Peter Gøtzsche

Rational Diagnosis and Treatment (eBook, PDF)

Evidence-Based Clinical Decision-Making

• Format: PDF

Produktbeschreibung

Now in its fourth edition, Rational Diagnosis and Treatment: Evidence-Based Clinical Decision-Making is a unique book to look at evidence-based medicine and the difficulty of applying evidence from group studies to individual patients. The book analyses the successive stages of the decision process and deals with topics such as the examination of the patient, the reliability of clinical data, the logic of diagnosis, the fallacies of uncontrolled therapeutic experience and the need for randomised clinical trials and meta-analyses. It is the main theme of the book that, whenever possible, clinical decisions must be based on the evidence from clinical research, but the authors also explain the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient. For this new edition, the sections on placebo and meta-analysis and on alternative medicine have been thoroughly updated, and there is more focus on insufficient reporting of harms of interventions. The sections on different research designs describe advantages and limitations, and the increased medicalisation and the effects of cancer screening on health people are noted. A section on academic freedom when clinicians collaborate with industry and ghost authors is added. This essential reference work integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice; distinguishing between data, sets of data, knowledge and wisdom, and their application. Such an intellectually challenging book is ideal for both medical students and doctors who require theoretical and practical clinical skills to help ensure that they apply theory in practice.

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Produktdetails

• Verlag: John Wiley & Sons
• Seitenzahl: 244
• Erscheinungstermin: 2. August 2008
• Englisch
• ISBN-13: 9780470723685
• Artikelnr.: 37298797

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)