Clinical Research Transformed

ISBN-13: 9783030061753 / Angielski / Twarda / 2019 / 302 str.

Olli Miettinen; Johann Steurer; Albert Hofman

Spis treści

Foreword

Preface

Acknowledgements

Essence of Clinical Medicine

Essence of Clinical Research

Clinical Research and Clinical Medicine at present

Clinical Research Transformative of Clinical Medicine

Core Concepts of Epidemiology and Epidemiological Research

The Epidemiological Interface of Gnostic Clinical Research

The Logistic Regression Model

Statistics from the Model’s Fitting to Gnostic Data

The Types of Diagnostic Challenge and Needs for Knowledge

Harvesting Experts’ Diagnostic Probability Estimates

Objects Design for a Diagnostic Probability Study

Methods Design for a Diagnostic Probability Study

The Bayes’ Theorem Framework for Diagnostic Research

Research Focused on Diagnostic Tests

Introduction to Etiognostic Research

Objects Design for an Etiognostic Study

Methods Design for an Etiognostic Study

Introduction to Prognostic Research

Example: Research on ‘Hormone Replacement Therapy’

Prognostic Probability Functions from Clinical-trial Data

Non-experimental Intervention-prognostic Studies

Intervention-prognostic Derivative Research

Theory of Medicine Defining the Essential Missions for Clinical Research

Theory of Clinical Research  for Its Essential - Gnosis-serving - Missions

Toward Worldwide Scientific Clinical Medicine

Glossary

Appendix 1: What about ‘Machine Learning’?

Appendix 2: On Excellence of Epidemiologic Academia

Index

O autorze

Olli Miettinen was born in Piikkiö, Finland on 31 July 1936. He obtained his MD from the University of Helsinki and the MPH and PhD degrees from the University of Minnesota. He was Professor of Epidemiology and Biostatistics at Harvard School of Public Health from 1974 to 1986, and has been a Professor in the Department of Epidemiology, Biostatistics, and Occupational Health and in the Department of Medicine of the Faculty of Medicine at McGill University since 1985. He is the author of 3 textbooks and a veteran of extensive teaching internationally.

Albert Hofman, is the Stephen B. Kay Family Professor of Public Health and Clinical Epidemiology and Chair, Department of Epidemiology at the Harvard T.H. Chan School of Public Health. 

Dr. Hofman received an MD in 1976 from the University of Groningen, and a PhD in 1983 from the Erasmus University Rotterdam. He was appointed in 1981 as an Assistant Professor at the Erasmus University Medical School and was promoted to Associate Professor in 1984. Since 1988 he has been full Professor and Chair in the Department of Epidemiology at the Erasmus Medical Center. In addition, Dr. Hofman has been a Science Director at the Netherlands Institute for Health Sciences since 1992, as well as an adjunct Professor of Epidemiology at our School since 1998, and a Visiting Professor of Clinical Epidemiology since January 2016. Dr. Hofman has an excellent record of teaching, including being the initiator and program director of the Erasmus Summer Program since 1991, and teaching the summer session courses on Fundamentals of Epidemiology and on Study Design in Clinical Epidemiology at Harvard.

 

Johann Steurer is the Director of the Horten Centre for patient oriented research and knowledge transfer. University of Zürich.

Blurb

This book delineates the fundamental transformations that, according to its precepts,

are now needed in the objects and methods of ‘patient-oriented’ clinical research, in

order to make it genuinely patient-relevant. These transformations are presented as

providing for transition from today’s ‘evidence-based’ practices (advocated by ‘clinical

epidemiologists’) to knowledge-based succedanea of these. While those existing

practices vary according to doctors’ personal opinions about the burden of the available

evidence, their knowledge-based succedanea will be essentially invariant across

individual doctors, as they’ll be guided by ‘expert systems’ (imbedded in cyberspace). At

issue in this is transformation in what the authors present as the very essence of clinical

medicine, namely clinical doctors’ esoteric ad-hoc knowing: “gnosis.” This is clinical

doctors’ knowing — probabilistic — about relevant-but-hidden truths about their patients’

health, and constitutes the basis for their teaching (“doctoring”) the patients about these

esoteric insights. The probabilities are ‘personalized’ in the meaning of their specificity

to the cases’ gnostic profiles.

Genuinely patient-relevant clinical knowledge this book presents as the requisite

basis for three species of clinical doctors’ gnosis: diagnosis — knowing about whether a

particular type of illness is present (though hidden) in the patient; etiognosis — knowing

about whether the patient’s illness was caused by a particular antecedent of it; and

prognosis — knowing about the patient’s future health, including as to its dependence

on the choice of treatment. Pivotal in gnostic clinical research this book presents to be

the studies’ objects design in terms of a statistical model for the rate of occurrence of

the entity of health in question, in a defined domain of case presentations. The

essentials of the studies’ methods designs are deduced from their objects designs.

Study of this book — on the theory of “meta-epidemiological clinical research” — is

essential preparation for teaching ‘patient-oriented’ clinical research and for actual

design & conduct of the studies and of their critical reviews. And by the same token,

study of this book is essential preparation for the needed replacement of ‘case-based

learning’ of clinical medicine, for suitably-learned teaching of the practice of clinical

medicine — focused on the status quo of the scientific knowledge-base for (gnoses in)

the discipline (‘specialty’) at issue.