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Rational Medical Decision Making


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Table of Contents

1"A History Lesson" To provide a historical perspective on the development of original medical literature as we know it today. *History of first medical papers *History of The Lancet *How and why the medical literature has grown 2"Searching for the Right Stuff" To provide skills in searching electronic databases and other resources for the best available evidence. *Organization of Medline *Searching Medline *Accessing and searching evidence-based medicine databases *Searching the Internet for the best available evidence 3"Anatomy of a Research Article" To provide an overview of the structure of most original medical research articles and to describe the process through which articles are published *Basic structure of research articles and the purpose of each component *Principles of peer review, editorial freedom and author confidentiality *Types of research articles and journalsThree 4A Statistics Primer To provide an overview of essential descriptive & comparative statistics for practicing physicians *Basic, descriptive statistics *Normal and other distributions *Samples & populations *Principles of comparative statistics *Principles underlying all tests of significance 5Diagnostic Reasoning To provide an overview of how doctors think about diagnosis, how diagnostic tests are developed and evaluated, and how studies about diagnostic tests should be evaluated *Psychology of medical diagnosis *Developing and assessing a new diagnostic test *Tools for evaluating diagnostic tests (sensitivity, specificity, predictive values, likelihood ratios, Bayes Theorem, ROC curves) 6Studying Therapies To provide an overview of how new therapies are evaluated (including different research designs and summary and analysis of results) *Elements of "sound" clinical questions *Research designs used to evaluate new therapies (including Bayesian designs) *Analysis of results of new therapies (p values, confidence intervals, etc.) 7Risk & Prognosis To provide an overview of how doctors and patients think about risk and prognosis and how risk and prognosis are systematically evaluated *Measures of risk *Study designs used to assess risk *Patient preferences with respect to risk *Measures of prognosis (i.e. survival curves, etc.) 8Systematic Reviews To provide an overview of the principal characteristics and usefulness of qualitative and quantitative (meta-analyses) systematic reviews. *Definitions of qualitative & quantitative systematic reviews *The Cochrane Collaboration *Principles of meta-analyses *Interpretation of systematic reviews 9Decision Analysis To provide a basic overview of the design and interpretation of decision analyses *Definition and purpose of decision analysis *Interpretation of decision analyses 10Clinical Practice Guidelines To provide an overview of the purpose, development and use of clinical practice guidelines *Definition and purpose of clinical practice guidelines *Steps in development of "sound" clinical practice guidelines *Use of guidelines to aid in patient care decisions 11Qualitative Research To provide an overview of qualitative methods to address questions of importance to physicians and patients *Definition of qualitative research *Summary of qualitative research methods *How to use qualitative research in patient care decisions Appendix *Answers to problems *Glossary of terms Estimate of total number of pages excluding index: 220

About the Author

Goutham Rao, MD Associate Professor Department of Pediatrics Assistant Professor, Department of Family Medicine University of Pittsburgh School of Medicine Dr. Rao teaches the first year course Introduction to Medical Decision Making, from which this text is drawn. He is Director of Predoctoral Education, and Director of Medical Information Technology, at St Margaret's Hospital, in addition to being on faculty at the University of Pittsburgh School of Medicine. He is also Director of the Family Medicine Yr 3 Clerkship. He is Associate Editor of ACP's Journal Club journal, and serves on the Home Study Committee for the American Academy of Family Practice.

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