Medical Decision Making

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  • Edition: 1st
  • Format: Paperback
  • Copyright: 2006-09-01

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Supplemental Materials

What is included with this book?


Reprint focuses on estimating probability, measuring accuracy of clinical data, interpreting new information, and making decisions. Topics include differential diagnosis, uncertainty and probability in medicine, basic concepts of expected value decision making, and more. For students. Previous edition published by Butterworth Heinemann, c1988. Softcover.

Table of Contents

Preface to the ACP Reprintp. VII
Preface to the 1988 First Editionp. IX
Introductionp. 1
How May I Be Thorough Yet Efficient When Considering the Possible Causes of My Patient's Problems?p. 1
How Do I Characterize the Information I Have Gathered during the Medical Interview and Physical Examination?p. 1
How Do I Interpret New Diagnostic Information?p. 5
How Do I Select the Appropriate Diagnostic Test?p. 6
How Do I Choose among Several Risky Treatment Alternatives?p. 6
Summaryp. 7
Differential Diagnosisp. 9
Introductionp. 9
Learning from Observations of Skilled Cliniciansp. 10
The Process of Differential Diagnosisp. 12
An Extended Examplep. 22
Summaryp. 25
Referencesp. 26
Probability: Quantifying Uncertaintyp. 27
Uncertainty and Probability in Medicinep. 27
Use of Persona! Experience to Estimate Probabilityp. 34
Use of Published Experience to Estimate Probabilityp. 52
Consideration of the Special Characteristics of the Patient When Estimating Probabilityp. 60
Summaryp. 61
Problemsp. 62
New Words in this Chapterp. 64
Referencesp. 64
Understanding New Information: Bayes' Theoremp. 67
Introductionp. 67
Conditional Probability Definedp. 71
Bayes' Theoremp. 71
The Odds Ratio Form of Bayes' Theoremp. 75
Alternative Forms of Bayes' Theorem: The Tree and the 2 X 2 Tablep. 80
Lessons to Be Learned from Bayes' Theoremp. 84
The Assumption of Bayes' Theoremp. 91
Interpreting a Sequence of Testsp. 93
Using Bayes' Theorem When Many Diseases Are Under Considerationp. 97
Summaryp. 98
Problemsp. 99
New Words in this Chapterp. 100
Referencesp. 100
Measuring the Accuracy of Clinical Datap. 103
How Test Results Can Be Expressed as "Abnormal" and "Normal"p. 103
Measures of How Well a Test Discriminates between a Disease and All Other Conditionsp. 106
How Test Performance Is Measured: A Hypothetical Casep. 113
Pitfalls of Predictive Valuep. 115
Why Measures of Test Performance May Not Apply to Your Patientp. 116
Combining Data from Several Studiesp. 128
Expressing Test Results as Continuous Variablesp. 129
Summaryp. 138
Problemsp. 139
New Words in this Chapterp. 140
Referencesp. 141
Derivation of the Method for Using the ROC Curve to Choose the Definition of an Abnormal Test Resultp. 142
Expected Value Decision Makingp. 147
Basic Concepts of Expected Value Decision Makingp. 148
Decision Analysis: An Introductory Examplep. 151
Summaryp. 165
Problemp. 166
New Words in this Chapterp. 166
Measuring the Outcome of Carep. 167
Measuring the Patient's Preferences: Utility Assessmentp. 168
Estimating the Expected Length of Lifep. 182
Measuring How Well the Patient Is Able to Functionp. 194
Satisfaction with One's State of Healthp. 196
Using a Linear Scale to Express Strength of Preferencep. 196
Summaryp. 197
Problemsp. 198
New Words in this Chapterp. 199
Referencesp. 199
Axioms of Utility Theoryp. 200
Decision Making When the Outcomes Have Several Dimensionsp. 201
Assessing the Patient's Preferences for Outcomes with Several Dimensionsp. 202
Measuring the Patient's Utility for a Period of Time in III Health: An Introductionp. 206
Assessing Preferences for the Length of Lifep. 208
The Time Trade-Off Methodp. 216
Measuring Preferences for Any Period of Time in III Healthp. 220
Another Method for Adjusting Life Expectancy for the Quality of Lifep. 225
Sources of Error in Utility Assessmentp. 230
Last Wordsp. 232
Summaryp. 232
New Words in this Chapterp. 233
Problemsp. 233
Referencesp. 236
Selection and Interpretation of Diagnostic Testsp. 239
Taking Action When the Consequences Are Uncertain: Principles and Definitionsp. 239
Could a Diagnostic Test Change the Treatment of the Patient?p. 243
The Treatment Threshold Probabilityp. 246
The Decision to Obtain a Diagnostic Testp. 249
Setting the Treatment Threshold Probabilityp. 257
Taking Account of the Costs and Risks of the Testp. 270
A Clinical Case: Test Selection for Suspected Brain Tumorp. 274
Sensitivity Analysisp. 277
Choosing among Diagnostic Testsp. 280
Choosing the Best Combination of Diagnostic Testsp. 283
Summaryp. 285
New Words in this Chapterp. 289
Referencesp. 289
Bedside Decision Analysisp. 291
A Difficult Clinical Problem: Bleeding Esophageal Varicesp. 291
Sensitivity Analysisp. 301
A Decision Problem in Which Three-Way Sensitivity Analysis Was Usefulp. 309
Conclusionsp. 314
Referencesp. 315
Cost-Effectiveness Analysis and Cost-Benefit Analysisp. 317
The Physician's Conflicting Roles: Patient Advocate, Member of Society, and Entrepreneurp. 317
Cost-Effectiveness Analysis: A Method for Comparing Management Strategiesp. 319
Cost-Benefit Analysis: A Method for Measuring the Net Benefit of Medical Policiesp. 328
Measuring the Costs of Medical Carep. 331
Summaryp. 333
New Words in this Chapterp. 334
Problemp. 334
Referencesp. 335
Test Characteristicsp. 337
Life Tablep. 373
Glossaryp. 379
Answers to Problemsp. 383
Indexp. 399
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