Clinical epidemiology & evidence-based medicine : fundamental principles of clinical reasoning & research / David L. Katz.

Format:

Book

Author/Creator:

Katz, David L., 1963-

Language:

English

Subjects (All):

Clinical epidemiology.

Evidence-based medicine.

Epidemiology.

Evidence-Based Medicine.

Medical Subjects:

Epidemiology.

Evidence-Based Medicine.

Physical Description:

xxi, 295 pages : illustrations ; 24 cm

Other Title:

Clinical epidemiology and evidence-based medicine

Place of Publication:

Thousand Oaks, Calif. : Sage Publications, [2001]

Summary:

If a patient is older or younger than, sicker or healthier than, taller or shorter than or simply different from the subjects of a study, do the results pertain? Clinical Epidemiology & Evidence-based Medicine is a resource for all health-care workers involved in applying evidence to the care of their patients. Using clinical examples and citing liberally from the peer-reviewed literature, the book shows how statistical principles can improve medical decisions. Plus, as Katz shows how probability, risk and alternatives are fundamental considerations in all clinical decisions, he demonstrates the intuitive basis for using clinical epidemiolgy as a science underlying medical decisions. After reading this text, the practitioner should be better able to access, interpret, and apply evidence to patient care as well as better understand and control the process of medical decision making.

Contents:

Section I Principles of Clinical Reasoning

1. Of Patients and Populations: Population-Based Data in Clinical Practice 5

2. Test Performance: Disease Probability, Test Interpretation and Diagnosis 13

Test Performance 13

Disease Probability 25

Test Interpretation 31

3. Quantitative Aspects of Clinical Thinking: Predictive Values and Bayes' Theorem 45

Application 50

Alternative Applications 56

Odds and Probabilities: Bayes' Theorem and Likelihood Ratios 57

Implications of Bayes' Theorem for Diagnostic Testing 60

Conceptual Factors Influencing Probability Estimates 62

Bayes' Theorem and the Sequence of Testing 64

4. Fundamentals of Screening: The Art and Science of Looking for Trouble 69

Screening Defined 70

Screening Criteria 70

Statistical Considerations Pertinent to Screening 73

Sequential Testing 77

Statistics, Screening and Monetary Costs 79

Statistics, Screening and Human Costs 84

Screening Pros and Cons 87

5. Measuring and Conveying Risk 91

Measuring Risk to the Individual Patient 92

Risk Factors 96

Measuring Risk in Clinical Investigation 96

Measuring Risk Modification 97

Section II Principles of Clinical Research

6. Hypothesis Testing 1: Principles 107

Association 110

Variation 112

Measuring Central Tendency: The Mean 113

Measuring Dispersion: Variance and Standard Deviation 114

Testing Hypotheses: The Signal to Noise Ratio 116

Types of Clinical Data 116

Characterizing Associations: Univariate, Bivariate, and Multivariate Methods 119

Eliminating Alternative Explanations: The Threat of Confounding and Bias 120

7. Hypothesis Testing 2: Mechanics 127

Parametric Methods 128

Nonparametric Methods 134

Odds Ratios and Risk Ratios 139

Other Methods of Hypothesis Testing 141

Hypothesis Testing and the Stipulation of Outcome 142

8. Study Design 147

Case-control Studies 151

Cohort Studies 155

Retrospective Cohort Studies 155

Prospective Cohort Studies 156

Randomized Clinical Trials 158

Meta-Analysis 160

Active Control Equivalence Studies (ACES) 163

Crossover Trials 164

Factorial Trial Designs 164

Other Study Designs 165

Sampling 166

Assessing Study Validity 167

The Strength of Evidence 169

Constructively Deconstructing the Medical Literature 170

9. Interpreting Statistics in the Medical Literature 181

Statistical Significance 182

One-tailed and Two-tailed Tests of Significance 185

Type I and Type II error 188

p-values 190

Sample Size 191

Confidence Intervals 194

Section III From Research to Reasoning: The Application of Evidence in Clinical Practice

10. Decision Analysis 203

11. Diagnosis 211

12. Management 219

Appendix A Getting at the Evidence 225

Appendix A.1 Accessing the Medical Literature: How to Get There from Here 225

Appendix A.2 A Walking Tour of Medline 241

Appendix A.3 Publication Bias: The Limits of Accessible Evidence 245

Appendix B Considering Cost In Clinical Practice: The Constraint of Resource Limitations 249

Appendix C Clinically Useful Measures Derived from the 2 x 2 Contingency Table 257.

Notes:

Errata note inserted.

Includes bibliographical references (pages 279-282) and index.

ISBN:

0761919384

0761919392

OCLC:

46359738