By Professor Andrew J Stevens, Professor Keith R Abrams, Mr John Brazier, Mr Ray Fitzpatrick, Richard J Lilford

ISBN-10: 0761961445

ISBN-13: 9780761961444

ISBN-10: 1847876757

ISBN-13: 9781847876751

The `effectiveness revolution' either in learn and scientific perform, has verified on hand tools for wellbeing and fitness providers examine to the intense. How a ways can observational tools, regimen information and qualitative equipment be utilized in healthiness care review? What rate and final result measures are applicable, and the way may still facts be collected? With the aid of over million kilos from the British wellbeing and fitness expertise evaluation examine Programme, the examine venture for this guide has ended in either a synthesis of the entire latest wisdom in those parts and an schedule for destiny debate and examine. The chapters and their authors were chosen via a cautious strategy of peer evaluate and supply a coher

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Because individual equipoise is such an elusive state in practice, Freedman argues, it can be discounted as too stringent a moral basis for trial entry. When individuals are equipoised, this is simply a bonus, not a requirement. As scientists, we would like to go along with Freedman, but we are conscious of serious flaws in his argument. Problems with Freedman’s Argument The first point that Freedman ignores is that collective equipoise is seldom evenly balanced. It, too, is a fragile state, only now among a group of people.

He argues that the obligation of a doctor to a patient is different from those which, say, a parent has towards a child – Freedman thus argues that clinicians need not adhere to the ‘gold standard’, whereby one should not randomise a patient unless one was prepared to do the same for a beloved family member. Freedman defends his position on the grounds that doctors are judged by, and should behave according to, collective norms. However, this does not say how the doctor is supposed to operationalise the concept of collective versus individual equipoise – is the doctor to tell the patient only that there is collective uncertainty about the best treatment while keeping any personal preference under wraps?

The Randomised Controlled Trial (RCT) is deemed the most reliable scientific method in medicine today by virtue of its unique capacity to eliminate selection bias. However, there is an apparent moral tension between serving the interests of society at large, and those of individual participants. 2 Medical research advances medical practice and hence goes some way towards alleviating suffering and avoiding harm. The RCT is not always scientifically necessary or desirable, but it is most useful when expected treatment effects are small, yet worthwhile.

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Advanced Handbook of Methods in Evidence-Based Healthcare by Professor Andrew J Stevens, Professor Keith R Abrams, Mr John Brazier, Mr Ray Fitzpatrick, Richard J Lilford

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