Peter C. Gøtzsche

Rational Diagnosis and Treatment

Evidence-Based Clinical Decision-Making

• Gebundenes Buch

Produktbeschreibung

This fourth edition of Peter Gotzsche's 'Rational Diagnosis and Treatment' argues that clinical decision-making should be built from first principles. By asking relevant questions, such as 'how reliable are various sorts of data?', 'how has the disease classification evolved over time, and is it logical?', fewer mistakes will be made by the practising physician and trainee.

This beautifully written book integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice. It stresses that, whenever possible, clinical decisions must be based on the best evidence from clinical research; but also highlights the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient.

Such an intellectually challenging book is ideal for medical students, practitioners and doctors who require theoretical and practical clinical skills to help ensure that they apply theory to their practice, to achieve the best possible outcomes.

_ How does the diagnostic process narrow down options, and what are the pitfalls in diagnostic reasoning?

_ How do randomness, the spontaneous course of the disease, the placebo effect, luck and clinical trials come together?

_ What is the nature of reasoning?

_ What is the true value of the published literature?

_ How do commercial interests distort our perceptions about drugs?

_ Should people get screened for cancer and other diseases?

New edition contains:

_ Updated sections on placebo and meta-analysis

_ Sections on different research designs, focusing on advantages and limitations

_ Notes on increased medicalisation and the effects of cancer screening on healthy people

_ Updated section on alternative medicine

_ Greater focus on insufficient reporting of harms of interventions

_ Additional text on academic freedom.

Produktdetails

• Verlag: Wiley & Sons
• 4. Aufl.
• Seitenzahl: 248
• Erscheinungstermin: 1. Januar 2008
• Englisch
• Abmessung: 233mm x 154mm x 20mm
• Gewicht: 480g
• ISBN-13: 9780470515037
• ISBN-10: 0470515031
• Artikelnr.: 23153923

Autorenporträt

Peter C. Gøtzsche, D. MSc. Director, Specialist in internal medicine, Director of the Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark.

Inhaltsangabe

Preface Introduction 1 The Foundation of Clinical Decisions The clinical
decision process Clinical data Scales of measurement Taking the history The
physical examination Paraclinical findings Global assessments 2 Reliability
and relevance of clinical data Clinical data on an interval scale Clinical
data on an ordinal scale Clinical data on a binary scale Descriptive
paraclinical findings Descriptive physical signs The statistical concept of
normality The concept of disease Interpretation and relevance Indicators 3
The disease classification The historical perspective The seventeenth and
eighteenth centuries The nineteenth and twentieth centuries The theoretical
perspective The mechanical model of disease Molecular biology Disease and
the environment The practical perspective Name of disease Definition Causes
of disease (aetiology and pathogenesis) The clinical picture Diagnosis and
treatment 4 Diagnosis The diagnostic universe Diagnosis of diseases with an
accessible defining criterion The direct method for assessing the accuracy
of test results The indirect method for assessing the accuracy of test
results Terminological confusion Quantitative data Diagnosis of diseases
with a concealed defining criterion Syndrome diagnosis Three patients
Diagnosis in practice Frequential and subjective probabilities Diagnostic
strategy 5 Uncontrolled experience Uncontrolled experience in a
pre-scientific era The numerical method The era of laboratory research The
spontaneous course of the disease Regression towards the mean Run of luck
Bias The placebo effect The need for controlled experience Alternative
medicine: pseudoscientific thinking 6 The randomized clinical trial
Selection of patients Randomization Choice of treatment in the control
group Principles of blinding Cross-over trials Measures of benefits and
harms Stopping rules Assessment of the results Statistical analysis
Hypothesis testing Estimation Other statistical measures of effect Subgroup
analyses Systematic reviews From trials to practice Evidence-based medicine
and commercial pressures 7 Medicine and the humanities The four components
of clinical reasoning The empathic-hermeneutic component The ethical
component Three kinds of norms The foundation of health care ethics The
structure of ethical reasoning Assessment of the facts of the case
Consequential considerations Deontological considerations The ethical
decision Quality of life Autonomy and paternalism Clinical examples
Clinical research ethics 8 Critical reading of medical journals Logical
analysis of medical papers Assets and limitations of cohort studies Assets
and limitations of case-control studies Other designs Descriptive
statistics Estimation Testing Hypotheses Psuedohypothetico-deductive logic
Wrong sampling unit Sample size calculations Interpretation of P-values
Statistical tests Examples Correlation analysis Life table analysis
References Index

Rezensionen

"An extremely interesting and intellectually stimulating book ... .I would recommend this book, particularly to medical students and junior doctors." ( Evidence Based Medicine , December 2008)