scholarly journals Emergence and Evidence: A Close Look at Bunge’s Philosophy of Medicine

Philosophies ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. 50 ◽  
Author(s):  
Rainer J. Klement ◽  
Prasanta S. Bandyopadhyay
Keyword(s):  
Philosophy Of Medicine ◽  
Open Systems ◽  
Emergent Properties ◽  
Evidence Based ◽  
Medical Philosophy ◽  
Randomized Controlled ◽  
Book Medical ◽  
Medical Hypothesis ◽  
Based Medicine ◽  
Realist Ontology

In his book “Medical Philosophy: Conceptual issues in Medicine”, Mario Bunge provides a unique account of medical philosophy that is deeply rooted in a realist ontology he calls “systemism”. According to systemism, the world consists of systems and their parts, and systems possess emergent properties that their parts lack. Events within systems may form causes and effects that are constantly conjoined via particular mechanisms. Bunge supports the views of the evidence-based medicine movement that randomized controlled trials (RCTs) provide the best evidence to establish the truth of causal hypothesis; in fact, he argues that only RCTs have this ability. Here, we argue that Bunge neglects the important feature of patients being open systems which are in steady interaction with their environment. We show that accepting this feature leads to counter-intuitive consequences for his account of medical hypothesis testing. In particular, we point out that (i) the confirmation of hypotheses is inherently stochastic and affords a probabilistic account of both confirmation and evidence which we provide here; (ii) RCTs are neither necessary nor sufficient to establish the truth of a causal claim; (iii) testing of causal hypotheses requires taking into account background knowledge and the context within which an intervention is applied. We conclude that there is no “best” research methodology in medicine, but that different methodologies should coexist in a complementary fashion.

scholarly journals Breast Cancer Research to Support Evidence-Based Medicine in Nigeria: A Review of the Literature

2021 ◽  
pp. 384-390
Author(s):  
Omolara A. Fatiregun ◽  
Temiloluwa Oluokun ◽  
Nwamaka N. Lasebikan ◽  
Emmanuella Nwachukwu ◽  
Abiola A. Ibraheem ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Research ◽  
Randomized Controlled Trials ◽  
Evidence Based Medicine ◽  
Treatment Guidelines ◽  
Breast Cancer Research ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Based Medicine

PURPOSE Breast cancer is the most common malignancy in women worldwide. In Nigeria, it accounts for 22.7% of all new cancer cases among women. Evidence-based medicine (EBM) entails using the results from healthcare research to enhance the clinical decision-making process and develop evidence-based treatment guidelines. Level 1 and 2 studies, such as randomized controlled trials, meta-analyses, and systematic reviews of randomized controlled trials, yield more robust types of evidence. This study reviewed the levels of evidence of breast cancer publications in Nigeria. METHODS We conducted an electronic literature search of all studies published on breast cancer in Nigeria from January 1961 to August 2019. We reviewed all the articles found under the search term “Breast Cancer in Nigeria” on medical databases. RESULTS Our search identified 2,242 publications. One thousand two hundred fifty duplicates were removed, and 520 were excluded. A total of 472 articles were considered eligible for this review. Most of these articles were case series or reports (30.7%), qualitative studies (15.7%), followed by cross-sectional studies (13.3%), laboratory studies (12.9%), case-control studies (6.1%), case reports (7%), and cohort (5.7%). CONCLUSION Breast cancer research in Nigeria is yet to produce much evidence of the types considered to best support EBM. The scarcity of data hampers the implementation of EBM in Nigeria. Currently, most treatment guidelines are adapted from those developed in other countries, despite genetic differences among populations and different environmental influencing factors.

Person-Centered Research: A novel approach to Randomized Controlled Trials

2018 ◽  
Vol 6 (2) ◽  
pp. 209
Author(s):  
Reza A Badian ◽  
Brendan McCormack ◽  
Vibeke Sundling
Keyword(s):  
Randomized Controlled Trial ◽  
Randomized Controlled Trials ◽  
Study Design ◽  
Controlled Trial ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Centered Care ◽  
Based Medicine ◽  
Novel Design

Introduction: Integrating person-centered values with randomized controlled trials methodology is a novel idea. Person-centeredness is gaining steadily more prominence and attention in healthcare and health-related policy and research. Randomized controlled trials are considered as the gold standard in evidence-based medicine for evaluating the effects of treatment or determining the causal effect. A wide array of study designs is available, but there is a lack of designs with both strong person-centered principles and a strong position with respect to the level of evidence. In this paper we intend to introduce a novel design to fill such a gap.Aims and objectives: The aim of this paper is to introduce a novel study design where essential values of person-centered care (PCC) are integrated with randomized controlled trial (RCT) methodology into a novel study design termed a person-centered randomized controlled trial (PC-RCT).Methods: In this paper we discuss the importance and role of evidence in clinical research, levels of evidence, as well as the significance of study design in evidence-based medicine. Moreover, we discuss randomized controlled trials that are considered the gold standard to achieve high quality evidence. In this paper we will explain what the concept of person-centered care is and discuss the values associated with person-centeredness.The theoretical and methodological considerations that are relevant in applying this concept will be discussed before presenting how we intend to incorporate person-centered values into a randomized controlled trial in a novel study design that is both person-centered and randomized controlled (PC-RCT). Different aspects of this proposed novel study design will be discussed, including the theory and methods underlying this new proposed design, its novelty, different stages and practical steps involved in this proposed design. Challenges, drawbacks and possible solutions for addressing challenges of this novel design will be explored, focusing on the construct, dynamics, advantages, disadvantages and novelty of PC-RCT design.Conclusion: This paper presents how person-centered values and traditional randomised controlled trial principal values are integrated into one study design where the strengths of both concepts are merged into one. The proposed novel study design has stronger person-centered characteristics and is solid in its RCT features. This design ensures that participants have much more active participation in decision-making and gain more choice in their treatment. The proposed novel study design in this paper has clearly an important role to play in satisfying the need for a study design that can address both the need for rendering higher levels of evidence as well as simultaneously securing greater integration of person-centered values in the same study design.

Methodological, Theoretical, Infrastructural, and Design Issues in Conducting Good Outcome Studies

2011 ◽  
Vol 21 (6) ◽  
pp. 644-653 ◽  
Author(s):  
Michael P. Kelly ◽  
Tessa A. Moore
Keyword(s):  
Best Practice ◽  
Outcome Studies ◽  
Controlled Trials ◽  
Evidence Based ◽  
Good Outcome ◽  
Randomized Controlled ◽  
Causal Pathways ◽  
Causal Pathway ◽  
Based Medicine

This article outlines a set of methodological, theoretical, and other issues relating to the conduct of good outcome studies. The article begins by considering the contribution of evidence-based medicine to the methodology of outcome research. The lessons which can be applied in outcome studies in nonmedical settings are described. The article then examines the role of causal pathways between interventions and outcomes and especially the importance of delineating them in advance of undertaking investigations. The development of designs based on randomized controlled trials (RCTs) with fully articulated causal pathways is described. Ways of supplementing RCTs with methods to highlight elements in the causal pathway in outcome studies are indicated. The importance of adhering to best practice in reporting and analysis is also noted.

scholarly journals Automated confidence ranked classification of randomized controlled trial articles: an aid to evidence-based medicine

2015 ◽  
Vol 22 (3) ◽  
pp. 707-717 ◽  
Author(s):  
Aaron M Cohen ◽  
Neil R Smalheiser ◽  
Marian S McDonagh ◽  
Clement Yu ◽  
Clive E Adams ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Evidence Based Medicine ◽  
Mean Squared Error ◽  
Controlled Trial ◽  
Classification Model ◽  
Evidence Based ◽  
Randomized Controlled ◽  
User Query ◽  
Mesh Terms ◽  
Based Medicine

ABSTRACT Objective: For many literature review tasks, including systematic review (SR) and other aspects of evidence-based medicine, it is important to know whether an article describes a randomized controlled trial (RCT). Current manual annotation is not complete or flexible enough for the SR process. In this work, highly accurate machine learning predictive models were built that include confidence predictions of whether an article is an RCT. Materials and Methods: The LibSVM classifier was used with forward selection of potential feature sets on a large human-related subset of MEDLINE to create a classification model requiring only the citation, abstract, and MeSH terms for each article. Results: The model achieved an area under the receiver operating characteristic curve of 0.973 and mean squared error of 0.013 on the held out year 2011 data. Accurate confidence estimates were confirmed on a manually reviewed set of test articles. A second model not requiring MeSH terms was also created, and performs almost as well. Discussion: Both models accurately rank and predict article RCT confidence. Using the model and the manually reviewed samples, it is estimated that about 8000 (3%) additional RCTs can be identified in MEDLINE, and that 5% of articles tagged as RCTs in Medline may not be identified. Conclusion: Retagging human-related studies with a continuously valued RCT confidence is potentially more useful for article ranking and review than a simple yes/no prediction. The automated RCT tagging tool should offer significant savings of time and effort during the process of writing SRs, and is a key component of a multistep text mining pipeline that we are building to streamline SR workflow. In addition, the model may be useful for identifying errors in MEDLINE publication types. The RCT confidence predictions described here have been made available to users as a web service with a user query form front end at: http://arrowsmith.psych.uic.edu/cgi-bin/arrowsmith_uic/RCT_Tagger.cgi.

scholarly journals Confounding in Observational Studies Explained

2012 ◽  
Vol 5 (1) ◽  
pp. 18-20 ◽  
Author(s):  
Bikaramjit Mann ◽  
Evan Wood
Keyword(s):  
Randomized Controlled Trial ◽  
Health Information ◽  
Observational Studies ◽  
Controlled Trial ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Disease Outcomes ◽  
Different Types ◽  
Based Medicine ◽  
The Impact

Practical and ethical constraints mean that many clinical and/or epidemiological questions cannot be answered through the implementation of a randomized controlled trial. Under these circumstances, observational studies are often required to assess relationships between certain exposures and disease outcomes. Unfortunately, observational studies are notoriously vulnerable to the effect of different types of “confounding,” a concept that is often a source of confusion among trainees, clinicians and users of health information. This article discusses the concept of confounding by way of examples and offers a simple guide for assessing the impact of is effects for learners of evidence-based medicine.

scholarly journals Absurdity in Medicine. Stanisław Trzebiński’s Philosophy of Medicine

2021 ◽  
pp. 9-23
Author(s):  
Jarosław Barański ◽  
Wojciech Mackiewicz
Keyword(s):  
Evidence Based Medicine ◽  
Philosophy Of Medicine ◽  
Medical Knowledge ◽  
Second World War ◽  
Evidence Based ◽  
World War ◽  
Medicine And Literature ◽  
Knowledge And Practice ◽  
Based Medicine ◽  
Second World

Stanisław Trzebiński (1861–1930), professor at Stefan Batory University in Vilnius, was one of the most distinguished representatives of the Polish School of Philosophy of Medicine before the Second World War. He undertook studies in neurology, philosophy of medicine, and literature. The article explores Trzebiński’s philosophical ideas, especially his call for rationality in medicine and the concept of absurdity in medicine as a precondition for the development of medical knowledge and practice. Today this method is an essential background in Evidence-Based Medicine and confirms cultural and scientific forms of cognition.

The history of evidence-based medicine

2016 ◽  
Keyword(s):  
Randomized Controlled Trial ◽  
Evidence Based Medicine ◽  
Controlled Trial ◽  
Scientific Data ◽  
Therapeutic Interventions ◽  
Evidence Based ◽  
Randomized Controlled ◽  
History Of ◽  
Historical Accounts ◽  
Based Medicine

The pursuit of tests for therapeutic interventions has been a characteristic of Western medicine since ancient times. Historical accounts of the clinical trial are usually expressed through the lens of presentism: how the various components of the first modern randomized controlled trial-the comparison, blinding, and randomization-culminated in Austin Bradford Hill’s 1946 trial of streptomycin for tuberculosis. The factual context of the development of the randomized controlled trial is important if only to emphasize the historicity of contemporary research methodology. However, the adoption of the various components of the trial at any one time has as much to do with changing the socio-political and ethical contexts as the ‘objective’ scientific standards of evidence. Evidence is not just scientific data floating in some ethereal medium, but is also linked to facts and beliefs of the various members of diverse medical communities who interpret evidence and deploy it to legitimize various strategies. This introductory chapter aims to present the background and context through which evidence-based medicine has emerged.

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