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Medical Decision Making
368
by Harold C. Sox, Michael C. Higgins, Douglas K. Owens, Gillian Sanders Schmidler
Harold C. Sox
![Medical Decision Making](http://img.images-bn.com/static/redesign/srcs/images/grey-box.png?v11.8.5)
Medical Decision Making
368
by Harold C. Sox, Michael C. Higgins, Douglas K. Owens, Gillian Sanders Schmidler
Harold C. Sox
eBook
$43.00
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Overview
Immediately upon initial publication, Medical Decision Making became the worldwide standard introductory textbook in the field. Written to meet the needs of medical students and experienced clinicians alike, Medical Decision Making is a clearly presented, step-by-step guide to understanding how, through the processes of decision analysis, a physician can reach valid, reasoned conclusions about medical treatment despite imperfect information about the patient. The focus of Medical Decision Making is on estimating probability, measuring the accuracy of clinical data, interpreting new information, and making decisions. It presents a framework for answering the following basic questions. Should the patient be treated immediately? Should more information be obtained? Should nothing be done at present? The authors use many clinical examples to illustrate Bayesian analysis, formal decision analysis, and basic concepts of evaluating the usefulness of diagnostic tests in various situations. The text is supplemented with many illustrations, useful end-of-chapter self-assessment questions, and an appendix giving the sensitivity and specificity of nearly 100 diagnostic tests.
Product Details
ISBN-13: | 9781119627722 |
---|---|
Publisher: | Wiley |
Publication date: | 02/05/2024 |
Sold by: | JOHN WILEY & SONS |
Format: | eBook |
Pages: | 368 |
File size: | 18 MB |
Note: | This product may take a few minutes to download. |
About the Author
Harold C. Sox is Emeritus Professor of Medicine and of the Dartmouth Institute at Geisel School of Medicine at Dartmouth, USA.
Michael C. Higgins is Adjunct Professor at the Stanford Center for Biomedical Informatics Research, Stanford University, USA.
Douglas K. Owens is a general internist and Professor and Chair of the Department of Health Policy, School of Medicine, and Director of Stanford Health Policy, Freeman-Spogli Institute for International Studies, Stanford University, USA.
Gillian Sanders Schmidler is Professor of Population Health Sciences and Medicine at Duke University and Deputy Director of the Duke-Margolis Institute for Health Policy, Durham, USA.
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Table of Contents
Preface to the ACP Reprint VII
Preface to the 1988 First Edition IX
Introduction 1
How May I Be Thorough Yet Efficient When Considering the Possible Causes of My Patient's Problems? 1
How Do I Characterize the Information I Have Gathered during the Medical Interview and Physical Examination? 1
How Do I Interpret New Diagnostic Information? 5
How Do I Select the Appropriate Diagnostic Test? 6
How Do I Choose among Several Risky Treatment Alternatives? 6
Summary 7
Differential Diagnosis 9
Introduction 9
Learning from Observations of Skilled Clinicians 10
The Process of Differential Diagnosis 12
An Extended Example 22
Summary 25
References 26
Probability: Quantifying Uncertainty 27
Uncertainty and Probability in Medicine 27
Use of Persona! Experience to Estimate Probability 34
Use of Published Experience to Estimate Probability 52
Consideration of the Special Characteristics of the Patient When Estimating Probability 60
Summary 61
Problems 62
New Words in thisChapter 64
References 64
Understanding New Information: Bayes' Theorem 67
Introduction 67
Conditional Probability Defined 71
Bayes' Theorem 71
The Odds Ratio Form of Bayes' Theorem 75
Alternative Forms of Bayes' Theorem: The Tree and the 2 X 2 Table 80
Lessons to Be Learned from Bayes' Theorem 84
The Assumption of Bayes' Theorem 91
Interpreting a Sequence of Tests 93
Using Bayes' Theorem When Many Diseases Are Under Consideration 97
Summary 98
Problems 99
New Words in this Chapter 100
References 100
Measuring the Accuracy of Clinical Data 103
How Test Results Can Be Expressed as "Abnormal" and "Normal" 103
Measures of How Well a Test Discriminates between a Disease and All Other Conditions 106
How Test Performance Is Measured: A Hypothetical Case 113
Pitfalls of Predictive Value 115
Why Measures of Test Performance May Not Apply to Your Patient 116
Combining Data from Several Studies 128
Expressing Test Results as Continuous Variables 129
Summary 138
Problems 139
New Words in this Chapter 140
References 141
Derivation of the Method for Using the ROC Curve to Choose the Definition of an Abnormal Test Result 142
Expected Value Decision Making 147
Basic Concepts of Expected Value Decision Making 148
Decision Analysis: An Introductory Example 151
Summary 165
Problem 166
New Words in this Chapter 166
Measuring the Outcome of Care 167
Measuring the Patient's Preferences: Utility Assessment 168
Estimating the Expected Length of Life 182
Measuring How Well the Patient Is Able to Function 194
Satisfaction with One's State of Health 196
Using a Linear Scale to Express Strength of Preference 196
Summary 197
Problems 198
New Words in this Chapter 199
References 199
Axioms of Utility Theory 200
Decision Making When the Outcomes Have Several Dimensions 201
Assessing the Patient's Preferences for Outcomes with Several Dimensions 202
Measuring the Patient's Utility for a Period of Time in III Health: An Introduction 206
Assessing Preferences for the Length of Life 208
The Time Trade-Off Method 216
Measuring Preferences for Any Period of Time in III Health 220
Another Method for Adjusting Life Expectancy for the Quality of Life 225
Sources of Error in Utility Assessment 230
Last Words 232
Summary 232
New Words in this Chapter 233
Problems 233
References 236
Selection and Interpretation of Diagnostic Tests 239
Taking Action When the Consequences Are Uncertain: Principles and Definitions 239
Could a Diagnostic Test Change the Treatment of the Patient? 243
The Treatment Threshold Probability 246
The Decision to Obtain a Diagnostic Test 249
Setting the Treatment Threshold Probability 257
Taking Account of the Costs and Risks of the Test 270
A Clinical Case: Test Selection for Suspected Brain Tumor 274
Sensitivity Analysis 277
Choosing among Diagnostic Tests 280
Choosing the Best Combination of Diagnostic Tests 283
Summary 285
New Words in this Chapter 289
References 289
Bedside Decision Analysis 291
A Difficult Clinical Problem: Bleeding Esophageal Varices 291
Sensitivity Analysis 301
A Decision Problem in Which Three-Way Sensitivity Analysis Was Useful 309
Conclusions 314
References 315
Cost-Effectiveness Analysis and Cost-Benefit Analysis 317
The Physician's Conflicting Roles: Patient Advocate, Member of Society, and Entrepreneur 317
Cost-Effectiveness Analysis: A Method for Comparing Management Strategies 319
Cost-Benefit Analysis: A Method for Measuring the Net Benefit of Medical Policies 328
Measuring the Costs of Medical Care 331
Summary 333
New Words in this Chapter 334
Problem 334
References 335
Test Characteristics 337
Life Table 373
Glossary 379
Answers to Problems 383
Index 399
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