Rational Diagnosis and Treatment - Evidence-Based Clinical Decision-Making

Informationen zum Autor Peter C. Gøtzsche, D. MSc. Director, Specialist in internal medicine, Director of the Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark. Klappentext 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. Zusammenfassung 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. Inhaltsverzeichnis 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. ...

List of contents

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
 
Te

Report

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

Product details

• Authors: P Gotzsche, Peter Gotzsche, Peter (Consultant Physician Gotzsche, Peter C. Gotzsche, Peter C. Götzsche, Peter Gøtzsche, Peter (Consultant Physician Gøtzsche, Peter C. Gøtzsche, GOTZSCHE PETER C, Peter Gtzsche, Peter (Consultant Physician Gtzsche
• Publisher: Wiley, John and Sons Ltd
• Languages: English
• Product format: Hardback
• Released: 23.11.2007
• EAN: 9780470515037
• ISBN: 978-0-470-51503-7
• No. of pages: 248
• Subjects: Natural sciences, medicine, IT, technology > Medicine > Clinical medicine; Heilkunde, Medizin, Medical Science, Allg. Medizin