absolute Risk 85
Attributable Risk 85
Relative Risk 86
Interpreting Estimates of Individual Risk 86
Population Risk 87
chapter O
Risk: Looking Backward 91
CASE CONTROL STUDIES 92
DESIGN OF CASE CONTROL STUDIES 94
Selecting Cases 94
Selecting Controls 95
The Population Approach 95
Hospital and Community Controls 96
Multiple Control Croups 96
Multiple Controls per Case 96
Matching 96
Measuring Exposure 97
THE ODDS RATIO: AN ESTIMATE OF RELATIVE
RISK 98
CONTROLLING FOR EXTRANEOUS VARIABLES 99
INVESTIGATION OF A DISEASE OUTBREAK 99
SCIENTIFIC STANDARDS FOR CASE CONTROL
RESEARCH 100
RISK COMMUNICATION 101
CHAPTER 7
Prognosis 105
DIFFERENCES IN RISK AND PROGNOSTIC
FACTORS 106
Patients Are Different 106
Outcomes Are Different 106
Rates Are Different 106
Risk and Prognostic Factors Are Different 106
CLINICAL COURSE AND NATURAL HISTORY OF
DISEASE 106
ELEMENTS OF PROGNOSTIC STUDIES 107
The Patient Sample 107
Zero Time 108
Follow Up 108
Outcomes of Disease 108
DESCRIBING PROGNOSIS 109
A Trade Off: Simplicity Versus More
Information 109
Survival Analysis 110
Survival of a Cohort 110
Survival Curves 111
Survival Curves That Include Other Information 112
Interpreting Survival Curves 112
FALSE COHORTS 113
IDENTIFYING PROGNOSTIC FACTORS 114
PREDICTION RULES 115
BIAS IN COHORT STUDIES 116
Susceptibility Bias 116
CONTENTS xiii
Migration Bias 117
Measurement Bias 118
DEALING WITH SELECTION BIAS AND
CONFOUNDING 118
Randomization 119
Restriction 119
Matching 120
Stratification 120
Standardization 120
Multivariable Adjustment 121
Sensitivity Analysis 121
Overall Strategy for Controlling Bias 122
GENERALIZABILITY AND SAMPLING BIAS 122
BIAS, PERHAPS, BUT DOES IT MATTER? 122
CHAPTER 8
Treatment 125
IDEAS AND EVIDENCE 125
Ideas 125
Testing Ideas 127
STUDIES OF TREATMENT EFFECTS 127
Observational and Experimental Studies of
Treatment Effects 128
RANDOMIZED CONTROLLED TRIALS 128
Sampling 129
Intervention 131
Comparison Groups 131
Allocating Treatment 132
Differences Arising After Randomization 133
Patients Do Not Have the Disease Under Study 134
Compliance 134
Co interventions 134
Comparisons ofResponders to
Nonresponders 134
Blinding 135
Assessment of Outcomes 136
INTENTION TO TREAT AND EXPLANATORY
TRIALS 136
EFFICACY AND EFFECTIVENESS 137
TAILORING THE RESULTS OF TRIALS TO INDIVIDUAL
PATIENTS 138
Subgroups 138
Trials of W = 1 138
Effectiveness in Individual Patients 139
LIMITATIONS OF RANDOMIZED TRIALS 139
xiv CONTENTS
ALTERNATIVES TO RANDOMIZED TRIALS 139
Comparisons Across Time and Place 140
Uncontrolled Trials 141
Unpredictable Clinical Course 141
Nonspecific Effects 141
Regression to the Mean 141
Predictable Improvement 142
OBSERVATIONAL STUDIES OF
INTERVENTIONS 142
STANDARDS FOR REPORTING RANDOMIZED
CONTROLLED TRIALS 142
PHASES OF STUDIES OF TREATMENT 143
CHAPTER 9
Prevention 147
POPULATION AND CLINICAL PREVENTION 148
Types of Clinical Prevention 148
Immunization 148
Screening 148
Behavioral Counseling (Lifestyle Changes) 148
Chemoprevention 148
LEVELS OF PREVENTION 148
Primary Prevention 149
Secondary Prevention 149
Tertiary Prevention 149
APPROACH TO CLINICAL PREVENTION 150
BURDEN OF SUFFERING 150
SCREENING TESTS IN PREVENTIVE CARE 151
Prevalence and Incidence Screens 151
Special Biases in Screening 151
Lead Time Bias 152
Length Time Bias 153
Compliance Bias 153
CRITERIA FOR A GOOD SCREENING TEST 155
High Sensitivity and Specificity 155
Detection and Incidence Methods for Calculating
Sensitivity 156
High Positive Predictive Value 157
Simplicity and Low Cost 157
Safety 158
Acceptable to Patients and Clinicians 158
Labeling 158
POSSIBLE ADVERSE EFFECTS FROM
SCREENING 159
Risk of False Positive Result 159
Risk of Pseudodi?ease (Overdiagnosis) in Cancer
Screening 160
EFFECTIVENESS OF TREATMENT 161
CURRENT RECOMMENDATIONS 163
CHAPTER 10
Chance 169
TWO APPROACHES TO CHANCE 170
HYPOTHESIS TESTING 170
False Positive and False Negative Statistical
Results 170
Concluding That a Treatment Works 171
Dicf otomous and Exact P Values 171
Statistical Significance and Clinical
Importance 172
Statistical Tests 172
Concluding That a Treatment Does Not Work 173
POINT ESTIMATES AND CONFIDENCE
INTERVALS 174
HOW MANY STUDY PATIENTS ARE ENOUGH? 176
Estimating Sample Size Requirements 176
Effect Size 176
Type I Error 176
Type II Error 176
Characteristics of the Data 176
Interrelationships 177
Sample Size Depends on the Context 177
Sample Size Based on Confidence Intervals 179
Statistical Power After the Study Is Completed 179
EQUIVALENCE TRIALS 179
DETECTING RARE EVENTS 179
MULTIPLE COMPARISONS 180
SUBGROUP ANALYSIS 181
SECONDARY ANALYSES 181
DESCRIBING ASSOCIATIONS 182
MULTIVARIABLE METHODS 182
BAYESIAN REASONING 183
CHAPTER I 1
Cause 187
CONCEPTS OF CAUSE 188
Single and Multiple Causes 188
Proximity of Cause to Effect 189
Interaction of Multiple Causes 190
Effect Modification 191
ESTABLISHING CAUSE 191
Association and Cause 193
Hierarchy of Research Designs 193
ECOLOGICAL STUDIES 194
Time Series Studies 194
Multiple Time Series Studies 195
EVIDENCE FOR AND AGAINST CAUSE 195
Temporal Relationships Between Cause and
Effect 196
Strength of the Association 197
Dose Response Relationships 197
Reversible Associations 198
Consistency 198
Biologic Plausibility 198
Specificity 199
Analogy 199
WEIGHING THE EVIDENCE 199
Grading the Quality of Evidence 200
chapter 12
Systematic Reviews 205
PROVIDING THE CONTEXT FOR INDIVIDUAL
STUDIES 205
TRADITIONAL REVIEWS 206
SYSTEMATIC REVIEWS 206
When Are Systematic Reviews Appropriate? 206
Finding All Relevant Studies 206
Systematic Reviews Are Limited to Scientifically
Strong Studies 207
Publication Bias 208
How Good Are the Best Studies? 210
Is Scientific Quality Related to Research
Results? 210
Summarizing Results 211
Summarizing Observational and Diagnostic Test
Studies 212
COMBINING STUDIES IN META ANALYSES 213
Are the Studies Similar Enough to Justify
Combining? 213
What Is Combined Studies or Patients? 214
How Are the Results Summarized? 214
Displaying the Summary Effect 215
Cumulative Meta analysis 215
CONTENTS xv
What Are the Advantages and Risks of Combining
Studies? 216
When Meta analyses and Large Trials
Disagree 217
CHAPTER 13
Knowledge Management 221
A BASIC CHOICE DO IT YOURSELF OR
DELEGATE? 221
WHICH MEDIUM SHOULD I USE? 222
LOOKING UP ANSWERS TO CLINICAL
QUESTIONS 222
Criteria for Useful Clinical Information
Sources 222
Rapid Access 222
Up To Date 222
Tailored to the Specific Question 223
Sorted by Scientific Strength 224
Portable 225
Modem Solutions 225
Electronic Textbooks 225
Clinical Practice Guidelines 225
The Cochrane Database of Systematic
Reviews 226
Clinical Evidence 226
MEDLINE 226
SURVEILLANCE ON NEW DEVELOPMENTS 226
JOURNALS 227
Guardians of Science 227
The Diversity of Medicine 228
Reading Journals 228
PUTTING KNOWLEDGE MANAGEMENT INTO
PRACTICE 230
APPENDIX A
Answers to Review
Questions 233
APPENDIX B
Additional Readings 241
|
| adam_txt |
1 Introduction 1
2 Abnormality 17
3 Diagnosis 35
4 Frequency 59
5 Risk: Looking Forward 75
6 Risk: Looking Backward 91
7 Prognosis 105
8 Treatment 125
9 Prevention 147
10 Chance 169
11 Cause 187
12 Systematic Reviews 205
13 Knowledge Management 221
Appendix A—Answers to Review
Questions 233
Appendix B Additional Readings 241
ix
CHAPTER I
Introduction 1
THE SCIENTIFIC BASIS FOR CLINICAL
MEDICINE 2
CLINICAL EPIDEMIOLOGY 3
BASIC PRINCIPLES 4
Clinical Questions 4
Variables 5
Health Outcomes 5
Numbers and Probability 5
Populations and Samples 6
Bias (Systematic Error) 7
Chance 9
The Effects of Bias and Chance Are Cumulative 9
Internal and External Validity 10
INFORMATION AND DECISIONS 12
ORGANIZATION OF THIS BOOK 12
CHAPTER 2
Abnormality 17
TYPES OF DATA 18
Nominal Data 18
Ordinal Data 18
Interval Data 19
PERFORMANCE OF MEASUREMENTS 19
Validity 19
Content Validity 20
Construct Validity 20
Criterion Validity 20
Reliability 20
Range 21
Responsiveness 21
Interpretability 21
VARIATION 21
Variation Resulting from Measure lent 22
Variation Resulting from Biologic Differences 23
Total Variation 24
Effects of Variation 24
DISTRIBUTIONS 25
Describing Distributions 25
Actual Distributions 25
The Normal Distribution 27
CRITERIA FOR ABNORMALITY 28
Abnormal = Unusual 29
Abnormal = Associated with Disease 31
Abnormal = Treatable 31
REGRESSION TO THE MEAN 32
CHAPTER 3
Diagnosis 35
SIMPLIFYING DATA 35
THE ACCURACY OF A TEST RESULT 36
The Gold Standard 36
Lack of Information on Negative Tests 37
Lack of Information on Test Results in the
Nondiseased 37
Lack of Objective Standards for Disease 37
Consequences of Imperfect Standards 38
SENSITIVITY AND SPECIFICITY 38
Definitions 40
Use of Sensitive Tests 40
Use of Specific Tests 40
Trade Offs Between Sensitivity and Specificity 40
The ROC Curve 40
ESTABLISHING SENSITIVITY AND SPECIFICITY 42
Spectrum of Patients 42
Bias 43
Chance 44
PREDICTIVE VALUE 45
Definitions 45
Determinants of Predictive Value 45
Estimating Prevalence 47
xi
All uun i cm i j
Increasing the Prevalence of Disease Before
Testing 47
Referral Process 47
Selected Demographic Croups 47
Specifics of the Clinical Situation 47
Implications for Interpreting the Medical
Literature 48
LIKELIHOOD RATIOS 49
Odds 49
Definitions 49
Use of Likelihood Ratios 49
Techniques for Using Likelihood Ratios 50
MULTIPLE TESTS 51
Parallel Testing 52
Clinical Prediction Rules 55
Serial Testing 55
Serial Likelihood Ratios 56
Assumption of Independence 56
CHAPTER 4
Frequency 59
ARE WORDS SUITABLE SUBSTITUTES FOR
NUMBERS? 60
PREVALENCE AND INCIDENCE 60
Prevalence 60
Incidence 60
Prevalence and Incidence in Relation to Time 61
Distinguishing Prevalence and Incidence 62
RELATIONSHIPS AMONG PREVALENCE, INCIDENCE,
AND DURATION OF DISEASE 62
SOME OTHER RATES 63
STUDIES OF PREVALENCE AND INCIDENCE 63
Prevalence Studies 64
Incidence Studies 64
Cumulative Incidence 64
Incidence Density (Person Years) 65
INTERPRETING MEASURES OF FREQUENCY 65
What Is a Case?: Defining the Numerator 65
What Is the Population?: Defining the
Denominator 66
Sampling 67
DISTRIBUTION OF DISEASE BY TIME, PLACE, AND
PERSON 68
Time 68
Place 69
Person 69
VALUE AND LIMITATIONS OF PREVALENCE
STUDIES 69
What Are Prevalence Studies Good For? 70
When Are Prevalence Studies Not Particularly
Good? 71
POSTSCRIPT 71
CHAPTER 5
Risk: Looking Forward 75
RISK FACTORS 76
RECOGNIZING RISK 76
Long Latency 76
Common. Exposure to Risk Factors 76
Low Incidence of Disease 77
Small Risk 77
Common Risk 77
Multiple Causes and Effects 78
USES OF RISK 79
Risk Factors Predict Future Disease 79
Risk Factors May or May Not Be Causal 79
Risk Factors Help Establish Pretest Disease
Probability for Diagnostic Testing 80
Risk Stratification for Screening Programs 80
Removing Risk Factors May Prevent Disease 80
STUDIES OF RISK 80
When Experiments Are Not Possible 81
Cohorts 81
Cohort Studies 81
Prospective and Historical Cohort Studies 82
Case Cohort Studies 83
Advantages and Disadvantages of Cohort
Studies 83
WAYS TO EXPRESS AND COMPARE RISK 85
Absolute Risk 85
Attributable Risk 85
Relative Risk 86
Interpreting Estimates of Individual Risk 86
Population Risk 87
chapter O
Risk: Looking Backward 91
CASE CONTROL STUDIES 92
DESIGN OF CASE CONTROL STUDIES 94
Selecting Cases 94
Selecting Controls 95
The Population Approach 95
Hospital and Community Controls 96
Multiple Control Croups 96
Multiple Controls per Case 96
Matching 96
Measuring Exposure 97
THE ODDS RATIO: AN ESTIMATE OF RELATIVE
RISK 98
CONTROLLING FOR EXTRANEOUS VARIABLES 99
INVESTIGATION OF A DISEASE OUTBREAK 99
SCIENTIFIC STANDARDS FOR CASE CONTROL
RESEARCH 100
RISK COMMUNICATION 101
CHAPTER 7
Prognosis 105
DIFFERENCES IN RISK AND PROGNOSTIC
FACTORS 106
Patients Are Different 106
Outcomes Are Different 106
Rates Are Different 106
Risk and Prognostic Factors Are Different 106
CLINICAL COURSE AND NATURAL HISTORY OF
DISEASE 106
ELEMENTS OF PROGNOSTIC STUDIES 107
The Patient Sample 107
Zero Time 108
Follow Up 108
Outcomes of Disease 108
DESCRIBING PROGNOSIS 109
A Trade Off: Simplicity Versus More
Information 109
Survival Analysis 110
Survival of a Cohort 110
Survival Curves 111
Survival Curves That Include Other Information 112
Interpreting Survival Curves 112
FALSE COHORTS 113
IDENTIFYING PROGNOSTIC FACTORS 114
PREDICTION RULES 115
BIAS IN COHORT STUDIES 116
Susceptibility Bias 116
CONTENTS xiii
Migration Bias 117
Measurement Bias 118
DEALING WITH SELECTION BIAS AND
CONFOUNDING 118
Randomization 119
Restriction 119
Matching 120
Stratification 120
Standardization 120
Multivariable Adjustment 121
Sensitivity Analysis 121
Overall Strategy for Controlling Bias 122
GENERALIZABILITY AND SAMPLING BIAS 122
BIAS, PERHAPS, BUT DOES IT MATTER? 122
CHAPTER 8
Treatment 125
IDEAS AND EVIDENCE 125
Ideas 125
Testing Ideas 127
STUDIES OF TREATMENT EFFECTS 127
Observational and Experimental Studies of
Treatment Effects 128
RANDOMIZED CONTROLLED TRIALS 128
Sampling 129
Intervention 131
Comparison Groups 131
Allocating Treatment 132
Differences Arising After Randomization 133
Patients Do Not Have the Disease Under Study 134
Compliance 134
Co interventions 134
Comparisons ofResponders to
Nonresponders 134
Blinding 135
Assessment of Outcomes 136
INTENTION TO TREAT AND EXPLANATORY
TRIALS 136
EFFICACY AND EFFECTIVENESS 137
TAILORING THE RESULTS OF TRIALS TO INDIVIDUAL
PATIENTS 138
Subgroups 138
Trials of W = 1 138
Effectiveness in Individual Patients 139
LIMITATIONS OF RANDOMIZED TRIALS 139
xiv CONTENTS
ALTERNATIVES TO RANDOMIZED TRIALS 139
Comparisons Across Time and Place 140
Uncontrolled Trials 141
Unpredictable Clinical Course 141
Nonspecific Effects 141
Regression to the Mean 141
Predictable Improvement 142
OBSERVATIONAL STUDIES OF
INTERVENTIONS 142
STANDARDS FOR REPORTING RANDOMIZED
CONTROLLED TRIALS 142
PHASES OF STUDIES OF TREATMENT 143
CHAPTER 9
Prevention 147
POPULATION AND CLINICAL PREVENTION 148
Types of Clinical Prevention 148
Immunization 148
Screening 148
Behavioral Counseling (Lifestyle Changes) 148
Chemoprevention 148
LEVELS OF PREVENTION 148
Primary Prevention 149
Secondary Prevention 149
Tertiary Prevention 149
APPROACH TO CLINICAL PREVENTION 150
BURDEN OF SUFFERING 150
SCREENING TESTS IN PREVENTIVE CARE 151
Prevalence and Incidence Screens 151
Special Biases in Screening 151
Lead Time Bias 152
Length Time Bias 153
Compliance Bias 153
CRITERIA FOR A GOOD SCREENING TEST 155
High Sensitivity and Specificity 155
Detection and Incidence Methods for Calculating
Sensitivity 156
High Positive Predictive Value 157
Simplicity and Low Cost 157
Safety 158
Acceptable to Patients and Clinicians 158
Labeling 158
POSSIBLE ADVERSE EFFECTS FROM
SCREENING 159
Risk of False Positive Result 159
Risk of Pseudodi?ease (Overdiagnosis) in Cancer
Screening 160
EFFECTIVENESS OF TREATMENT 161
CURRENT RECOMMENDATIONS 163
CHAPTER 10
Chance 169
TWO APPROACHES TO CHANCE 170
HYPOTHESIS TESTING 170
False Positive and False Negative Statistical
Results 170
Concluding That a Treatment Works 171
Dicf otomous and Exact P Values 171
Statistical Significance and Clinical
Importance 172
Statistical Tests 172
Concluding That a Treatment Does Not Work 173
POINT ESTIMATES AND CONFIDENCE
INTERVALS 174
HOW MANY STUDY PATIENTS ARE ENOUGH? 176
Estimating Sample Size Requirements 176
Effect Size 176
Type I Error 176
Type II Error 176
Characteristics of the Data 176
Interrelationships 177
Sample Size Depends on the Context 177
Sample Size Based on Confidence Intervals 179
Statistical Power After the Study Is Completed 179
EQUIVALENCE TRIALS 179
DETECTING RARE EVENTS 179
MULTIPLE COMPARISONS 180
SUBGROUP ANALYSIS 181
SECONDARY ANALYSES 181
DESCRIBING ASSOCIATIONS 182
MULTIVARIABLE METHODS 182
BAYESIAN REASONING 183
CHAPTER I 1
Cause 187
CONCEPTS OF CAUSE 188
Single and Multiple Causes 188
Proximity of Cause to Effect 189
Interaction of Multiple Causes 190
Effect Modification 191
ESTABLISHING CAUSE 191
Association and Cause 193
Hierarchy of Research Designs 193
ECOLOGICAL STUDIES 194
Time Series Studies 194
Multiple Time Series Studies 195
EVIDENCE FOR AND AGAINST CAUSE 195
Temporal Relationships Between Cause and
Effect 196
Strength of the Association 197
Dose Response Relationships 197
Reversible Associations 198
Consistency 198
Biologic Plausibility 198
Specificity 199
Analogy 199
WEIGHING THE EVIDENCE 199
Grading the Quality of Evidence 200
chapter 12
Systematic Reviews 205
PROVIDING THE CONTEXT FOR INDIVIDUAL
STUDIES 205
TRADITIONAL REVIEWS 206
SYSTEMATIC REVIEWS 206
When Are Systematic Reviews Appropriate? 206
Finding All Relevant Studies 206
Systematic Reviews Are Limited to Scientifically
Strong Studies 207
Publication Bias 208
How Good Are the Best Studies? 210
Is Scientific Quality Related to Research
Results? 210
Summarizing Results 211
Summarizing Observational and Diagnostic Test
Studies 212
COMBINING STUDIES IN META ANALYSES 213
Are the Studies Similar Enough to Justify
Combining? 213
What Is Combined Studies or Patients? 214
How Are the Results Summarized? 214
Displaying the Summary Effect 215
Cumulative Meta analysis 215
CONTENTS xv
What Are the Advantages and Risks of Combining
Studies? 216
When Meta analyses and Large Trials
Disagree 217
CHAPTER 13
Knowledge Management 221
A BASIC CHOICE DO IT YOURSELF OR
DELEGATE? 221
WHICH MEDIUM SHOULD I USE? 222
LOOKING UP ANSWERS TO CLINICAL
QUESTIONS 222
Criteria for Useful Clinical Information
Sources 222
Rapid Access 222
Up To Date 222
Tailored to the Specific Question 223
Sorted by Scientific Strength 224
Portable 225
Modem Solutions 225
Electronic Textbooks 225
Clinical Practice Guidelines 225
The Cochrane Database of Systematic
Reviews 226
Clinical Evidence 226
MEDLINE 226
SURVEILLANCE ON NEW DEVELOPMENTS 226
JOURNALS 227
Guardians of Science 227
The Diversity of Medicine 228
"Reading" Journals 228
PUTTING KNOWLEDGE MANAGEMENT INTO
PRACTICE 230
APPENDIX A
Answers to Review
Questions 233
APPENDIX B
Additional Readings 241 |
| any_adam_object | 1 |
| any_adam_object_boolean | 1 |
| author | Fletcher, Robert H. Fletcher, Suzanne W. |
| author_GND | (DE-588)137930178 (DE-588)137930305 |
| author_facet | Fletcher, Robert H. Fletcher, Suzanne W. |
| author_role | aut aut |
| author_sort | Fletcher, Robert H. |
| author_variant | r h f rh rhf s w f sw swf |
| building | Verbundindex |
| bvnumber | BV021787108 |
| callnumber-first | R - Medicine |
| callnumber-label | RA652 |
| callnumber-raw | RA652.2.C55 |
| callnumber-search | RA652.2.C55 |
| callnumber-sort | RA 3652.2 C55 |
| callnumber-subject | RA - Public Medicine |
| classification_rvk | XF 4200 |
| ctrlnum | (OCoLC)57251369 (DE-599)BVBBV021787108 |
| dewey-full | 614.4 |
| dewey-hundreds | 600 - Technology (Applied sciences) |
| dewey-ones | 614 - Forensic medicine; incidence of disease |
| dewey-raw | 614.4 |
| dewey-search | 614.4 |
| dewey-sort | 3614.4 |
| dewey-tens | 610 - Medicine and health |
| discipline | Medizin |
| discipline_str_mv | Medizin |
| edition | 4. ed. |
| format | Book |
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| genre | 1\p (DE-588)4123623-3 Lehrbuch gnd-content |
| genre_facet | Lehrbuch |
| id | DE-604.BV021787108 |
| illustrated | Illustrated |
| index_date | 2024-07-02T15:43:11Z |
| indexdate | 2024-07-09T20:44:04Z |
| institution | BVB |
| isbn | 0781752159 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-014999810 |
| oclc_num | 57251369 |
| open_access_boolean | |
| owner | DE-20 |
| owner_facet | DE-20 |
| physical | XV, 252 S. Ill., graph. Darst. |
| publishDate | 2005 |
| publishDateSearch | 2005 |
| publishDateSort | 2005 |
| publisher | Lippincott Williams & Wilkins |
| record_format | marc |
| spelling | Fletcher, Robert H. Verfasser (DE-588)137930178 aut Clinical epidemiology the essentials Robert H. Fletcher ; Suzanne W. Fletcher 4. ed. Philadelphia [u.a.] Lippincott Williams & Wilkins 2005 XV, 252 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clínica geral larpcal Epidemiologia analítica larpcal Epidemiologie gtt Métodos epidemiológicos larpcal Surtos de doenças (prevenção e controle) larpcal Épidémiologie clinique Clinical epidemiology Epidemiologic Methods Epidemiologie (DE-588)4015016-1 gnd rswk-swf 1\p (DE-588)4123623-3 Lehrbuch gnd-content Epidemiologie (DE-588)4015016-1 s DE-604 Fletcher, Suzanne W. Verfasser (DE-588)137930305 aut HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014999810&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis 1\p cgwrk 20201028 DE-101 https://d-nb.info/provenance/plan#cgwrk |
| spellingShingle | Fletcher, Robert H. Fletcher, Suzanne W. Clinical epidemiology the essentials Clínica geral larpcal Epidemiologia analítica larpcal Epidemiologie gtt Métodos epidemiológicos larpcal Surtos de doenças (prevenção e controle) larpcal Épidémiologie clinique Clinical epidemiology Epidemiologic Methods Epidemiologie (DE-588)4015016-1 gnd |
| subject_GND | (DE-588)4015016-1 (DE-588)4123623-3 |
| title | Clinical epidemiology the essentials |
| title_auth | Clinical epidemiology the essentials |
| title_exact_search | Clinical epidemiology the essentials |
| title_exact_search_txtP | Clinical epidemiology the essentials |
| title_full | Clinical epidemiology the essentials Robert H. Fletcher ; Suzanne W. Fletcher |
| title_fullStr | Clinical epidemiology the essentials Robert H. Fletcher ; Suzanne W. Fletcher |
| title_full_unstemmed | Clinical epidemiology the essentials Robert H. Fletcher ; Suzanne W. Fletcher |
| title_short | Clinical epidemiology |
| title_sort | clinical epidemiology the essentials |
| title_sub | the essentials |
| topic | Clínica geral larpcal Epidemiologia analítica larpcal Epidemiologie gtt Métodos epidemiológicos larpcal Surtos de doenças (prevenção e controle) larpcal Épidémiologie clinique Clinical epidemiology Epidemiologic Methods Epidemiologie (DE-588)4015016-1 gnd |
| topic_facet | Clínica geral Epidemiologia analítica Epidemiologie Métodos epidemiológicos Surtos de doenças (prevenção e controle) Épidémiologie clinique Clinical epidemiology Epidemiologic Methods Lehrbuch |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014999810&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| work_keys_str_mv | AT fletcherroberth clinicalepidemiologytheessentials AT fletchersuzannew clinicalepidemiologytheessentials |