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      What Decision Analysis Can Offer the Clinical Decision Maker

      Hormone Research in Paediatrics

      S. Karger AG

      Decision analysis, Utilities, Preferences, Cognitive continuum, Probabilities, Clinical decision making

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          Abstract

          Cognitive Continuum Theory can be used to explain why the relationship between research and practice is more problematic than is customarily assumed. The various possible sources of evidence for clinical decision making and the alternative approaches to such decision making can be located within the main modes of this continuum, each of which embodies a different balance of intuition and analysis. Decision analysis is the only technique that provides the analytical depth necessary to arrive at a decision that systematically identifies, structures and integrates all the relevant evidence on clinical parameters and patient preferences, within whatever mode that evidence is generated. The inappropriateness of using research criteria in action evaluations is pointed out. In order to illustrate the application of the Cognitive Continuum Theory and decision analysis to growth hormone (GH) therapy, and to stimulate discussion of this area, a primitive clinical decision analysis and prototype ‘clinical guidance tree’ for GH is presented here.

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          Most cited references 3

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          A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction.

          To examine the temporal relationship between accumulating data from randomized control trials of treatments for myocardial infarction and the recommendations of clinical experts writing review articles and textbook chapters. (1) MEDLINE search from 1966 to present; search terms used were myocardial infarction, clinical trials, multicenter studies, double-blind method, meta-analysis, and the text word "random:"; (2) references from pertinent articles and books; and (3) all editions of English-language general medical texts and manuals and review articles on treatment of myocardial infarction. Randomized control trials of therapies for reducing the risk of total mortality in myocardial infarction (acute and secondary prevention). Review articles and textbook chapters dealing with the general clinical management of patients with myocardial infarction. Two authors read the material and recorded the results; disagreements were resolved by conference. We used the technique of cumulative meta-analysis (performing a new meta-analysis when the results of a new clinical trial are published) and compared the results with the recommendations of the experts for various treatments for myocardial infarction. Discrepancies were detected between the meta-analytic patterns of effectiveness in the randomized trials and the recommendations of reviewers. Review articles often failed to mention important advances or exhibited delays in recommending effective preventive measures. In some cases, treatments that have no effect on mortality or are potentially harmful continued to be recommended by several clinical experts. Finding and analyzing all therapeutic trials in a given field has become such a difficult and specialized task that the clinical experts called on to summarize the evidence in a timely fashion need access to better databases and new statistical techniques to assist them in this important task.
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            Clinical ResearchPerceptions, Reality, and Proposed Solutions

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              The variation phenomenon in 1994.

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                Author and article information

                Journal
                HRE
                Horm Res Paediatr
                10.1159/issn.1663-2818
                Hormone Research in Paediatrics
                S. Karger AG
                978-3-8055-6898-2
                978-3-318-00450-2
                1663-2818
                1663-2826
                1999
                June 1999
                17 November 2004
                : 51
                : Suppl 1
                : 73-82
                Affiliations
                Applied Social Sciences, The Open University, Milton Keynes, UK
                Article
                53139 Horm Res 1999;51(suppl 1):73–82
                10.1159/000053139
                10393495
                © 2004 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, Tables: 2, References: 17, Pages: 10
                Categories
                Evidence-Based Medicine

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