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Published in Milos Jenicek, How to Think in Medicine, 2018
In medicine, we infer in two directions. In the first, we infer from observing individuals individually and applying the experience to the whole problem which those individuals represent. ‘Classical’ or field epidemiologists often do this by looking at the characteristics of patients one by one to establish the clinical picture of disease they represent, or studying disease outbreaks or cancer occurrence in the community). The “clinical epidemiology” approach is used in clinical medicine. In this approach, we observe from what we already know about groups of similar patients, medical care and their diseases and infer (see how they fit) to solve individual patients’ problems. Figure 4.7 (in Chapter 4) illustrates these two strategies and ways of reasoning. Both are necessary for good understanding and decision-making.
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Published in Filomena Pereira-Maxwell, Medical Statistics, 2018
The evaluation of the methods, results and conclusions of a research study, based on an understanding of research methodology and accepted standards of quality and validity, in the context of the particular clinical or public health issue being investigated. See also hierarchy of evidence, evidence-based medicine, clinical epidemiology, epidemiology, Cochrane Collaboration. For a comprehensive guide, see GUYATT et al. (2014). See also GREENHALGH (1997; 2014), AJETUNMOBI (2002) and HENEGHAN & BADENOCH (2006). See the UK-based Critical Appraisal Skills Programme (CASP, www.casp-uk.net) for critical appraisal checklists. HIGGINS et al. (2011) report on the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. For reporting guidelines, see CONSORT statement, PRISMA statement, STROBE statement, STARD statement, TRIPOD statement. For additional reporting guidelines see SIMERA et al. (2010) and EQUATOR Network (www.equator-network.org). See also GRADE approach (www.gradeworkinggroup.org).
Limitations of epidemiologic exposure studies on the health effects of asbestos
Published in Dorsett D. Smith, The Health Effects of Asbestos, 2015
A dose response between the exposure and cancer should be present. In other words, greater exposure to asbestos fibers should result in a greater incidence of lung cancer. For example, the risk of lung cancer in cigarette smokers is related to the duration and intensity of smoking. If a biological gradient between smoking and lung cancer is not present, then the proof of possible causation is not probable. This is only an association of exposure and disease, but this does not prove causation. I am not an epidemiologist but a student of clinical epidemiological methods and an experienced reviewer of many epidemiological studies submitted to clinical pulmonary and occupational medical journals. I recommend Sven Hernberg’s book (Introduction to Occupational Epidemiology. Chelsea: Lewis Publishers, 1992) to those interested in a clear, succinct introduction to occupational epidemiology. For a clear, concise history of the epidemiology of malignant mesothelioma, read a brief review by JC McDonald. (McDonald JC. Epidemiology of malignant mesothelioma—An outline. Ann Occup Hyg 2010;54:851–7.) For a more in-depth review, I recommend: Gibbs G, Berry G. Epidemiology and risk assessment. In JC Craighead, AR Gibbs (Eds.), Asbestos and Its Diseases. Oxford University Press, 2008, pp. 94–119; McDonald JC. Epidemiology of Work Related Diseases, 2nd Edition. London: BMJ Books, 2000; Gardner MJ, Machin D, Bryant TN, Altman DG. Statistics with Confidence. Confidence Intervals and Statistical Guidelines. London: BMJ Books, 2002; Fletcher, RH, Fletcher SW. Clinical Epidemiology: The Essentials, 4th Edition. Baltimore: Lippincott, Williams & Wilkins, 2005; Rothman KJ, Greenland S. Modern Epidemiology. Philadelphia: Lippincott, Williams & Wilkins, 1998; Checkoway H, Pearce N, Crawford-Brown DJ. Research Methods in Occupational Epidemiology. New York: Oxford University Press, 1989 and 2004; Gehlback S. Interpreting the Medical Literature, 5th Edition. New York: McGraw-Hill, 2006.
Rationale and design of the peripheral nerve tumor registry: an observational cohort study
Published in Neurological Research, 2023
Nora F. Dengler, Christoph Scholz, Jürgen Beck, Anne-Kathrin Uerschels, Ullrich Sure, Christian Scheller, Christian Strauss, Daniel Martin, Gabriele Schackert, Christian Heinen, Johannes Woitzik, Anna Lawson McLean, Steffen K. Rosahl, Jonas Kolbenschlag, Johannes Heinzel, Martin Schuhmann, Marco Soares Tatagiba, Waltraud Kleist-Welch Guerra, Henry W. S. Schroeder, Ignazio Gaspare Vetrano, Rezvan Ahmadi, Andreas Unterberg, Jennifer Reinsch, Anna Zdunczyk, Meike Unteroberdoerster, Peter Vajkoczy, Sarah Wehner, Michael Becker, Cordula Matthies, Jose Pérez-Tejón, Annie Dubuisson, Damiano G. Barrone, Rikin Trivedi, Crescenzo Capone, Stefano Ferraresi, Jakob Kraschl, Thomas Kretschmer, Thomas Dombert, Frank Staub, Michael Ronellenfitsch, Gerhard Marquardt, Vincent Prinz, Marcus Czabanka, Anne Carolus, Veit Braun, Ralph König, Gregor Antoniadis, Christian Rainer Wirtz, Lukas Rasulic, Maria Teresa Pedro
Since the registry is a non-interventional, purely observational study, and treatment strategies are devised by specialists at each center independent of the registry, there is no added risk for participating patients. Statistical analyses are conducted by the Institute of Biometry and Clinical Epidemiology at the Charité Berlin. Since the registry does not aim to examine a specific hypothesis, there is no set case number as a goal. Depending on center volume, 5–50 annual PNT cases are expected per center. The analysis will be descriptive in nature to allow for a formulation of hypotheses in future studies. Statistical methods will include event history analyses and binary regression analyses with the endpoints as dependent variables and factors such as patient age, sex, tumor size and complete tumor resection as independent variables. A report of the first results is planned after the first 100 patients will be included retrospectively and prospectively.
In memoriam of Dr. Mark FitzGerald, MD, MB, FCCP, FRCPI, FRCPC
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Louis-Philippe Boulet, Mohsen Sadatsafavi, Paul M. O’Byrne
Dr. Mark FitzGerald, a giant of the Canadian and international respiratory community, passed away on January 18, 2022, in Vancouver after fighting a battle with cancer for a number of years. Dr FitzGerald was born in Ireland and graduated from the National University of Ireland, campus UCD (university college Dublin), Dublin medical school, in 1978. He initially worked as an internist in Lesotho, South Africa, for two years, then completed post-graduate training in Respiratory Medicine and Clinical Epidemiology at McMaster University. His initial academic appointment was at McMaster in 1987, and he then moved to the University of British Columbia (UBC) in 1989, where he became the director of the Center for Heart and Lung Health at the Vancouver Costal Health Research Institute. This same year, he took part in the first Canadian Asthma Consensus Guideline conference, with a panel of internationally renowned colleagues (Figure 1). He would subsequently be involved in the development of Canadian asthma guidelines, as Chair and member of the Canadian Thoracic Society (CTS) Asthma Assembly and was the lead author of the 2017 CTS position paper on the recognition and management of severe asthma.
Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance
Published in Dermato-Endocrinology, 2018
Gloria González-Saldivar, René Rodríguez-Gutiérrez, Andrés Marcelo Treviño-Alvarez, Minerva Gómez-Flores, Juan Montes-Villarreal, Neri Alejandro Álvarez-Villalobos, Anasofía Elizondo-Plazas, Alejandro Salcido-Montenegro, Jorge Ocampo-Candiani, José Gerardo González-González
Most AN publications in the last 2 decades focused on two main points: case reports of young subjects with severe AN, typically in quite obese individuals, associated to very high insulin values or retrospective studies designed to identify the prevalence of AN or validate its link to IR.14,22,27-30 There is a paucity of evidence, however, on the clinical epidemiology of AN. For example, AN prevalence among different BMI or age ranges, different anatomical sites, subjects with 1 or 2 skin phototypes, varieties of clinical expression in these two phototypes, and as a diagnostic tool beyond the link to hyperinsulinemia in overweight or obese subjects. The clinical value of AN in the knuckles in our study could be addressed with two aims: as an easy and costless diagnostic tool suggesting hyperinsulinemia due to IR; and as an early warning marker of IR even in the absence of obesity or overweight. In our study, subjects with a normal BMI and AN in the knuckles had a significantly elevated HOMA-IR index and mean baseline insulin, indicating that hyperinsulinemia due to IR is surely occurring before the BMI increase. This speculation could propose that hyperinsulinemia secondary to IR is an earlier phenomenon, not the consequence, of weight gain. Once overweight or obesity takes place, they potentiate hyperinsulinemia and weight increase. In fact, some authors have proposed obesity as a state of primary insulin hypersecretion leading to obesity.31,32 Management interventions able to modify insulin action could be addressed to prove whether hyperinsulinemia is the effect or the origin of weight increase and to assess prevention or delay of the clinical consequences of chronic hyperinsulinemia due to IR.