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The success of the Apgar score demonstrates the astounding power of an appropriate clinical instrument. This down-to-earth book provides practical advice, underpinned by theoretical principles, on developing and evaluating measurement instruments in all fields of medicine. It equips you to choose the most appropriate instrument for specific purposes. The book covers measurement theories, methods and criteria for evaluating and selecting instruments. It provides methods to assess measurement properties, such as reliability, validity and responsiveness, and interpret the results. Worked examples and end-of-chapter assignments use real data and well-known instruments to build your skills at implementation and interpretation through hands-on analysis of real-life cases. All data and solutions are available online. This is a perfect course book for students and a perfect companion for professionals/researchers in the medical and health sciences who care about the quality and meaning of the measurements they perform.

This book challenges the evidence-based practice movement to re-think its assumptions. Firmly rooted in real practice while drawing lucidly on a great breadth of theoretical frameworks, it examines afresh how clinicians use knowledge. Evidence-based practice has recently become a key part of the training of all health professionals. Yet despite its ‘gold-standard’ status, it is faltering because too much effort has gone into insisting on an idealised model of how clinicians ought to use the best evidence, while not enough has been done to understand why they so often don’t. Practice-based Evidence for Healthcare is a groundbreaking attempt to redress that imbalance. Examining how clinicians actually develop and use clinical knowledge day-to-day, the authors conclude that they use ‘mindlines’– internalised, collectively reinforced, tacit guidelines. Mindlines embody the composite and flexible knowledge that clinicians need in practice. They are built up during training and continually updated from a wide range of formal and informal sources. Before new evidence becomes part of practitioners’ mindlines, it is transformed by their interactions with colleagues and patients via their communities of practice and networks of trusted colleagues. To explore how mindlines work Gabbay and le May draw on a wide range of disciplines to analyse their detailed observations of clinical practice in the UK and the US. Their conclusions and provocative recommendations will be of value to all practitioners, health service managers, policymakers, researchers, educators and students involved in the promotion of evidence-based practice. 1. Introduction: evidence in practice; 2. From formal knowledge guided complexity; 3.Clinical thinking and knowledge in practice; 4. Growing mindlines: laying the foundations; 5. Growing mindlines: cultivating contextual adroitness; 6. The place of storytelling in knowledge sharing; 7. A community of clinical practice?; 8. Co-constructing collective mindlines; 9. Co-constructing clinical reality; 10; Conclusions and implications John Gabbay is Emeritus Professor at the Wessex Institute for Health Research and Development, University of Southampton, UK. Andrée le May is Professor of Nursing at the University of Southampton, UK. 'This book is one of the most important publications about clinical practice in general and evidence based medicine in particular to appear in the last 20 years. Those who consider themselves to be working at the ‘cutting edge’ in these fields should make time to read it.' - Trisha Greenhalgh, University College London, UK 'This amazing book, which will revolutionize the way we think about clinical practice as well as the way we teach practitioners, should push the whole field forward by a quantum leap. Practice-based Evidence will come as a big relief to thinking practitioners who have felt oppressed by the evidence-based practice movement, and should be on the 'must read' list for anyone involved with meeting continuing competency requirements in both nursing and medicine.' - Lesley Degner, University of Manitoba, Canada 'This is a fascinating analysis that rings true with my own clinical experience. It will doubtless be eagerly devoured by those who study clinical decision-making but anyone concerned with clinical practice and policy, however busy, will gain by reading it. This valuable book addresses issues that are of crucial importance and from which we all need to learn.' - Joel Howell, University of Michigan, USA 'The actors who speak at the beginning of each chapter remind me of people I have met and worked with all through my career; they describe my behaviours at various stages of my life as a clinician. So, I felt very comfortable reading this book, which is filled with wisdom distilled from many disciplines and raises major issues about professional development. It will have a significant and lasting impact on how I view a number of concepts. Very few books have such a powerful influence.' - John Balla , Centre for Evidence Based Medicine, University of Oxford, UK and University of Melbourne, Australia 'This important book makes a major contribution to our understanding about the everyday problems of making sense of clinical knowledge in practice. Grounded in real world research that gives a unique insight into the real world of health professionals, John Gabbay and Andrée le May will not only inform the implementation of evidence-based practice, but also help to shape future studies of this key problem of contemporary health care, which has never been more politically contentious' - Carl May, Newcastle University, UK

This paper presents a year-long study of our project, aiming at (1) understanding the work practices of clinical staff in trauma intensive care units (TICUs) at a trauma center, with respect to their usage of clinical data interface systems, and (2) developing and evaluating an intuitive and user-centered clinical data interface system for their TICU environments. Based on a long-term field study in an urban trauma center that involved observation-, interview-, and survey-based studies to understand our target users and their working environment, we designed and implemented MediSenseView as a working prototype. MediSenseView is a clinical-data interface system, which was developed through the identification of three core challenges of existing interface system use in a trauma care unit— device separation , usage inefficiency , and system immobility —from the perspectives of three staff groups in our target environment (i.e., doctors, clinical nurses and research nurses), and through an iterative design study. The results from our pilot deployment of MediSenseView and a user study performed with 28 trauma center staff members highlight their work efficiency and satisfaction with MediSenseView compared to existing clinical data interface systems in the hospital.

Evidence-Based Diagnosis explains diagnostic, screening, and prognostic tests in clinical medicine. The authors' approach is based on many years of experience teaching physicians in a clinical research training program. Although needing only a minimum of mathematics, the quantitative discussions in this book are deeper and more rigorous than in most introductory texts. The book includes numerous worked examples and 60 problems (with answers) based on real clinical situations and journal articles. This book is a great choice for anyone looking to select, develop, or apply medical tests. Topics covered include: the diagnostic process; test reliability and accuracy; testing and treatment thresholds; critical appraisal of studies of diagnostic, screening and prognostic tests; test independence and methods of combining tests; quantifying treatment benefits using randomized trials and observational studies; Bayesian interpretation of P values and confidence intervals; challenges for evidence-based diagnosis; likelihood ratios and ROC curves.

Background Treatment of shigellosis in rabbits with butyrate reduces clinical severity and counteracts the downregulation of cathelicidin (CAP-18) in the large intestinal epithelia. Here, we aimed to evaluate whether butyrate can be used as an adjunct to antibiotics in the treatment of shigellosis in patients. Methods A randomized, double-blind, placebo-controlled, parallel-group designed clinical trial was conducted. Eighty adult patients with shigellosis were randomized to either the Intervention group (butyrate, n = 40) or the Placebo group (normal saline, n = 40). The Intervention group was given an enema containing sodium butyrate (80 mM), twice daily for 3 days, while the Placebo group received the same dose of normal saline. The primary endpoint of the trial was to assess the efficacy of butyrate in improving clinical, endoscopic and histological features of shigellosis. The secondary endpoint was to study the effect of butyrate on the induction of antimicrobial peptides in the rectum. Clinical outcomes were assessed and concentrations of antimicrobial peptides (LL-37, human beta defensin1 [HBD-1] and human beta defensin 3 [HBD-3]) and pro-inflammatory cytokines (interleukin-1β [IL-1β] and interleukin-8 [IL-8]) were measured in the stool. Sigmoidoscopic and histopathological analyses, and immunostaining of LL-37 in the rectal mucosa were performed in a subgroup of patients. Results Compared with placebo, butyrate therapy led to the early reduction of macrophages, pus cells, IL-8 and IL-1β in the stool and improvement in rectal histopathology. Butyrate treatment induced LL-37 expression in the rectal epithelia. Stool concentration of LL-37 remained significantly higher in the Intervention group on days 4 and 7. Conclusion Adjunct therapy with butyrate during shigellosis led to early reduction of inflammation and enhanced LL-37 expression in the rectal epithelia with prolonged release of LL-37 in the stool. Trial Registration ClinicalTrials.gov, NCT00800930.

In low-income countries, the use of laboratory monitoring of patients taking antiretroviral therapy (ART) remains controversial in view of persistent resource constraints. The Stratall trial did not show that clinical monitoring alone was non-inferior to laboratory and clinical monitoring in terms of immunological recovery. We aimed to evaluate the costs and cost-effectiveness of the ART monitoring approaches assessed in the Stratall trial. The randomised, controlled, non-inferiority Stratall trial was done in a decentralised setting in Cameroon. Between May 23, 2006, and Jan 31, 2008, ART-naive adults were randomly assigned (1:1) to clinical monitoring (CLIN) or viral load and CD4 cell count plus clinical monitoring (LAB) and followed up for 24 months. We calculated costs, number of life-years saved (LYS), and incremental cost-effectiveness ratios (ICERs) with data from patients who had been followed up for at least 6 months. We considered two cost scenarios in which viral load plus CD4 cell count tests cost either US$95 (scenario 1; Abbott RealTime HIV-1 assay) or $63 (scenario 2; generic assay). We compared ICERs with a WHO-recommended threshold of three times the per-person gross domestic product (GDP) for Cameroon ($3670–3800) and an alternative lower threshold of $2385 to determine cost-effectiveness. We assessed uncertainty with one-way sensitivity analyses and cost-effectiveness acceptability curves. 188 participants who underwent LAB and 197 who underwent CLIN were followed up for at least 6 months. In scenario 1, LAB increased costs by a mean of $489 (SD 430) per patient and saved 0·103 life-years compared with CLIN (ICER of $4768 [95% CI 3926–5613] per LYS). In scenario 2, the incremental mean cost of LAB was $343 (SD 425) —ie, an ICER of $3339 (2507–4173) per LYS. A combined strategy in which LAB would only be used in patients starting ART with a CD4 count of 200 cells per μL or fewer suggests that 0·120 life-years would be saved at an additional cost of $259 per patient in scenario 1 (ICER of $2167 [95% CI 1314–3020] per LYS) and $181 in scenario 2 (ICER of $1510 [692–2329] per LYS) when compared with CLIN. Laboratory monitoring was not cost effective in 2006–10 compared with clinical monitoring when the Abbott RealTime HIV-1 assay was used according to the $3670 cost-effectiveness threshold (three times per-person GDP in Cameroon), but it might be cost effective if a generic in-house assay is used. French National Agency for Research on AIDS and Viral Hepatitis (ANRS) and Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau (ESTHER).

Background Large Language Models (LLMs), advanced AI tools based on transformer architectures, demonstrate significant potential in clinical medicine by enhancing decision support, diagnostics, and medical education. However, their integration into clinical workflows requires rigorous evaluation to ensure reliability, safety, and ethical alignment. Objective This systematic review examines the evaluation parameters and methodologies applied to LLMs in clinical medicine, highlighting their capabilities, limitations, and application trends. Methods A comprehensive review of the literature was conducted across PubMed, Scopus, Web of Science, IEEE Xplore, and arXiv databases, encompassing both peer-reviewed and preprint studies. Studies were screened against predefined inclusion and exclusion criteria to identify original research evaluating LLM performance in medical contexts. Results The results reveal a growing interest in leveraging LLM tools in clinical settings, with 761 studies meeting the inclusion criteria. While general-domain LLMs, particularly ChatGPT and GPT-4, dominated evaluations (93.55%), medical-domain LLMs accounted for only 6.45%. Accuracy emerged as the most commonly assessed parameter (21.78%). Despite these advancements, the evidence base highlights certain limitations and biases across the included studies, emphasizing the need for careful interpretation and robust evaluation frameworks. Conclusions The exponential growth in LLM research underscores their transformative potential in healthcare. However, addressing challenges such as ethical risks, evaluation variability, and underrepresentation of critical specialties will be essential. Future efforts should prioritize standardized frameworks to ensure safe, effective, and equitable LLM integration in clinical practice.