This book is intended to help decision-makers use, assess and appraise the evidence that underpins decisions about the use of therapeutic interventions. It will inform decision-makers about the nature of evidence, the strengths and weaknesses of the available approaches, and how these can be most effectively distilled for the purpose of reaching reliable conclusions. It aims to encourage decision-makers to base their judgements about the use of therapeutic interventions on an informed appraisal of the totality of the evidence base. Is it reliable? Is it generalisable beyond the context of the environment in which the primary research has been conducted? Do the intervention's benefits outweigh its harms? Is it cost effective as well as clinically effective? Is it, indeed, fit-for-purpose? Ultimately, good judgement is at the heart of decision-making in therapeutics. An invaluable text for all physicians, pharmacists, nurses, health commissioners and purchasers and indeed anyone having to make decisions concerning evidence-based therapeutics.
The annual National Institute for Clinical Excellence conference annually brings together a diverse group of people involved with healthcare, including clinicians, managers and patients: people who are responsible for raising clinical standards in the NHS and for implementing best practice. Innovation and excellence across the health service are again reflected throughout the 2005 edition of this book, highlighting the fresh thinking of health professionals who are at the front line in developing and delivering quality for patient care. This book will serve as a vital reference for all health professionals in raising standards nationally and locally, providing examples of best practice that are continually carried out throughout the NHS.
Variability in Human Drug Response examines why individual patients differ significantly in their response to drug administration. This book is devoted mainly to pharmacokinetics and covers topics such as drug absorption, distribution, metabolism, and excretion. The sensitivity of tissues of the body to drugs and the importance of monitoring drug therapy are also discussed. This book is comprised of 10 chapters and begins with an introduction to variability in clinical response to administration of defined drugs, as well as the importance of closely matching dosage to the individual patient's requirement to achieve an optimal response to drug administration. The chapters that follow highlight the pharmacokinetic origin of most variability in the clinical response to drugs, along with the difficulties inherent in predicting the effect of drug administration in an individual patient. The role of genetic and environmental factors, disease, and the concomitant administration of other drugs in determining an individual's response to any therapeutic maneuver is also examined. The last chapter describes two methods of monitoring drug therapy: monitoring drug effects or monitoring the plasma levels of drugs. This monograph will be of interest to practicing clinicians and senior medical students.
The annual National Institute for Clinical Excellence conference annually brings together a diverse group of people involved with healthcare, including clinicians, managers and patients: people who are responsible for raising clinical standards in the NHS and for implementing best practice. Innovation and excellence across the health service are again reflected throughout the 2005 edition of this book, highlighting the fresh thinking of health professionals who are at the front line in developing and delivering quality for patient care. This book will serve as a vital reference for all health professionals in raising standards nationally and locally, providing examples of best practice that are continually carried out throughout the NHS.
Decision making in health care involves consideration of a complex set of diagnostic, therapeutic and prognostic uncertainties. Medical therapies have side effects, surgical interventions may lead to complications, and diagnostic tests can produce misleading results. Furthermore, patient values and service costs must be considered. Decisions in clinical and health policy require careful weighing of risks and benefits and are commonly a trade-off of competing objectives: maximizing quality of life vs maximizing life expectancy vs minimizing the resources required. This text takes a proactive, systematic and rational approach to medical decision making. It covers decision trees, Bayesian revision, receiver operating characteristic curves, and cost-effectiveness analysis, as well as advanced topics such as Markov models, microsimulation, probabilistic sensitivity analysis and value of information analysis. It provides an essential resource for trainees and researchers involved in medical decision modelling, evidence-based medicine, clinical epidemiology, comparative effectiveness, public health, health economics, and health technology assessment.
This book is intended to help decision-makers use, assess and appraise the evidence that underpins decisions about the use of therapeutic interventions. It will inform decision-makers about the nature of evidence, the strengths and weaknesses of the available approaches, and how these can be most effectively distilled for the purpose of reaching reliable conclusions. It aims to encourage decision-makers to base their judgements about the use of therapeutic interventions on an informed appraisal of the totality of the evidence base. Is it reliable? Is it generalisable beyond the context of the environment in which the primary research has been conducted? Do the intervention's benefits outweigh its harms? Is it cost effective as well as clinically effective? Is it, indeed, fit-for-purpose? Ultimately, good judgement is at the heart of decision-making in therapeutics. An invaluable text for all physicians, pharmacists, nurses, health commissioners and purchasers and indeed anyone having to make decisions concerning evidence-based therapeutics.
Variability in Human Drug Response examines why individual patients differ significantly in their response to drug administration. This book is devoted mainly to pharmacokinetics and covers topics such as drug absorption, distribution, metabolism, and excretion. The sensitivity of tissues of the body to drugs and the importance of monitoring drug therapy are also discussed. This book is comprised of 10 chapters and begins with an introduction to variability in clinical response to administration of defined drugs, as well as the importance of closely matching dosage to the individual patient's requirement to achieve an optimal response to drug administration. The chapters that follow highlight the pharmacokinetic origin of most variability in the clinical response to drugs, along with the difficulties inherent in predicting the effect of drug administration in an individual patient. The role of genetic and environmental factors, disease, and the concomitant administration of other drugs in determining an individual's response to any therapeutic maneuver is also examined. The last chapter describes two methods of monitoring drug therapy: monitoring drug effects or monitoring the plasma levels of drugs. This monograph will be of interest to practicing clinicians and senior medical students.
This book is open access under a CC BY license. This book is the first to develop explicit methods for evaluating evidence of mechanisms in the field of medicine. It explains why it can be important to make this evidence explicit, and describes how to take such evidence into account in the evidence appraisal process. In addition, it develops procedures for seeking evidence of mechanisms, for evaluating evidence of mechanisms, and for combining this evaluation with evidence of association in order to yield an overall assessment of effectiveness. Evidence-based medicine seeks to achieve improved health outcomes by making evidence explicit and by developing explicit methods for evaluating it. To date, evidence-based medicine has largely focused on evidence of association produced by clinical studies. As such, it has tended to overlook evidence of pathophysiological mechanisms and evidence of the mechanisms of action of interventions. The book offers a useful guide for all those whose work involves evaluating evidence in the health sciences, including those who need to determine the effectiveness of health interventions and those who need to ascertain the effects of environmental exposures.
This collection profiles understudied figures in the book and print trades of the seventeenth century. With an equal balance between women and men, it intervenes in the history of the trades, emphasising the broad range of material, cultural, and ideological work these people undertook. It offers a biographical introduction to each figure, placing them in their social, professional, and institutional settings. The collection considers varied print trade roles including that of the printer, publisher, paper-maker, and bookseller, as well as several specific trade networks and numerous textual forms. The biographies draw on extensive new archival research, with details of key sources for further study on each figure. Chronologically organised, this Element offers a primer both on numerous individual figures, and on the tribulations and innovations of the print trade in the century of revolution.
In the first book to critically examine each of the fourteen feature films Sam Peckinpah directed during his career, Michael Bliss stresses the persistent moral and structural elements that permeate Peckinpah’s work. By examining the films in great detail, Bliss makes clear the moral framework of temptation and redemption with which Peckinpah was concerned while revealing the director’s attention to narrative. Bliss shows that each of Peckinpah’s protagonists is involved with attempting, in the words of Ride the High Country’s Steve Judd, "to enter my house justified." The validity of this systematic method is clearly demonstrated in the chapter devoted to The Wild Bunch. By enumerating the doublings and triplings of action and dialogue found in the film, Bliss underscores its symbolic and structural complexity. Beginning the chapters treating Junior Bonner and The Getaway with analyses of their important title sequences, Bliss shows how these frequently disregarded pieces present in miniature the major moral and narrative concerns of the films. In his chapter on The Osterman Weekend, Bliss makes apparent Peckinpahs awareness of and concern with the self-reflexive nature of filmmaking itself. Bliss shows that like John Ford, Peckinpah moved from optimism to pessimism. The films of the director’s early period, from The Deadly Companions to Cable Hogue, support the romantic ideals of adventure and camaraderie and affirm a potential for goodness in America. In his second group of films, which begins with Straw Dogs and ends with Bring Me the Head of Alfredo Garcia, both heroes and hope have vanished. It is only in The Osterman Weekend that Peckinpah appears finally to have renewed his capacity for hope, allowing his career to close in a positive way.
The definitive guide to the clinical and scientific aspects of pulmonary medicine―fully updated with the latest advances in the field A Doody's Core Title for 2023! Fishman’s Pulmonary Diseases and Disorders delivers unparalleled coverage of pulmonary medicine. With nearly 2500 illustrations, 60 videos, and 22,000 references, this peerless, two-volume resource provides a comprehensive overview of the scientific basis of lung function in health and disease. You’ll find detailed coverage of the broad array of disorders affecting the respiratory system, including obstructive and restrictive diseases, pulmonary vascular disorders, sleep-disordered breathing, lung neoplasms, respiratory infections, and respiratory failure. In addition, you’ll learn about all the latest advances, including molecular development of the lung, stem cells and respiratory disease, the genetics of pulmonary disease, the growth of personalized medicine, technical advances in lung transplantation, and much more. Notable new content in the 6th edition includes discussion of the respiratory effects of vaping, detailed consideration of the idiopathic interstitial pneumonitides, state-of the-art discussion of lung nodules, a summary of the use of immunotherapy in the treatment of lung cancer, COVID-19-related lung disease and its management, and a comprehensive discussion of noninvasive ventilation, including its use in ambulatory and ICU settings. In addition, new chapters on cystic lung disease, lung cancer screening, the lung microbiome, developmental lung disorders, nocardiosis and actinomycosis, and application of ECMO are included.
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