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This book is a revised and substantially expanded successor to Causal Relationships in Medicine: APractical System for Critical Appraisal, published by Oxford in 1988. This new edition has beenthoroughly rewritten and new sections on meta-analysis, evidence-based medicine andmisclassification have been added. The appraisal system proposed here is applicable to studiesinvolving randomized clinical trials, and epidemiologic studies of the survey, cohort, and casecontrol design. It covers all major study designs used in clinical medicine and public health toassess the etiology of conditions, the efficacy of treatment, and the outcomes of healthmanagement. The book presents a logical system of critical appraisal, from the description of thenature of the study and its results to the consideration of observational bias, the effects ofextraneous factors, chance variation, the types of positive evidence expected where causalrelationships exist and the issues of generalization of the results. Each chapter concludes with asummary and a set of self-test questions, with answer key. The book has two unique features. Oneis the presentation of six important studies illustrating randomized trials, prospective andretrospective cohort designs and case control designs, each with a critical appraisal. The other isthe summary of major statistical methods used in the analysis of each study design in a series oflogical tables with worked examples.

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