Clinical Epidemiology: The Essentials / Edition 5 by Robert Fletcher, Suzanne W. Fletcher, Grant S. Fletcher | | 9781451144475 | Paperback | Barnes & Noble
Clinical Epidemiology: The Essentials / Edition 5

Clinical Epidemiology: The Essentials / Edition 5

by Robert Fletcher, Suzanne W. Fletcher, Grant S. Fletcher
     
 

ISBN-10: 1451144474

ISBN-13: 9781451144475

Pub. Date: 02/15/2013

Publisher: Lippincott Williams & Wilkins


Now in its Fifth Edition, Clinical Epidemiology: The Essentials is a comprehensive, concise, and clinically oriented introduction to the subject of epidemiology. Written by expert educators, this text introduces students to the principles of evidence-based medicine that will help them develop and apply methods of clinical observation in order to

Overview


Now in its Fifth Edition, Clinical Epidemiology: The Essentials is a comprehensive, concise, and clinically oriented introduction to the subject of epidemiology. Written by expert educators, this text introduces students to the principles of evidence-based medicine that will help them develop and apply methods of clinical observation in order to form accurate conclusions. The Fifth Edition includes more complete coverage of systematic reviews and knowledge management, as well as other key topics such as abnormality, diagnosis, frequency and risk, prognosis, treatment, prevention, chance, studying cases and cause.

Product Details

ISBN-13:
9781451144475
Publisher:
Lippincott Williams & Wilkins
Publication date:
02/15/2013
Edition description:
Fifth
Pages:
272
Sales rank:
1,108,646
Product dimensions:
6.90(w) x 9.90(h) x 0.60(d)

Table of Contents

Chapter 1 Introduction 1

Clinical Questions and Clinical Epidemiology 2

Health Outcomes 2

The Scientific Basis for Clinical Medicine 3

Basic Principles 6

Variables 6

Numbers and Probability 6

Populations and Samples 6

Bias (Systematic Error) 7

Selection Bias 7

Measurement Bias 8

Confounding 8

Chance 10

The Effects of Bias and Chance Are Cumulative 10

Internal and External Validity 11

Information and Decisions 12

Organization of this Book 12

Chapter 2 Frequency 17

Are Words Suitable Substitutes for Numbers? 18

Prevalence and Incidence 18

Prevalence 18

Incidence 18

Prevalence and Incidence in Relation to Time 19

Relationships Among Prevalence, Incidence, and Duration of Disease 19

Some other Rates 20

Studies of Prevalence and Incidence 21

Prevalence Studies 21

Incidence Studies 21

Cumulative Incidence 21

Incidence Density (Person-Years) 22

Basic Elements of Frequency Studies 23

What Is a Case? Defining the Numerator 23

What Is the Population? Defining the Denominator 25

Does the Study Sample Represent the Population? 25

Distribution of Disease by Time, Place, and Person 25

Time 26

Place 27

Person 27

Uses of Prevalence Studies 28

What Are Prevalence Studies Good For? 28

What Are Prevalence Studies Not Particularly Good For? 28

Chapter 3 Abnormality 31

Types of Data 32

Nominal Data 32

Ordinal Data 32

Interval Data 32

Performance of Measurements 33

Validity 33

Content Validity 33

Criterion Validity 33

Construct Validity 34

Reliability 34

Range 34

Responsiveness 34

Interpretability 35

Variation 35

Variation Resulting from Measurement 35

Variation Resulting from Biologic Differences 36

Total Variation 37

Effects of Variation 37

Distributions 38

Describing Distributions 38

Actual Distributions 39

The Normal Distribution 40

Criteria for Abnormality 41

Abnormal = Unusual 42

Abnormal = Associated with Disease 43

Abnormal = Treating the Condition Leads to a Better Clinical Outcome 43

Regression to the Mean 45

Chapter 4 Risk: Basic Principles 50

Risk Factors 51

Recognizing Risk 51

Long Latency 51

Immediate Versus Distant Causes 51

Common Exposure to Risk Factors 52

Low Incidence of Disease 52

Small Risk 52

Multiple Causes and Multiple Effects 52

Risk Factors May or May Not Be Causal 53

Predicting Risk 54

Combining Multiple Risk Factors to Predict Risk 54

Risk Prediction in Individual Patients and Groups 54

Evaluating Risk Prediction Tools 56

Calibration 56

Discrimination 56

Sensitivity and Specificity of a Risk Prediction Tool 56

Risk Stratification 57

Why Risk Prediction Tools Do Not Discriminate Well Among Individuals 57

Clinical Uses of Risk Factors and Risk Prediction Tools 58

Risk Factors and Pretest Probability for Diagnostic Testing 58

Using Risk Factors to Choose Treatment 58

Risk Stratification for Screening Programs 58

Removing Risk Factors to Prevent Disease 59

Chapter 5 Risk: Exposure to Disease 61

Studies of Risk 61

When Experiments Are Not Possible or Ethical 61

Cohorts 62

Cohort Studies 62

Prospective and Historical Cohort Studies 63

Prospective Cohort Studies 63

Historical Cohort Studies Using Medical Databases 64

Case-Cohort Studies 65

Advantages and Disadvantages of Cohort Studies 65

Ways to Express and Compare Risk 67

Absolute Risk 67

Attributable Risk 68

Relative Risk 68

Interpreting Attributable and Relative Risk 68

Population Risk 69

Taking other Variables into Account 71

Extraneous Variables 71

Simple Descriptions of Risk 71

Confounding 71

Working Definition 72

Potential Confounders 72

Confirming Confounding 72

Control of Confounding 72

Randomization 73

Restriction 73

Matching 74

Stratification 74

Standardization 75

Multivariable Adjustment 75

Overall Strategy for Control of Confounding 75

Observational Studies and Cause 76

Effect Modification 76

Chapter 6 Risk: From Disease to Exposure 80

Case-Control Studies 81

Design of Case-Control Studies 83

Selecting Cases 83

Selecting Controls 83

The Population Approach 83

The Cohort Approach 84

Hospital and Community Controls 84

Multiple Control Groups 84

Multiple Controls per Case 85

Matching 85

Measuring Exposure 85

Multiple Exposures 87

The Odds Ratio: An Estimate of Relative Risk 87

Controlling for Extraneous Variables 88

Investigation of A Disease Outbreak 89

Chapter 7 Prognosis 93

Differences in Risk and Prognostic Factors 93

The Patients Ate Different 94

The Outcomes Are Different 94

The Rates Are Different 94

The Factors May be Different 94

Clinical Course and Natural History of Disease 94

Elements of Prognostic Studies 95

Patient Sample 95

Zero Time 96

Follow-Up 96

Outcomes of Disease 96

Describing Prognosis 97

A Trade-Off: Simplicity versus More Information 97

Survival Analysis 97

Survival of a Cohort 97

Survival Curves 98

Interpreting Survival Curves 100

Identifying Prognostic Factors 100

Case Series 101

Clinical Prediction Rules 102

Bias in Cohort Studies 102

Sampling Bias 103

Migration Bias 103

Measurement Bias 104

Bias from "Non-differential" Misclassification 104

Bias, Perhaps, but does it Matter? 104

Sensitivity Analysis 104

Chapter 8 Diagnosis 108

Simplifying Data 108

The Accuracy of a Test Result 109

The Gold Standard 109

Lack of Information on Negative Tests 110

Lack of Information on Test Results in the Nondiseased 110

Lack of Objective Standards for Disease 110

Consequences of Imperfect Gold Standards 111

Sensitivity and Specificity 111

Definitions 113

Use of Sensitive Tests 113

Use of Specific Tests 113

Trade-Offs between Sensitivity and Specificity 113

The Receiver Operator Characteristic (ROC) Curve 114

Establishing Sensitivity and Specificity 115

Spectrum of Patients 116

Bias 116

Chance 117

Predictive Value 117

Definitions 117

Determinants of Predictive Value 118

Estimating Prevalence (Pretest Probability) 119

Increasing the Pretest Probability of Disease 120

Specifics of the Clinical Situation 120

Selected Demographic Groups 120

Referral Process 120

Implications for Interpreting the Medical Literature 122

Likelihood Ratios 122

Odds 122

Definitions 122

Use of Likelihood Ratios 122

Why Use Likelihood Ratios? 123

Calculating Likelihood Ratios 124

Multiple Tests 125

Parallel Testing 126

Clinical Prediction Rules 127

Serial Testing 128

Serial Likelihood Ratios 128

Assumption of Independence 129

Chapter 9 Treatment 132

Ideas and Evidence 132

Ideas 132

Testing Ideas 133

Studies of Treatment Effects 134

Observational and Experimental Studies of Treatment Effects 134

Randomized Controlled Trials 134

Ethics 135

Sampling 135

Intervention 136

Comparison Groups 138

Allocating Treatment 139

Differences Arising after Randomization 139

Patients May Not Have the Disease Being Studied 140

Compliance 140

Cross-over 141

Cointerventions 141

Blinding 141

Assessment of Outcomes 142

Efficacy and Effectiveness 143

Intention-to-Treat and Explanatory Trials 144

Superiority, Equivalence, and Non-Inferiority 145

Variations on Basic Randomized Trials 145

Tailoring the Results of Trials to Individual Patients 146

Subgroups 146

Effectiveness in Individual Patients 146

Trials of N = 1 146

Alternatives to Randomized Controlled Trials 147

Limitations of Randomized Trials 147

Observational Studies of Interventions 147

Clinical Databases 148

Randomized versus Observational Studies? 148

Phases of Clinical Trials 148

Chapter 10 Prevention 152

Preventive Activities in Clinical Settings 152

Types of Clinical Prevention 152

Immunization 153

Screening 153

Behavioral Counseling (Lifestyle Changes) 153

Chemoprevention 153

Levels of Prevention 153

Primary Prevention 153

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