Clinical Research Transformed

Description

In this Information Age, the practices of clinical medicine should no longer be based on what clinical doctors actively know. Rather, all of the importantly practice-relevant knowledge should not only already exist but also be codified in cyberspace, in directly practice-guiding 'expert systems' -- for the benefit of both doctors and patients everywhere. Each of these systems (discipline-specific) would, prompted by a particular type of case presentation, present the doctor a questionnaire specific to cases of the type at issue, and document the doctor's answers to the questions. If at issue would be a case of complaint about a (particular type of) sickness, the system would translate the resulting diagnostic profile of the case into the corresponding probabilities of the illnesses to be considered. Similarly, if at issue would be an already-diagnosed case of a particular illness, the system would ask about, and record, the relevant elements in the prognostic profile of the case and then translate this profile into the probabilities of various outcomes to be considered, probabilities specific to the choice of treatment and prospective time in addition to that profile. And besides, these systems would analogously address the causal origin -- etiogenesis -- of cases of particular types of illness. While the requisite knowledge-base for these systems -- notably for the probabilities in them -- has not been addressed by such 'patient-oriented' clinical research as has been conducted (very extensively) up to now, this book delineates the nature of the suitably-transformed research (gnostic). The critically-transformative innovation in the research is the studies' focus on Gnostic Probability Functions -- dia-, etio-, and prognostic -- in the framework of logistic regression models. This book also presents a vision of how this critically-transformative research would most expeditiously be provided for and also conducted, among select sets of academic teaching hospitals. Front Matter ....Pages i-xxiv Front Matter ....Pages 1-1 The Essence of Clinical Medicine (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 3-8 The Essence of Clinical Research (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 9-14 Clinical Research and Clinical Medicine at Present (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 15-29 Clinical Research Transformative of Clinical Medicine (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 31-36 Front Matter ....Pages 37-37 Core Concepts of Epidemiology and Epidemiological Research (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 39-49 The Epidemiological Interface of Gnostic Clinical Research (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 51-57 Front Matter ....Pages 59-59 The Logistic Regression Model (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 61-70 Statistics from the Model’s Fitting to Gnostic Data (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 71-74 Front Matter ....Pages 75-75 The Types of Diagnostic Challenge and Needs for Knowledge (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 77-80 Harvesting Experts’ Diagnostic Probability Estimates (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 81-88 Objects Design for a Diagnostic Probability Study (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 89-98 Methods Design for a Diagnostic Probability Study (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 99-108 The Bayes’ Theorem Framework for Diagnostic Research (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 109-114 Research Focused on Diagnostic Tests (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 115-123 Front Matter ....Pages 125-125 Introduction to Etiognostic Research (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 127-135 Objects Design for an Etiognostic Study (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 137-144 Methods Design for an Etiognostic Study (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 145-157 Front Matter ....Pages 159-159 Introduction to Prognostic Research (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 161-167 Example: Research on ‘Hormone Replacement Therapy’ (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 169-192 Prognostic Probability Functions from Clinical-Trial Data (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 193-213 Non-experimental Intervention-Prognostic Studies (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 215-232 Intervention-Prognostic Derivative Research (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 233-242 Front Matter ....Pages 243-243 Theory of Medicine Defining the Essential Missions for Clinical Research (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 245-247 Theory of Clinical Research for its Gnosis-Serving Missions (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 249-253 Toward Worldwide Scientific Medicine (Olli S. Miettinen, Johann Steurer, Albert Hofman)....Pages 255-260 Back Matter ....Pages 261-302