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Bibliographic Details
Main Authors: Fletcher, Robert H. (Author), Fletcher, Suzanne W. (Author)
Format: Book
Language:English
Published: Philadelphia [u.a.] Lippincott Williams & Wilkins 2005
Edition:4. ed.
Subjects:
Clínica geral
Epidemiologia analítica
Epidemiologie
Métodos epidemiológicos
Surtos de doenças (prevenção e controle)
Épidémiologie clinique
Clinical epidemiology
Epidemiologic Methods
Lehrbuch
Links: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
Physical Description:XV, 252 S. Ill., graph. Darst.
ISBN:0781752159
Staff View

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Record in the Search Index

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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
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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_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
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