Dictionary of Evidence-based Medicine.pdf

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Dictionary of Evidence-based Medicine 117 which has its roots in the hospice movement, (i) affirms life and regards dying as a normal process; (ii) neither hastens nor postpones death; (iii) provides relief from pain and other distressing symptoms; (iv) integrates the psychological and spiritual aspects of patient care; (v) offers a support system to help patients live as actively as possible until death; (vi) offers a support system to help the family cope during the patient's illness and in their own bereavement (WHO (1990) Cancer pain relief and palliative care. WHO Technical Report Series 804. World Health Organization, Geneva). Paradigm A paradigm is made up of the general assumptions, laws and techniques used by members of a particular scientific community. The paradigm defines what is acceptable within the science which it governs. Kuhn popularized this concept (Kuhn T (1970) The structure of scientific revolutions. Chicago University Press, Chicago) in his explanation of the way science develops. He defines a pre-science phase when research activity within a given field is disorganized and diverse. This then becomes more directed and structured (the normal science phase). During this phase, scientists develop further explanations but come across difficulties and falsifications of laws and assumptions underlying the existing paradigm. A crisis develops when controversy gets out of hand. With new theories to resolve the crisis, a new normal science phase is re-established before the next crisis is encountered. The work of Copernicus, for example, led to a paradigmatic change. Commentators are suggesting that the wide acceptance of evidence-based medicine is leading to a paradigm change in clinical practice. Paradox of thrift (see under Fallacy of composition) Pareto criterion The Pareto criterion, based on a suggestion made by Vilfredo Pareto, states that a change can be said to be an improvement only if it makes at least one person better off without making another worse off (Pareto V (1906) Manual of political economy. (Schwier AS, Page AN (eds)) Macmillan, London). Pareto efficiency (see under Efficiency)
118 Dictionary of Evidence-based Medicine Pareto improvement A Pareto improvement is one by which at least one person is made better off while no one is made worse off. Pareto optimality A situation is said to be Pareto optimal if no one can be made better off without making another person worse off. Pareto optimality is often used as a reason for maintaining the status quo and is criticized for this. Patient outcomes research team (PORT) The patient outcomes research team programme was established in 1989 by the Agency for Health Care Policy and Research of the US Department of Health and Human Services to organize and fund researchers to resolve the diagnosis and treatment of common conditions such as angina, cataracts and prostate disease. PORT teams are usually made up of clinicians, assisted by scientists such as biostatisticians. Patient's expected event rate The patient's expected event rate (PEER) is the probability that the patient will experience the event concerned (e.g. myocardial infarction) over the time frame considered. Estimates of PEER are ideally obtained from robust prognosis papers. However, in practice it may be necessary to obtain PEER from historical controls. PEER is used for calculating number needed to treat (NNT) from reported odds ratios as follows: I - (PEER) x (1 -OR) (1 - PEER) x (PEER) x (1 - OR) Patients' preferences (see Utility) PEER (see Patient's expected event rate) Perceived substitute effect This is used to describe the effect which the perception that a product can be satisfactorily substituted by another has on price sensitivity (Nagle TT,
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Dictionary of Evidence-based Medici
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Preface This book was conceived at
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A Ability to pay Ability to pay is
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Figure I Audit: Clinical audit cycl
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B Balanced design In an experiment,
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Figure 9 Concept of externality Dic
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Page 72 and 73: G Game theory Game theory, first de
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Page 86 and 87: I ICD (see International Classifica
Page 94 and 95: K Keynes, John Maynard (1883-1946)
Page 100 and 101: M Macroeconomics Macroeconomics is
Page 112 and 113: N N of I trial An N of 1 trial is a
Page 116 and 117: o OBM (see Opinion-based medicine)
Page 140 and 141: Figure 25 Measuring quality of life
Page 150 and 151: S Scarcity Scarcity is often referr
Page 158 and 159: T TDM (see Therapeutic drug monitor
Page 162 and 163: u Unique value effect This term is
Page 170: Z Z variate A random variable which
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