There are many books explaining the importance of evidence-based medicine and how randomised clinical trials (RCTs) and systematic reviews should be performed. However, this is the first book to tackle the apparent conflict between the importance of evidence-based decision making and the widely held view that it is often very difficult to apply the overall results of RCTs and systematic reviews to decisions about individual patients in routine clinical practice. The book brings together experienced clinicians, statisticians and trialists to focus on the two key questions that are most frequently asked by clinicians. Is the evidence relevant to my clinical practice? How can I judge whether the probability of benefit from treatment in my current patient is likely to differ substantially from the average probability of benefit reported in the relevant trial or systematic review? These questions are addressed from methodological and clinical perspectives, and potential approaches to improving the targeting of treatment are considered, with detailed reviews of several areas of medicine and surgery where useful progress has been made.
1) Reliable assessment of the effects of treatment on mortality and major morbidity
2) The lethal consequences of failing to make full use of all relevant evidence about the effects of medical treatments: the importance of systematic reviews
Section 2: Is the trial relevant to this patient?
3) Assessment of the external validity of randomised trials
4) Applying results to treatment decisions in primary care
5) The older patient
6) Applying results to treatment decisions in complex clinical situations
7) External validity of pharmaceutical trials in neuropathic pain
8) External validity of pharmaceutical trials in asthma and chronic obstructive pulmonary disease
Section 3: Is the overall trial result sufficiently relevant this patient?
9) When should we expect clinically important differences in response to treatment?
10) Genes and the individual response to treatment
11) Reliable estimation and interpretation of the effects of treatment in subgroups
12) Can meta-analysis help target interventions at individuals most likely to benefit?
13) Use of risk models to predict the likely effects of treatment in individuals
14) Evaluating the performance of prognostic models
15) Are "n-of-1 trials of any practical value to clinicians or researchers?
Section 4: Targeting of treatment in routine practice
16) Primary prevention of cardiovascular disease: the absolute risk-based approach
17) Antithrombotic therapy to prevent stroke in patients with atrial fibrillation
18) Reperfusion therapies in acute cardiovascular and cerebrovascular syndromes
19) Choice of agent in treatment of epilepsy
20) Pharmacogenomic targeting of treatment for cancer