Hertzman: Clinical Trials in Psychopharmacology: A Better Brain 2nd Edition

Clinical trials have become the major vehicle by which medical treatments now gain official approval for widespread application. They are the focus of much of the major work by pharmaceutical companies, and certainly their greatest expenditures. Regulatory bodies such as the American Food and Drug Administration (FDA) rely heavily, sometimes almost exclusively, on the results of clinical trials to confer their blessing for purposes of marketing pharmaceuticals.

Psychopharmacology is, in certain respects, a microcosm of developments in clinical trials; more so over the past decade. During that time the extent of trials has expanded greatly. A number of trends have become discernible, largely reflective of the general direction of pharmaceuticals in medicine.

This volume attempts to update and reflect developments in psychopharmacology trials. The authors have selected a series of international experts to assist by preparing reviews of their own areas of expertise. A number of themes emerge from the chapters comprising this collection.

Although clinical trials were virtually unheard of in psychiatry for many years, they are now the gold standard for judging whether drugs are safe and useful. But should they be? What is the true status of clinical trials? Even when they ostensibly demonstrate a benefit of a certain treatment, the strict patient selection criteria, poor compliance and high drop-out rate leave the conclusions open to question. Are the new treatments really better or more cost-effective than the old? Do they have fewer side effects?

In this book the authors take a critical look at recent developments and present a series of trenchant and challenging observations. Section I examines the significant changes in law and the regulatory environment that have occurred during the past ten years. Has fossilization handicapped the US Food and Drug Administration in promoting treatment advances? How can the plethora of findings be regulated? This is particularly pertinent in genomic studies and there are two chapters addressing the impact of genomics on psychiatric research. This section also addresses the role of women in drug trials – a group long excluded but now demanding a part, for without testing how can optimal treatments be devised?

The next two Sections highlight clinical trials in the major areas of psychiatric pharmacological treatment, including Mood Disorders, especially Bipolar, Anxiety Disorders, and addictions. Chapters on pharmacological treatments for Eating Disorders, Attention Deficit Disorder, Autism and Asperger’s Syndrome, and Impulse Control Disorder represent the latest thinking on these subjects.

The final Section contains a consummate example of out-of-the [Western]- box thinking, namely consideration of herbal medicines – used by a large number of patients, with or without medical supervision. We conclude with a close look at the problem of side effects, then selected thoughts about methodology.

Clearly written, the text provides immediate access to new developments across the spectrum of drug testing. Clinical Trials in Psychopharmacology: A Better Brain is provocative reading for psychiatrists, pharmacologists and all those interested in improved drug treatments for patients with mental illness.

Key Features

• Raises questions about the conduct of trials and the credibility of their outcomes that are relevant not just in psychiatry but all areas of medicine.
• Discusses the ethical problems in assessing outcomes in humans, including children.

Contents 

SECTION I: The Health Care Environment and Medications.

1. FDA Reform Déjà vu Encore (John J. Cohrssen).

• 1.1 Introduction.
• 1.2 The 1992 prescription drug user fee act adds funds and changes FDA’s focus.
• 1.3 PDUFA shortens drug review times and eliminates the drug lag.
• 1.4 PDUFA timetables feed safety concerns.
• 1.5 FDA responds to safety concerns.
• 1.6 The pipeline problem.
• 1.7 The 2007 FDA Science Board’s Subcommittee on Science and Technology report.
• 1.8 The FDAAA of 2007 reauthorize PDUFA and provide new authority to address safety and the critical path initiative.
• 1.9 The impact of PDFUA on FDA.
• 1.10 Comparative medical benefits, comparative effectiveness and FDA.
• 1.11 FDA and non-inferiority trials.
• 1.12 FDA and CMS decisions on medicare coverage.
• 1.13 Preemption: FDA’s role in relation to liability litigation in state courts.
• 1.14 FDA’s exclusivity in allowing access to experimental drugs.
• 1.15 Conclusions.

2. Do Antidepressants Cause Suicide (Marc Hertzman).

• 2.1 Some definitional problems.
• 2.2 A brief history of the concerns of suicidality caused by antidepressants.
• 2.3 Politics rears its ugly head.
• 2.4 The FDA responds to fear of its own shadow.
• 2.5 What changes in public policy wrought.
• 2.6 A funny thing happened on the way to the forum.
• 2.7 Meanwhile back at the ranch.
• 2.8 Moral (maybe).

3. The Genome, Genes and Brain - Tailored Drugs (Lawrence Adler).

• 3.1 Introduction.
• 3.2 Issues in new drug development.
• 3.3 Early development of psychiatric pharmaceutical entities.
• 3.4 Advances in research technology.
• 3.5 Review of genetics.
• 3.6 Activation of genes by signal transduction cascades.
• 3.7 The human genome.
• 3.8 The sequencing of the genome.
• 3.9 DNA variation.
• 3.10 Genes and illness.
• 3.11 Genomic findings, potential targets and new drug development.
• 3.12 Conclusion .

4. Patenting and Licensing Concerns in Psychiatric Genetics (Jorge A. Goldstein and Karen R. Markowicz).

• 4.1 Genetic diagnoses in psychiatry.
• 4.2 The evolving patent landscape in psychiatry.
• 4.3 Approaches to solving potential problems.
• 4.4 Conclusions.

5. Women’s Issues in Clinical Trials (Mary Seeman).

• 5.1 History.
• 5.2 Perceived advantages of excluding women.
• 5.3 Change in perspective.
• 5.4 Have things changed?.
• 5.5 Progress since 1993.
• 5.6 Reported current difficulties in including women.
• 5.7 Contraception in clinical trials.
• 5.8 Drugs in lactating women.
• 5.9 How often do women take drugs during pregnancy?.
• 5.10 Ethical issues: risk/benefit analysis.
• 5.11 Adequate information.
• 5.12 Adolescent women.
• 5.13 Recruitment and retention of women. 

 

SECTION II Clinical Trials and Mood Disorders.

6. Issues and Clues in the Pharmacological Treatment of Mood Disorders (F. Jollant, A Ionita and P Courtet).

• 6.1 What do we know about mood disorders that may be relevant for their pharmacological treatment?.
• 6.2 Are there clues for the pharmacological treatment of mood disorders?.
• 6.3 Perspectives.

7. Bipolar Disorder (A. Bochetta).

• 7.1 Trials in acute mania.
• 7.2 Trials in acute bipolar depression.
• 7.3 Trials in maintenance of bipolar disorder.
• 7.4 What is a mood stabilizer?.
• 7.5 What controlled trials cannot tell us about treatment of bipolar disorder.

8. Special Issues of Research Methodology in Bipolar Disorder Clinical Treatment Trials (R. M. Post).

• 8.1 Introduction.
• 8.2 Efficacy–effectiveness gap.
• 8.3 Trials for drug registration versus those that are most clinically informative.
• 8.4 Needed for designs that more optimally inform clinical practice.
• 8.5 ‘Hidden’ high degrees of treatment resistance.
• 8.6 Controversy about optimal designs and rating instruments.
• 8.7 The traditional RCT is expensive, cumbersome and prone to failure.
• 8.8 Alternative designs for pilot and proof of principle efficacy studies.
• 8.9 Statistical analysis of N-of-1 trials.
• 8.10 Statistical approaches to estimating necessary trial durations in individual patients.
• 8.11 Crossover trials for enhancing clinical informatics and statistical power.
• 8.12 Carryover effects.
• 8.13 Long-term trend for understudy of bipolar disorder compared to other major mental disorders.
• 8.14 Parallel and pressing design issues for childhood-onset bipolar illness.
• 8.15 Contradictory balance between inclusiveness (for generalizability) and homogeneity (for efficacy).
• 8.16 Assessing moderators and mediators.
• 8.17 Conclusions and implications.

9. The Utility of Low-dose Antidepressants (Monica L. Zilberman, Clarice Gorenstein and Valentim Gentil).

• 9.1 Introduction.
• 9.2 Low dose antidepressants for chief indications.
• 9.3 Antidepressant use for other indications.
• 9.4 Emotion regulation in healthy individuals.
• 9.5 Conclusion. 

SECTION III Clinical Trials in Anxiety and Other Disorders.

10. Clinical Trials for Anxiety Disorders (Marco Mula and Gionata Strigaro).

• 10.1 Introduction.
• 10.2 Methodological issues in treatment research for anxiety disorders.
• 10.3 Panic disorder with/without agoraphobia.
• 10.4 Generalized anxiety disorder.
• 10.5 Social anxiety disorder.
• 10.6 Post-traumatic stress disorder.
• 10.7 Conclusions.

11. Pharmacological Trials for the Treatment of Substance Use Disorders (Lisa J. Merlo, Julia Arana and Amanda M. Stone).

• 11.1 Psychopharmacological trials for the treatment of substance use disorder.
• 11.2 Definitions of substance use disorders.
• 11.3 Introduction to psychopharmacotherapy for SUD.
• 11.4 Considerations in pharmacotherapy trials for SUDs.
• 11.5 Conclusions and future directions.

12. Clinical Psychopharmacology of Patients with Eating Disorders (James E Mitchell, Kristine Steffen, Scott Engel, Ross Crosby and James Roerig).

• 12.1 Introduction.
• 12.2 Diagnostic issues.
• 12.3 Methodological/statistical issues.
• 12.4 Pharmacotherapy trials.
• 12.5 Pharmacotherapy/psychotherapy combined trials.
• 12.6 Summary.

13. ADHD Clinical Trials (Anne Childress).

• 13.1 Introduction.
• 13.2 Lisdexamfetamine (Vyvanse).
• 13.3 Methylphenidate transdermal system (Daytrana).
• 13.4 Dexmethylphenidate (Focalin).
• 13.5 Dexmethylphenidate extended release (Focalin XR).
• 13.6 Atomoxetine (Strattera).
• 13.7 Extended release methylphenidate (Ritalin LA).
• 13.8 Modified release methylphenidate (Metadate CD).
• 13.9 Mixed amphetamine salts extended release (Adderall XR).
• 13.10 OROS methylphenidate (Concerta).
• 13.11 Guanfacine extended release.
• 13.12 SPD465.
• 13.13 Modafinil.
• 13.14 Bupropion XL.
• 13.15 Discussion.

14. Autism and Asperger’s Spectrum Disorders (Marc Hertzman).

• 14.1 Introduction.
• 14.2 Individual entities versus a spectrum disorder.
• 14.3 Recent psychopharmacological approaches to autism and Asperger’s spectrum disorders.
• 14.4 Recapitulation.

15. Pharmacological Treatments of Impulse Control Disorders (Helga Myrseth and Ståle Pallesen).

• 15.1 Impulse control disorders.
• 15.2 Pathological gambling.
• 15.3 Trichotillomania.
• 15.4 Kleptomania.
• 15.5 Pyromania.
• 15.6 Intermittent explosive disorder.
• 15.7 Conclusions. 

SECTION IV Special Issues in Psychopharmacology.

16. Potential Benefits of Herbal Medicine for Schizophrenia: from Empirical Observations to Clinical Trials (Zhang-Jin Zhang, Qing-Rong Tan, Xue-Chu Zhen and Yao Tong).

• 16.1 Potential benefits of herbal medicine used in the treatment of schizophrenia.
• 16.2 Possible psychopharmacological mechanisms of herbal actions.
• 16.3 Search strategies for herbal agents having antischizophrenic potentials.
• 16.4 Specific issues in the conduct of herbal medicine trials in schizophrenia.
• 16.5 Conclusions.

17. Adverse Effects of Antipsychotics (Pierre Landry, Anne-Marie Rousseau, and Leila Skalli).

• 17.1 Introduction.
• 17.2 Pharmacology of adverse events.
• 17.3 Discontinuation symptoms.
• 17.4 Conclusion.

18. Meta Musings on Methodology (Marc Hertzman).

• 18.1 Criticisms of assumptions about clinical trials methodology.
• 18.2 Thoughts on alternative study designs.
• 18.3 Conclusion: standardization can be stultifying.

Index.

About the Author

• Dr. Marc Hertzman, a psychopharmacologist, previously Professor of Psychiatry at George Washington University, is now in private practice. Before that he was a Division Director for the National Institute on Alcohol Abuse and Alcoholism and served as their representative to the US government task force which originated US policy on clinical trials. His publications, in addition to the first edition of this book, include work on Mood Disorders, Anxiety, and Autism Spectrum Disorders. He has also been a Principal Investigator on clinical trials for more than thirty years.
• Dr Lawrence Adler is the Owner/Director of Clinical Insights and Clinical Assistant Professor of Psychiatry at the University of Maryland. He is Board-certified in Psychiatry and Geriatric Psychiatry, and is a Certified Physician Investigator. From 1983 – 1998 he conducted research into the genetics and epidemiology of schizophrenia. He has been involved in clinical trials since 1993.

 

Product Details

• Hardcover: 406 pages
• Publisher: Wiley; 2 edition (March 23, 2010)
• Language: English
• ISBN-10: 0470740760
• ISBN-13: 978-0470740767
• Product Dimensions: 7 x 1.1 x 9.9 inches

List Price: $99.95 

 

Greenhalgh: How to Read a Paper: The Basics of Evidence-Based Medicine 4th Edition

How to Read a Paper describes the different types of clinical research reporting, and explains how to critically appraise the publications. The book provides the tools to find and evaluate the literature, and implement the findings in an evidence-based, patient-centered way. Written for anyone in the health care professions who has little or no knowledge of evidence-based medicine, it provides a clear understanding of the concepts and how to put them into practice at the basic, clinical level.

New to this edition

• The fourth edition will include two new chapters on important developments in health care research and delivery, but otherwise retains its original style, size, and scope.
• New chapter on quality improvement – describing papers on quality improvement projects using ebm methods; this will extend the readership to non clinical health care professionals working in hospitals and family practice, and to nurse specialists and practice nurses working in this field.
• New chapter on complex interventions - how to set up research projects involving both qualitative and quantitative methodology (known as mixed methods).
• Thorough revision and updating of existing chapters and references.
• New illustrations – diagrammatic representations of ebm concepts.

Contents

1 Why read papers at all?

• 1.1 Does 'evidence-based medicine' simply mean 'reading papers in medical journals'?
• 1.2 Why do people sometimes groan when you mention EBM?
• 1.3 Before you start: formulate the problem.

2 Searching the literature.

• 2.1 What are you looking for?
• 2.2 Levels upon levels of evidence.
• 2.3 Synthesised sources: systems, summaries and syntheses.
• 2.4 Pre-appraised sources: synopses of systematic reviews and primary studies.
• 2.5 Specialised resources.
• 2.6 Primary studies – tackling the jungle.
• 2.7 One-stop shopping: federated search engines.
• 2.8 Asking for help and asking around.

3 Getting your bearings – what is this paper about?

• 3.1 The science of 'trashing' papers.
• 3.2 Three preliminary questions to get your bearings.
• 3.3 Randomised controlled trials.
• 3.4 Cohort studies.
• 3.5 Case-control studies.
• 3.6 Cross-sectional surveys.
• 3.7 Case reports.
• 3.8 The traditional hierarchy of evidence.
• 3.9 A note on ethical considerations.

4 Assessing methodological quality.

• 4.1 Was the study original?
• 4.2 Whom is the study about?
• 4.3 Was the design of the study sensible?
• 4.4 Was systematic bias avoided or minimised?
• 4.5 Was assessment 'blind'?
• 4.6 Were preliminary statistical questions addressed?
• 4.7 Summing up.

5 Statistics for the non-statistician.

• 5.1 How can non-statisticians evaluate statistical tests?
• 5.2 Have the authors set the scene correctly?
• 5.3 Paired data, tails, and outliers.
• 5.4 Correlation, regression and causation.
• 5.5 Probability and confidence.
• 5.6 The bottom line.
• 5.7 Summary.

6 Papers that report trials of drug treatments and other simple interventions.

• 6.1 ‘Evidence’ and marketing.
• 6.2 Making decisions about therapy.
• 6.3 Surrogate endpoints.
• 6.4 What information to expect in a paper describing an RCT: the CONSORT statement.
• 6.5 Getting worthwhile evidence out of a pharmaceutical representative.

7 Papers that report trials of complex interventions.

• 7.1 Complex interventions.
• 7.2 Ten questions to ask about a paper describing a complex intervention.

8 Papers that report diagnostic or screening tests.

• 8.1 Ten men in the dock.
• 8.2 Validating diagnostic tests against a gold standard.
• 8.3 Ten questions to ask about a paper that claims to validate a diagnostic or screening test.
• 8.4 Likelihood ratios.
• 8.5 Clinical prediction rules.

9 Papers that summarise other papers (systematic reviews and meta-analyses).

• 9.1 When is a review systematic?
• 9.2 Evaluating systematic reviews.
• 9.3 Meta-analysis for the non-statistician.
• 9.4 Explaining heterogeneity.
• 9.5 New approaches to systematic review.

10 Papers that tell you what to do (guidelines).

• 10.1 The great guidelines debate.
• 10.2 How can we help ensure that evidence-based guidelines are followed?
• 10.3 Ten questions to ask about a clinical guideline.

11 Papers that tell you what things cost (economic analyses).

• 11.1 What is an economic analysis?
• 11.2 Measuring the costs and benefits of health interventions.
• 11.3 Ten questions to ask about an economic analysis.
• 11.4 Conclusion.

12 Papers that go beyond numbers (qualitative research).

• 12.1 What is qualitative research?
• 12.2 Evaluating papers that describe qualitative research.
• 12.3 Conclusion.

13 Papers that report questionnaire research.

• 13.1 The rise and rise of questionnaire research.
• 13.2 Ten questions to ask about a paper describing a questionnaire study.

14 Papers that report quality improvement case studies.

• 14.1 What are quality improvement studies – and how should we research them?
• 14.2 Ten questions to ask about a paper describing a quality improvement initiative.
• 14.3 Conclusion.

15 Getting evidence into practice.

• 15.1 Why are health professionals slow to adopt evidence-based practice?
• 15.2 How much avoidable suffering is caused by failing to implement evidence?
• 15.3 How can we influence health professionals' behaviour to promote evidence-based practice?
• 15.4 What does an 'evidence-based organisation' look like?
• 15.5 How can we help organisations develop the appropriate structures, systems and values to support evidence-based practice?
• 15.6 Why is it so hard to get evidence into policymaking?

Appendices 

• Appendix 1 Checklists for finding, appraising and implementing evidence.
• Appendix 2 Assessing the effects of an intervention.

Index.

 

About the Author 

Trisha Greenhalgh is Professor of Primary Health Care at University College, London and a practising GP. Her main areas of interest are:

• Web based teaching and learning, especially for health care professionals
• Evidence based health care and quality improvement, especially in relation to multiprofessional and interdisciplinary working.
• Health service management, especially organisation, delivery and evaluation of diabetes services in primary care.
• Use of personal narrative to explore the patient's perspective and illness experience, especially in relation to diabetes in minority ethnic groups.

Product Details

• Paperback: 256 pages
• Publisher: BMJ Books; 4 edition (2011)
• Language: English
• ISBN-10: 1444334360
• ISBN-13: 978-1444334364
• Product Dimensions: 8.4 x 5.4 x 0.6 inches

List Price: $47.95 

 

Huang: Evidence-Based Orthodontics

Evidence-Based Orthodontics satisfies the educational demands of orthodontics, which demands the integration of the best research evidence with the clinician’s expertise and the patient’s unique values and circumstances.

This land-mark text is the first to be devoted to the methodology, principles and practice of evidence-based practice in orthodontics. It aims to serve as a reference for those wishing to understand the principles of evidence-based practice including the foundation for clinical study design, epidemiology and the statistical inferences from data. The ability to define a search strategy from established databases and to identify relevant clinical and translational research in the scientific published literature requires a new approach in orthodontic education.

Evidence-Based Orthodontics provides a contemporary approach to those strategies in clinical orthodontic practice. The growing ability to translate critical appraisals of evidence into clinical practice and evaluate clinical evidence for its validity and potential usefulness requires an understanding of basic elements in epidemiology and biostatistics.

Evidence-Based Orthodontics provides its readers with a cogent, clear resource with which to navigate and understand this important subject area. It provides students and practitioners of orthodontics with an indispensible guide to this vital tenet of education, research, and clinical practice. 

Key Features 

• Land-mark text surveys the principles and practice of evidence-based orthodontics.
• Covers clinical study design, epidemiology, and understanding of statistical data.
• Equips readers with critical apparatus for understanding orthodontic literature.
• Reviews the available evidence and studies in orthodontics.
• Clear and cogent approach to clarify this vital area of study, research, and practice.

Contents

Part 1 Principles.

• Chapter 1 A Historical Perspective of Evidence-Based Orthodontics 
• Chapter 2 Clinical Research Designs 
• Chapter 3 Electronic Searching for Clinical Trials Information 

Part 2 Selected Topics.

• Chapter 4 The Treatment of Class II Malocclusion—Have We the Evidence to Make Decisions? 
• Chapter 5 External Root Resorption and Orthodontic Treatment—Assessment of the Evidence 
• Chapter 6 Malocclusion, Orthodontic Treatment, and Periodontal Health 
• Chapter 7 Stability of Anterior Open Bite Correction 
• Chapter 8 Orthodontics and Temporomandibular Joint (TMJ) Disorders 
• Chapter 9 Self-Ligation 
• Chapter 10 Prevention of Demineralization During Orthodontic Treatment with Fluoride-Containing Materials or Casein Phosphopeptide-Amorphous Calcium Phosphate 
• Chapter 11 Invisalign Therapy 
• Chapter 12 Retention 
• Chapter 13 Quality of Outcome 
• Chapter 14 Stability of Orthognathic Surgery 
• Chapter 15 Orthodontic Treatment of the Transverse Dimension 
• Chapter 16 Class III Malocclusion 

Part 3 Evidence-Based Orthodontics in Perspective

• Chapter 17 Evidence-Based Care in Context 
• Chapter 18 Playing Doctor: Evidence-Based Orthodontics 
• Chapter 19 Reflections on a Decade of Evidence-Based Dentistry 

Index. 

About the Authors 

• Greg J. Huang, DMD, MSD, MPH is Associate Professor and Chair of the Department of Orthodontics at the University of Washington.
• Stephen Richmond, BDS, DOrth RCS, MScD, FDSRCS, PhD is Professor of Orthodontics and Head of Applied Clinical Research and Public Health, Department of Applied Clinical Research and Public Health, at the University Dental Hospital at Cardiff University.
• Katherine W. L. Vig, BDS, MS, DOrth RCS, FDSRCS is Professor Emeritus and former Chair of Orthodontics at The Ohio State University, College of Dentistry. 

Product Details

• Paperback: 348 pages
• Publisher: Wiley-Blackwell; 1 edition (2011)
• Language: English
• ISBN-10: 0813806143
• ISBN-13: 978-0813806143
• Product Dimensions: 9.6 x 6.8 x 0.7 inches

List Price: $89.99 

Dagenais: Evidence-Based Management of Low Back Pain

Covering all commonly used interventions for acute and chronic low back pain conditions, Evidence-Based Management of Low Back Pain consolidates current scientific studies and research evidence into a single, practical resource. Its multidisciplinary approach covers a wide scope of treatments from manual therapies to medical interventions to surgery, organizing interventions from least to most invasive. Editors Simon Dagenais and Scott Haldeman, along with expert contributors from a variety of clinical and academic institutions throughout the world, focus on the best available scientific evidence, summarizing the results from the strongest to the weakest types of studies. No other book makes it so easy to compare the different interventions and treatment approaches, giving you the tools to make better, more informed clinical decisions.

Key Features 

• A multidisciplinary approach covers treatments from manual therapies to medical interventions to surgery, and many others in between.
• An interdisciplinary approach enables health care providers to work together.
• A logical, easy-to-follow organization covers information by intervention type, from least invasive to most invasive. 
• Integration of interventions provides information in a clinically useful way, so it's easier to consider more than one type of treatment or intervention for low back pain, and easier to see which methods should be tried first.
• 155 illustrations include x-rays, photos, and drawings.
• Tables and boxes summarize key information.
• Evidence-based content allows you to make clinical decisions based on the ranking the best available scientific studies from strongest to weakest.
• Patient history and examination chapters help in assessing the patient's condition and in ruling out serious pathology before making decisions about specific interventions.
• Experienced editors and contributors are proven authors, researchers, and teachers, and practitioners, well known in the areas of orthopedics, pain management, chiropractic, physical therapy, and behavioral medicine as well as complementary and alternative medicine; the book's contributors include some of the leading clinical and research experts in the field of low back pain.
• Coverage based on The Spine Journal special issue on low back pain ensures that topics are relevant and up to date.
• A systematic review of interventions for low back pain includes these categories: patient education, exercise and rehabilitation, medications, manual therapy, physical modalities, complementary and alternative medicine, behavioral modification, injections, minimally invasive procedures, and surgery.
• Surgical interventions include decompression, fusion, disc arthroplasty, and dynamic stabilization.
• Additional coverage includes patient education and multidisciplinary rehabilitation. 

Contents

Section 1: Introduction

• 1. Evidence-Based Management of Low Back Pain
• 2. Guide to Using This Textbook
• 3. Assessment of Low Back Pain
• 4. Management of Acute Low Back Pain

Section 2: Education

• 5. Physical Activity, Smoking Cessation, and Weight Loss
• 6. Watchful Waiting and Brief Education
• 7. Back Schools and Fear Avoidance Training

Section 3: Exercise

• 8. Lumbar Stabilization Exercise
• 9. Lumbar Strengthening Exercise
• 10. McKenzie Method

Section 4: Medication

• 11. Common Analgesics
• 12. Opioid Analgesics
• 13. Adjunctive Analgesics

Section 5: Physical Modalities

• 14. Electrotherapeutic Modalities and Physical Agents
• 15. Traction Therapy

Section 6: Manual Therapies

• 16. Massage Therapy
• 17. Spinal Manipulation and Mobilization
• 18. Medicine Assisted Manipulation

Section 7: Complementary and Alternative Medical Therapies

• 19. Nutritional, Herbal, and Homeopathic Supplements
• 20. Needle Acupuncture

Section 8: Behavioral Therapies

• 21. Cognitive Behavioral Therapy
• 22. Functional Restoration

Section 9: Injection Therapies

• 23. Epidural Steroid Injections
• 24. Trigger Point Injections
• 25. Prolotherapy

Section 10: Minimally Invasive Therapies

• 26. Lumbar Medial Branch Neurotomy
• 27. Intradiscal Thermal Therapies
• 28. Nucleoplasty

Section 11: Surgical Therapies

• 29. Decompression Surgery
• 30. Fusion Surgery and Disc Arthroplasty

Conclusion

Back Matter

Glossary 

Answer Key

Index

About the Author

• Simon Dagenais, DC, PhD, Division of Orthopaedic Surgery and Department fo Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontaria, Canada, Department of Social and Preventive Medicine, University at Buffalo, Buffalo, NY. 
• Scott Haldeman DC, MD, PhD,Department of Neurology, University of California, Irvine, Irvine, CA, Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA,Southern California University of Health Sciences, Whittier, CA.

Product Details

• Hardcover: 496 pages
• Publisher: Mosby; 1 edition (February 11, 2011)
• Language: English
• ISBN-10: 0323072933
• ISBN-13: 978-0323072939
• Product Dimensions: 11.1 x 8.7 x 1 inches

List Price: $115.00

Dahm: Evidence-based Urology

This unique book provides up-to-date information on the appropriateness of both medical and surgical treatment options for a broad spectrum of urological conditions based on the current best evidence.

Written by an international team of authors that stand out through their specialty expertise and leadership in practicing evidence-based urology, this book provides practical recommendations for the care of individual patients. Each chapter addresses a series of focused clinical questions that are addressed in a systematic fashion, including a comprehensive literature search, a rating of the quality of evidence, and an assessment of ratio of benefit and harm of a given treatment option.

Evidence-Based Urology is an invaluable source of evidence-based information distilled into guidance for clinical practice.

Contents 

• 1 Searching for evidence (Jeanette Buckingham).
• 2 Clinical trials in urology (Charles D. Scales Jr and David F. Penson).
• 3 Conduct and interpretation of systematic reviews and meta-analyses in urology (Martha M. Faraday).
• 4 Rating the quality of evidence and making recommendations (Philipp Dahm and Holger J. Schünemann).
• 5 Evidence-based guidelines in urology (Susan L. Norris).
• 6 Understanding concepts related to health economics in urology (Yair Lotan).
• 7 Antibiotic prophylaxis in urological surgery (Philipp Dahm, Ngoc-Bich Le and Susan F. Fesperman).
• 8 Venous thromboembolism: risks and prophylaxis in urological surgery (Melissa R. Kaufman and Roger R. Dmochowski).
• 9 Prophylaxis and treatment of urinary tract infections in adults (S.L. Matheson, Philip Masson, Angela C. Webster and Jonathan C. Craig).
• 10 Medical management of benign prostatic hyperplasia (John M. Hollingsworth, Elizabeth Soll and John T. Wei).
• 11 Surgical management of benign prostatic hyperplasia (Rustom P. Manecksha and John M. Fitzpatrick).
• 12 Treatment of chronic prostatitis/chronic pelvic pain syndrome (J. Curtis Nickel).
• 13 Treatment of interstitial cystitis: does anything work? (Ann Oldendorf and J. Quentin Clemens).
• 14 Treatment of premature ejaculation (Chris G. McMahon).
• 15 Management of erectile dysfunction (Mathew D. Sorensen and Hunter Wessells).
• 16 Male infertility (Ashok Agarwal, Fnu Deepinder and Edmund S. Sabanegh Jr).
• 17 Genitourinary trauma (Bryan B. Voelzke and Jack W. McAninch).
• 18 Urethral stricture disease (Bahaa S. Malaeb and Sean P. Elliott).
• 19 Antimuscarinic treatments in overactive bladder (Christopher R. Chapple, Dominic Muston and Zoe S. Kopp).
• 20 Medical management of urinary incontinence in women (Ryan Hutchinson, Roger R. Dmochowski and Harriette Scarpero).
• 21 Surgical treatment of female urinary incontinence (Alexander Gomelsky and Roger R. Dmochowski).
• 22 Medical management of stone disease (Timothy Y. Tseng and Glenn M. Preminger).
• 23 Surgical management of renal stone disease (Adam C. Mues, Bodo E. Knudsen and Benjamin K. Canales).
• 24 Surgical management of ureteral stone disease (Jay D. Raman and Margaret S. Pearle).
• 25 Chemoprevention of prostate cancer (Amanda Beth Reed, Kristin C. Reed and Dipen J. Parekh).
• 26 Early detection and screening for prostate cancer (Pim J. van Leeuwen, Monique J. Roobol and Fritz H. Schröder).
• 27 Surgical management of clinically localized prostate cancer (Daniel A. Barocas and Michael S. Cookson).
• 28 Surgical treatment options for locally advanced prostate cancer (Lawrence L. Yeung and Charles J. Rosser).
• 29 Radiation therapy for clinically localized prostate cancer (Michael Myers, Priya Mitra, Mitchell Anscher, Anthony Addesa and Michael Hagan).
• 30 Metastatic prostate cancer (Mike D. Shelley and Malcolm D. Mason).
• 31 Treatment of superficial bladder cancer (Alexander Karl and Badrinath R. Konety).
• 32 Treatment of muscle-invasive bladder cancer (James Thomasch and Sam S. Chang).
• 33 Metastatic bladder cancer (Mike D. Shelley and Malcolm D. Mason).
• 34 Treatment of localized kidney cancer (Frédéric Pouliot, Jeffrey C. LaRochelle and Allan J. Pantuck).
• 35 Treatment of metastatic kidney cancer (Przemyslaw W. Twardowski and Robert A. Figlin).
• 36 Seminoma (Mark Shaw, Peter Chung and Padraig Warde).
• 37 Nonseminomatous germ cell tumor (Alana M. Murphy and James M. McKiernan).
• 38 Pediatric urinary tract infections (Regina D. Norris and John S. Wiener).
• 39 Treatment of nocturnal enuresis (Alexander Gomelsky).
• 40 Treatment of Wilms' tumor (Puneeta Ramachandra and Fernando Ferrer).
• Index.

About the Author

• Philipp Dahm, MD, MHSc, FACS, Associate Professor, Department of Urology, University of Florida.
• Roger R. Dmochowski, MD, MHSc, FACS, Professor of Urology, Department of Urology, Vanderbilt University.

Product Details

• Hardcover: 432 pages
• Publisher: BMJ Books; 1 edition (July 21, 2010)
• Language: English
• ISBN-10: 1405185945
• ISBN-13: 978-1405185943
• Product Dimensions: 11 x 8.9 x 1.3 inches

List Price: $179.95 

 

Hansen: Handbook of Evidence-Based Radiation Oncology 2nd Edition

Building on the success of this book's first edition, Dr. Eric Hansen and Dr. Mack Roach have updated, revised, and expanded the Handbook of Evidence-based Radiation Oncology, a portable reference that utilizes evidence-based medicine as the basis for practical treatment recommendations and guidelines. Organized by body site, concise clinical chapters provide easy access to critical information. Important "pearls" of epidemiology, anatomy, pathology, and clinical presentation are highlighted.

Key facets of the work-up are listed, followed by staging and/or risk classification systems. Treatment recommendations are discussed based on stage, histology, and/or risk classification. Brief summaries of key trials and studies provide rationale for the recommendations. Practical guidelines for radiation techniques are described. Finally, complications and follow-up guidelines are outlined. Updates from the first edition include brand new color figures and color contouring mini-atlases for head and neck, gastrointestinal, prostate, and gynecological tumors; redesigned tables for increased readibility; new chapters on managment of the neck and unknown primary, clinical radiobiology, and pediatric malignancies and benign conditions; and new appendices including the American College of Radiology guidelines for administration of IV contrast.

Key Features

• Practical and portable reference on radiation oncology that contains essential information on cancer management for all anatomic sites.
• Easy-to-read tables present the most current staging and risk classification systems, including those from the AJCC Cancer Staging Manual, 7th edition (2010).
• Summarizes the most important studies and trials from the medical literature that form the basis of evidence-based treatment recommendations.

Contents 
I. Skin

• 1 Skin Cancer 

II. Central Nervous System

• 2 Central Nervous System

III. Head and Neck

• 3 Malignant and Benign Diseases of the Eye and Orbit
• 4 Cancer of the Ear
• 5 Nasopharyngeal Cancer
• 6 Nasal Cavity and Paranasal Sinus Cancer
• 7 Oropharyngeal Cancer
• 8 Cancer of the Lip and Oral Cavity
• 9 Larynx and Hypopharynx Cancer
• 10 Salivary Gland Tumors
• 11 Thyroid Cancer
• 12 Unusual Neoplasms of the Head and Neck
• 13 Management of the Neck and Unknown Primary of the Head and Neck

IV. Thorax

• 14 Small Cell Lung Cancer
• 15 Non-small Cell Lung Cancer
• 16 Mesothelioma and Thymic Tumors

V. Breast

• 17 Breast Cancer

VI. Digestive System

• 18 Esophageal Cancer
• 19 Gastric Cancer
• 20 Pancreatic Cancer
• 21 Hepatobiliary Cancer
• 22 Colorectal Cancer
• 23 Anal Cancer

VII. Genitourinary Sites

• 24 Renal Cell Carcinom
• 25 Bladder Cancer
• 26 Prostate Cancer
• 27 Cancer of the Penis
• 28 Testicular Cancer

VIII. Gynecologic Sites

• 29 Cervical Cancer
• 30 Endometrial Cancer
• 31 Ovarian Cancer
• 32 Vaginal Cancer
• 33 Vulvar Cancer
• 34 Urethral Cancer

IX. Lymphomas and Myeloma

• 35 Hodgkin’s Lymphoma
• 36 Non-Hodgkin’s Lymphoma
• 37 Cutaneous Lymphomas
• 38 Multiple Myeloma and Plasmacytoma

X. Musculoskeletal Sites

• 39 Bone Tumors
• 40 Soft-Tissue Sarcoma

XI. Pediatric (Non-CNS)

• 41 Pediatric (Non-CNS) Tumors

XII. Palliation

• 42 Palliation and Benign Conditions
• 43 Clinical Radiobiology and Physics

Appendices

• A Performance Status Scales
• B Commonly Prescribed Drugs
• C Intravascular Contrast Safety

Abbreviations
Index

Product Details 

• Paperback: 786 pages
• Publisher: Springer; 2nd edition (July 6, 2010)
• Language: English
• ISBN-10: 0387929878
• ISBN-13: 978-0387929873
• Product Dimensions: 7.9 x 5 x 1.5 inches 

List Price: $69.95 

 

Dans: Painless Evidence-Based Medicine

No clinician would consider entering clinical practice without knowing the rudiments of history-taking and physical examination. Nor would clinicians consider independent practice without a basic understanding of how the drugs they prescribe act on their patients. Yet, traditionally, clinicians have started practice without an ability to understand evidence about how they should interpret what they find on history and physical examination, or the magnitude of the effects they might expect when they offer patients medication.

Evidence-based medicine (EBM) provides a remedy for this problem. The movement to teach clinicians to become effective users of medical literature began in the 1970s and evolved through the 1980s into a whole system for the delivery of clinical care. We needed a name for this new way of practice and the term ‘evidence-based medicine’, which first appeared in the medical literature in 1991[1], proved extremely popular. Over the subsequent 16 years evidence-based medicine has evolved and now represents not only an approach to using the medical literature effectively, but a principled guide for the process of clinical decision-making.

Members of the general public are surprised, and often appalled, when they learn that most physicians remain unable to critically read an original research article or fully understand the results reported there. For the physician, inability to critically appraise a research study and grasp all that is implied in its findings limits their independence. The result is reliance on expert opinion, the practices of colleagues and on information from the pharmaceutical industry. But what is one to do if experts and colleagues disagree, or if one is mistrustful of the enthusiastic advice from a pharmaceutical industry representative?

This book represents the key to a world that provides the answer to that question, a world that has traditionally been closed to most practising physicians: the world of original medical literature. Opening the door to this world is enormously empowering. No longer must one choose what to believe on the basis of which recommendation is backed by the most authority, or speaks with the loudest voice. The ability to differentiate high from low quality evidence and large treatment effects from small allows clinicians to make independent judgements about what is best for their patients. It also allows them to explain the impact of alternatives to the patients themselves, and thus to ensure that choices are consistent with patients’ underlying values and preferences.

Ten years ago, experts and the official voices of the organizations to which they belonged consistently recommended longterm hormone replacement therapy (HRT) for post-menopausal women. These recommendations were made largely on the basis of observational studies suggesting that women taking HRT could expect large reductions to their risk of major cardiovascular events. Proponents of evidence-based medicine raised concerns about the wisdom of this strong advocacy of therapy for huge populations on the basis of the fundamentally weak methods of observational studies. Their voices were largely ignored, until randomized trials demonstrated that the results of the observational studies were incorrect. If HRT has any impact on cardiovascular disease at all, it is to increase its frequency.

Many clinical communities now endorse widespread population screening to prevent the occurrence of cancer and cardiovascular disease. Breast cancer screening for women as young as 40 years, colon cancer screening for entire populations and treatment to improve lipid profiles even in very low risk patients are widely advocated. Many clinicians are unaware that to prolong a single life, hundreds of individuals must be screened for breast or colon cancer or treated with lipid profile-modifying agents for periods of up to a decade. The costs include anxiety as a result of the many false positive results, complications of invasive procedures such as lumpectomy or colonoscopy, side effects of treatment (including deaths as a result of a lipidlowering agent now withdrawn from the market) and resource investment that, at least for some individuals, might be better allocated elsewhere. The point is not that the experts were uniformly wrong in suggesting that women consider HRT, nor that screening or treatment of low-risk individuals to modify their cancer or coronary risk is wrong. Rather, it is that clinicians should be aware there are important trade-offs in these decisions.

If clinicians don’t know the difference between an observational study and a randomized trial, or between a relative risk reduction and a risk difference, they are in no position to understand these trade-offs. If they are unable to understand the trade-offs, it is not possible for them to convey the possible benefits and risks to their patients, many of whom may, with a full understanding, decline screening or treatment.
This book provides the basic tools for the clinician to evaluate the strength of original studies, to understand their results and to apply those results in day-to-day clinical practice. I am delighted to inform the reader that its editors are not only brilliant teachers who have created a wonderful introductory text, but wonderful human beings. I met Tony and Inday Dans just about the time that our McMaster group was realizing that what we had been calling ‘critical appraisal’ had evolved into a systematic approach to medical practice, a system of thinking about clinical care and clinical decision-making.

Inday and Tony had come to McMaster to train in clinical epidemiology – the science that underlies evidence-based medicine. I had the great pleasure of working with both these brilliant, enthusiastic and critical young people. I was extremely fortunate that Tony chose me as one of his supervisors, and as a result we had the opportunity to work particularly closely together. It was not long before I discovered that I had the privilege of interacting with an extraordinary individual, exceptional even among the lively, intelligent, dedicated students who populated our Masters program. Tony was far more questioning than most students, and possessed a far deeper and more intense social conscience. To me, these qualities were very striking.

Since their days at McMaster, Inday and Tony have continued to demonstrate their high intelligence, tremendous initiative, extraordinary ability to question and explore issues at the deepest level and their unusual and extremely admirable social conscience. Having a social conscience leads you to challenge existing power structures and vested interests. Doing so requires more than conscience: it requires courage. I have had the good fortune and great pleasure to interact with Inday and Tony in a variety of settings at quite regular intervals, and have as a result seen first-hand how their courage has led them to repeatedly challenge authority and power, acting in the interests of the Philippine people. To use the adjective preferred by young Canadians nowadays, their performance has been consistently awesome.

I will add one final anecdote about what makes Tony and Inday so special. Each year, we conduct a ‘how to teach evidencebased medicine’ workshop at McMaster. In the last few years, Tony and Inday have participated in the workshop in the role of tutor trainees. Almost all participants in the workshop feel they learn a great deal, and take elements of what they have discovered back to their own teaching settings. But very few, and extremely few among the very experienced, make major innovations in their teaching as a result. Despite having run literally dozens of extremely successful workshops in the Philippines prior to their participation in the McMaster workshop, Inday and Tony took the key elements of the McMaster strategy and revamped their approach to their own workshops. The result has been a spectacular success, with Philippine participants reporting profoundly positive educational experiences. In the two decades in which I have participated in our workshop, I’ve never seen anyone make as good use of their experience with us. The message about Tony and Inday: a tremendous openness and ability to integrate what they’ve learned and apply in imaginative and perspicacious ways in their own setting.

One fortunate consequence of Inday and Tony’s brilliant teaching – which makes the presentation of this book so vividly clear – is that it inspires others. About ten years ago Mianne Silvestre, a neonatologist, attended one of the Dans’ workshops and emerged as an EBM enthusiast. She took on a teaching role and emerged as one of the most effective EBM facilitators in the Philippines. Her insights and experience have also contributed to the lucid presentations in this text.

We shall now take advantage of Inday, Tony and Mianne’s enormous experience of EBM and their imagination and brilliant teaching abilities in this wonderful book. The title ‘Painless EBM’ captures the essence of their work. They have presented challenging concepts in simple, clear and extremely appealing ways which make learning EBM painless and enjoyable. They have emphasized the last of the three pillars of the EBM approach: while the book tells you about validity and understanding the results, the focus is on applicability. What is the meaning of the evidence? How can you apply it in your own setting? How can you apply the evidence to patients with very different circumstances and varying values and preferences?

Increasingly, applying the literature to clinical practice does not mean a detailed reading of a large number of original studies. Rather, the clinician can recognize valid pre-appraised resources and differentiate them from poorly substantiated opinion. The book provides guides for assessing not only original studies of diagnosis and therapy, but also systematic reviews which summarize a number of such original studies. The ability to differentiate strong from weak literature reviews and to understand summaries of the magnitude of treatment effects is crucial for efficient evidence-based practice.

When a new pivotal study comes to light, evidence-based clinicians do not need to read it in detail to evaluate its significance or to decide how to use its results. Imagine that I am telling you about a recently conducted study reporting an apparently important treatment effect. I tell you: that the study was a randomized trial and that randomization was adequately concealed; that patients, caregivers and those collecting and adjudicating outcome data were blind to whether patients received treatment or control interventions; that investigators successfully followed all patients who were randomized; and that, in the analysis, all patients were included in the groups to which they were randomized.

Assuming that I am skilled in making these judgements, and am telling you the truth, you have all the information you need to judge the validity of the study. If I then provide you with a few crucial details of who was enrolled, how the interventions were administered and the magnitude and precision of estimates of the impact of the intervention on all patient-relevant outcomes, you have everything you need to apply the results in clinical practice.

Synopses of individual studies which provide the crucial information needed to understand the appropriate strength of inference to apply the results are increasingly available, as are systematic reviews and, to a lesser extent, high quality evidence based practice guidelines. Entire systems of knowledge based on evidence-based principles and textbooks of evidence-based medicine are beginning to arrive. The innovative electronic text UpToDate is an example of a resource that strives to be fully evidence-based and to provide guidance for most dilemmas that clinicians face in practice; UpToDate is effective in meeting both these aims.

When you, as a clinician, have read and digested the current text, you will have the tools to read and interpret synopses and systematic reviews and will be able to find such pearls in the rocky landscape of the current medical literature. In this text you will find case studies and examples directly relevant to your area of clinical practice. More importantly, you will find true to life examples of how to address the daily patient dilemmas you face more effectively. You will find clinical practice more satisfying and, most important, you will be more confident in providing your patients with optimal medical care. Finally, if you are interested in a deeper understanding of EBM, this book provides a stepping stone to a more comprehensive text that can provide knowledge and skills required for not only the practice, but also the teaching of EBM.

It has been my privilege and joy to reflect on EBM in the context of this wonderful book, prepared by two of my dear friends and their outstanding colleague.
- Gordon Guyatt, MD -

Key Features

• Offers a simplified approach to the complex or technical subject of evidence-based medicine, in terms of presentation as well as content.
• Is truly designed for the world market place.
• Breaks the subject into succinct chapters, each chapter being a self sufficient introduction to the topic.
• Includes pre-tested ‘tackle boxes’ throughout to help readers understand the issues.

Contents

• 1 Introduction
• 2 Evaluation of Articles on Therapy
• 3 Evaluation of Articles on Diagnosis
• 4 Evaluation of Articles on Harm
• 5 Evaluation of Articles on Prognosis
• 6 Evaluation of Systematic Reviews
• 7 Literature Searches
• Index

Book Details 
 

• Paperback: 160 pages
• Publisher: Wiley; 1 edition (August 26, 2008)
• Language: English
• ISBN-10: 0470519398
• ISBN-13: 978-0470519394
• Product Dimensions: 7.7 x 5 x 0.4 inches

List Price: $45.00 
 

JAMA: Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice 2nd Edition

The #1 guide to the principles and clinical applications of evidence-based medicine has just gotten better! 

No other resource helps you to put key evidence-based medicine protocols into daily clinical practice better than Users' Guides to the Medical Literature.

An instant classic in its first edition, this detailed, yet highly readable reference demystifies the statistical, analytical, and clinical principles of evidence-based medicine, giving you a hands-on, practical resource that no other text can match.

Here, you'll learn how to distinguish solid medical evidence from poor medical evidence, devise the best search strategies for each clinical question, critically appraise the medical literature, and optimally tailor evidence-based medicine for each patient. The new second edition of this landmark resource is now completely revised and refreshed throughout, with expanded coverage of both basic and advanced issues in using evidence-based medicine in clinical practice.

Key Features

• Completely revised and updated to reflect the enormous expansion in medical research and evidence-based resources since the first edition.
• Innovative organization guides you from the fundamentals of using the medical literature to the more advanced strategies and skills for use in every day patient care situations.
• Abundant and current real-world examples drawn from the medical literature are woven throughout, and include important related principles and pitfalls in using medical literature in patient care decisions.
• Practical focus on the key issues in evidence-based practice: 
• What are the results? 
• Are the results valid? 
• How to I apply to results to the care of my patients?
• More than 60 internationally recognized editors and contributors from the U.S., Canada, South America, Europe, and Asia -- the best of the best in the discipline.
• NEW coverage on how to:
• Avoid being misled by biased presentations of research findings
• Interpret the significance of clinical trials that are discontinued early
• Influence clinician behavior to improve patient care
• Apply key strategies for teaching evidence-based medicine
• Also look for JAMAevidence.com, a new interactive database for the best practice of evidence based medicine.

Contents

Part A. The Foundations

• 1. How to Use the Medical Literature—and This Book—to Improve Your Patient Care
• 2. The Philosophy of Evidence-Based Medicine
• 3. What Is the Question?
• 4. Finding the Evidence
• 5. Why Study Results Mislead: Bias and Random Error

Part B. Therapy

• 6. Therapy (Randomized Trials)
• 7. Does Treatment Lower Risk? Understanding the Results
• 8. Confidence Intervals
• 9. Advanced Topics in the Validity of Therapy Trials
• 9.1 An Illustration of Bias and Random Error
• 9.2 Surprising Results of Randomized Trials
• 9.3 Randomized Trials Stopped Early for Benefit
• 9.4 The Principle of Intention to Treat
• 9.5 N-of-1 Randomized Controlled Trials
• 9.6 Clinical Decision Support Systems
• 10. Advanced Topics in the Results of Therapy Trials
• 10.1 Hypothesis Testing
• 10.2 Understanding the Results: More About Odds Ratios
• 10.3 What Determines the Width of the Confidence Interval?
• 10.4 Composite endpoints
• 10.5 Measuring Patients’ Experience
• 11. Advanced Topics in Applying the Results of Therapy Trials
• 11.1 Applying Results to Individual Patients
• 11.2 Example Numbers Needed to Treat
• 11.3 Dealing with Misleading Presentations of Clinical Trial Results
• 11.4 Surrogate Outcomes
• 11.5 Qualitative Research

Part C. Harm (Observational Studies)

• 12. Harm (Observational Studies)
• 13. Advanced Topics in Harm: Correlation and Regression

Part D. Diagnosis

• 14. The Process of Diagnosis
• 15. Differential Diagnosis
• 16. Diagnostic Tests
• 17. Advanced Topics in Diagnosis
• 17.1 Spectrum Bias
• 17.2 Examples of Likelihood Ratios
• 17.3 Measuring Agreement Beyond Chance
• 17.4 Clinical Prediction Rules

Part E. Prognosis

• 18. Prognosis

Part F. Summarizing the Evidence

• 19. Summarizing the Evidence
• 20. Advanced Topics in Systematic Reviews
• 20.1 Reporting Bias
• 20.2 Fixed-Effects and Random-Effects Models
• 20.3 Making Sense of Variability in Study Results
• 20.4 When to Believe a Subgroup Analysis

Part G. Moving From Evidence to Action

• 21. How to Use a Patient Management Recommendation
• 22. Advanced Topics in Moving from Evidence to Action
• 22.1 Economic Analysis
• 22.2 Decision Making and the Patient
• 22.3 Moving From Evidence to Action: Recommendations About Screening
• 22.4 Grading Recommendations
• 22.5 Drug Class Effects
• 22.6 Parallel but Separate Goals: Evidence-Based Practitioners and Evidence-Based Care
• 22.7 Changing Behavior to Apply Best Evidence in Practice
• 22.8 Teachers’ Guides to the Users' Guides

Glossary

Index

About the Authors

• Gordon Guyatt, MD, MSc, Departments of Clinical Epidemiology and Biostatistics and Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario.
• Drummond Rennie, MD, JAMA, Chicago, IL, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
• Maureen O. Meade, MD, FRCPC, MSc, Departments of Medicine and Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario.
• Deborah J. Cook, MD, MSc, Department of Medicine and Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario.

Product Details

• Paperback: 860 pages
• Publisher: McGraw-Hill Professional; 2 edition (May 21, 2008)
• Language: English
• ISBN-10: 007159034X
• ISBN-13: 978-0071590341
• Product Dimensions: 8.8 x 5.9 x 1.3 inches

List Price: $67.95