Evidence-Based Medical Monitoring: From Principles to Practice

Glasziou PP, Irwig L, Aronson JK, eds. 362 pages. Oxford: BMJ Books; 2008. $95.95. ISBN 9781405153997. Order at www.wiley.com. Field of medicine: Clinical practice, from an evidence-based medicine perspective. Format: Softcover book. Audience: Patient-oriented researchers and clinicians interested in generating or applying information to appropriately guide monitoring in health care. Purpose: To outline the principles needed to guide better monitoring [of chronic or recurrent health conditions] and then illustrate those principles with examples. Content: The text is divided into 2 parts, covering the theory and practice of medical monitoring, and is subdivided into specific topics. After introductory chapters, sections regarding theory describe measurement, control phases of a disorder, the psychology of monitoring, and evaluation of monitoring techniques. The subsequent chapters regarding practice cover diabetes mellitus, oral anticoagulation, cholesterol-lowering interventions, thyroid replacement, renal transplantation, preeclampsia, intensive care, glaucoma, and osteoarthritis. The editors (from disciplines of evidence-based medicine, epidemiology, and pharmacology) and the authors (including some specialists) are based mainly in the United Kingdom and Australia; the citations are fairly representative of the worldwide clinical and research literature. Highlights: The book explores numerous aspects of conceptual models and practical strategies for using laboratory, clinical, or other tests to monitor patients. Each chapter has a concise Conclusions section, and most have tables and numerous figures. In addition to conventional medical topics, a focus on benefits and risks for home monitoring, and a comparison of clinician-led monitoring versus self-monitoring provide a broad scope. Limitations: The theoretical section relies predominantly on statistical approaches (for example, a criterion for real change in a measurement is based on a single measure 3 standard deviations from target), and the practical section is often simplistic (for example, monitoring cholesterol every 3 to 5 years is proposed, with a caveat acknowledging that clinicians may be concerned about such a long delay). The copious material in each chapter is sometimes not integrated fully. For example, several detailed conceptual models are sometimes presented for the same entity, and different assessments of the same situation are occasionally discussed without integration. In addition, coverage of the practical chapters is somewhat limited (for example, no oncology section), and the clinical information is not fully up to date (for example, urinary biomarkers are not included when discussing renal transplantation). Related reading: Specific issues involving clinical topics, epidemiology, evidence-based medicine and pharmacology disciplines can be found in journals and textbooks. Reviewer: John Concato, MD, MPH, Veterans Affairs Clinical Epidemiology Research Center and Yale University School of Medicine, West Haven, Connecticut.