The Hierarchy of Evidence

2009 ◽  
pp. 34-37 ◽  
Author(s):  
Michael Bigby
Keyword(s):  
Hierarchy Of Evidence

The making and unmaking of Hashimoto’s thyroiditis: On the mismatch between illness and disease. Results from an Italian study

2021 ◽  
pp. 136345932110483
Author(s):  
Mario Cardano ◽  
Eleonora Rossero
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Scientific Evidence ◽  
Systems Design ◽  
Population Based ◽  
Hashimoto's Thyroiditis ◽  
Diagnostic Process ◽  
Subjective Experiences ◽  
Ideal Types ◽  
Hierarchy Of Evidence ◽  
Illness And Disease

The diagnostic process in contemporary medical practice is increasingly technical, specialised and relying on population-based ranges of biological normalcy. Disease is defined according to a hierarchy of evidence that privileges specialist knowledge and marginalises subjective experiences of illness. Medical and individual definitions of the situation can conflict in two ways: (i) a diagnosis is made in the absence of symptoms, (ii) individual suffering does not constitute ‘real’ disease if it is not validated by scientific evidence. This article investigates how the discrepancy between specialist and embodied knowledge is experienced and tentatively solved by patients’ self-narratives. Starting from the analysis of 22 in-depth interviews with people affected by autoimmune diseases, we focus on the subgroup affected by Hashimoto’s thyroiditis. Applying the most-different-systems design, we confront two flesh-and-blood ideal-types of illness narratives characterised by a mismatch between illness and disease. Their diagnostic trajectories are outlined and discussed as poles of a continuum of experiences resulting from different configurations of medical evidence of disease and subjective evidence of illness.

Hierarchy of Evidence

2013 ◽  
pp. 963-964
Author(s):  
Sheina Orbell ◽  
Havah Schneider ◽  
Sabrina Esbitt ◽  
Jeffrey S. Gonzalez ◽  
Jeffrey S. Gonzalez ◽  
...  
Keyword(s):  
Hierarchy Of Evidence

scholarly journals Clinically, what ought we to believe?

2018 ◽  
Vol 27 (1) ◽  
pp. 72-74 ◽  
Author(s):  
John D Little ◽  
Lorraine Davison ◽  
Robert D Little
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Relevant Information ◽  
Evidence Base ◽  
Social Interventions ◽  
Hierarchy Of Evidence ◽  
Differences Of Opinion ◽  
The Status ◽  
Randomised Controlled ◽  
Clinical Strategy

Objective: To question the status of the randomised controlled trial (RCT) in the hierarchy of evidence. Conclusions: The RCT provides important and clinically relevant information, particularly in psychopharmacology. However, and as with other methodologies, RCTs too are flawed and automatic abdication to their conclusions, especially in complex social interventions, is unwise. A clinical example with conflicting and polarising views, each with their evidence base, is described alongside a suggested clinical strategy for resolving differences of opinion.

scholarly journals Miasmas, mental models and preventive public health: some philosophical reflections on science in the COVID-19 pandemic

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
Trisha Greenhalgh
Keyword(s):  
Mental Models ◽  
Relative Weight ◽  
Evidence Based ◽  
Science And Policy ◽  
Hierarchy Of Evidence ◽  
John Snow ◽  
History Of ◽  
Support Policy ◽  
Preventive Public Health ◽  
Based Medicine

When the history of the COVID-19 pandemic is written, it is likely to show that the mental models held by scientists sometimes facilitated their thinking, thereby leading to lives saved, and at other times constrained their thinking, thereby leading to lives lost. This paper explores some competing mental models of how infectious diseases spread and shows how these models influenced the scientific process and the kinds of facts that were generated, legitimized and used to support policy. A central theme in the paper is the relative weight given by dominant scientific voices to probabilistic arguments based on experimental measurements versus mechanistic arguments based on theory. Two examples are explored: the cholera epidemic in nineteenth century London—in which the story of John Snow and the Broad Street pump is retold—and the unfolding of the COVID-19 pandemic in 2020 and early 2021—in which the evidence-based medicine movement and its hierarchy of evidence features prominently. In each case, it is shown that prevailing mental models—which were assumed by some to transcend theory but were actually heavily theory-laden—powerfully shaped both science and policy, with fatal consequences for some.

Causal Impact

2019 ◽  
pp. 203-218
Author(s):  
Daniel Westreich
Keyword(s):  
Public Health ◽  
Health Policy ◽  
Implementation Science ◽  
Public Health Policy ◽  
Observational Studies ◽  
Epidemiologic Methods ◽  
Hierarchy Of Evidence ◽  
Causal Impact ◽  
Study Designs ◽  
Impact Framework

In Chapter 9, the author discusses the causal impact framework, an approach to epidemiologic methods that can be used to move from internally valid estimates to externally valid estimates to valid estimates of the effects of population interventions. Such work is essential if epidemiologists want the results of their experimental or observational studies to directly inform public health policy decisions. The bulk of this chapter outlines and describes an approach to epidemiologic methods relevant to implementation science. The author summarizes the entire book by briefly addressing the lessons of the previous chapters for the so-called hierarchy of evidence (hierarchy of study designs).

Reducing overuse by recognising the unintended harms of good intentions

2019 ◽  
pp. bmjebm-2019-111247
Author(s):  
David Slawson ◽  
Allen F Shaughnessy
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Clinical Care ◽  
Critical Role ◽  
Medical Decision ◽  
Wide Acceptance ◽  
Hierarchy Of Evidence ◽  
Healthcare Interventions

Overdiagnosis and overtreatment—overuse—is gaining wide acceptance as a leading nosocomial intervention in medicine. Not only does overuse create anxiety and diminish patients’ quality of life, in some cases it causes harm to both patients and others not directly involved in clinical care. Reducing overuse begins with the recognition and acceptance of the potential for unintended harm of our best intentions. In this paper, we introduce five cases to illustrate where harm can occur as the result of well-intended healthcare interventions. With this insight, clinicians can learn to appreciate the critical role of probability-based, evidence-informed decision-making in medicine and the need to consider the outcomes for all who may be affected by their actions. Likewise, educators need to evolve medical education and medical decision-making so that it focuses on the hierarchy of evidence and that what ‘ought to work’, based on traditional pathophysiological, disease-focused reasoning, should be subordinate to what ‘does work’.

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