Modern Methods of Clinical Investigation (1990) / Chapter Skim
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7. The Role of Decision Analysis in the Translation of Research Findings into Clinical Practice
7. The Role of Decision Analysis in the Translation of Research Findings into Clinical Practice
Pages 78-87
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From page 78... ...
Examples include drugs and procedures to treat coronary disease, devices to crush kidney stones or gallstones, immunoassays to detect disease or protect the blood supply, and devices that provide images of normal and diseased human anatomy. But if we consider these examples, or other new drugs, devices, or procedures on the horizon, it seems clear that the "demand-pull" of clinical practice is at least as powerful a force as the "innovation-push" of science and technology.
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From page 79... ...
making important distinctions between matters of fact—the evidence produced by clinical investigation- and the value judgments inherent in decisions about use of new drugs, devices, and technologies. This last function draws attention to agency and perspective: the clinician's role as rational agent for patients, the investigator or developer's responsibility to the public and prospective patients, and government officials' responsibility to protect the public welfare (see Figure 7.1~.
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From page 80... ...
As noted, willingness to make a decision based on the expected value of an alternative course of action depends on acceptance of the expected utility model. The results of decision analyses often seem overly precise.
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From page 81... ...
Watchful waiting versus immediate transurethral resection for symptomatic prostatism: The importance of patients' preferences. Journal of Me American Medical Association 1988;259:3010-3017.
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From page 82... ...
SETTING PRIORITIES AND PARAMETERS FOR CLINICAL INVESTIGATION The explicit formulation of a decision problem and the use of probabilities to represent uncertainty can prevent errors of intuition in anticipating the impact of a new drug, device, or procedure. However, the principal role of decision analysis in setting priorities and parameters for clinical investigation is in forcing an orientation to health outcomes and the values associated with them.
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From page 83... ...
Clinical research tends to focus on the efficacy of a particular drug or procedure, or on the sensitivity and specificity of a diagnostic test. Often it does not consider the string of uncertainties and choices that precede or follow an action and that provide the links between the initial choice among alternatives and the valued outcomes.
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From page 84... ...
Phelps and Muslin answer the question with a receiver operating characteristic curve that displays a "challenge region" for MRI (see Figure 7.5~. Again, the result is more targeted clinical investigation with clear and explicit definition of the "clinically important difference." SYNTHESIZING, INTERPRETING, AND DISSEMINATING RESULTS OF CLINICAL RESEARCH The characteristics of decision analysis that make it valuable for setting priorities and parameters are useful in bringing the results of research to clinical practice.
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From page 85... ...
Costs below zero indicate that the vaccine would actually save money. This analysis is a good example of the iterative, bidirectional process that decision analysis can facilitate; it puts the results of the randomized trial in context, while focusing additional research efforts aimed at identifying hepatitis risk for different populations.
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From page 86... ...
SOURCE: Mulley AG, Silverstein MD, Dienstag JL. Indications for use of hepatitis B vaccine, based on cost-effectiveness analysis.
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From page 87... ...
11. Silverstein MD, Mulley AG, Dienstag JL.
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