By S. Nassir Ghaemi
There's a professor of psychiatry in the market who does a greater activity than Nassir Ghaemi in transmitting his knowledge on to you - yet in 20 years i haven't came upon one. i've got learn the authors examine papers for years. As an editor, I grew to become accustomed to his publication "The techniques of Psychiatry" as I thought of the philosophical elements of the sector. His writing is usually transparent and his pondering regularly brilliant.
In this short quantity on records and epidemiology his historic and unique observations and outlines of modern strategies is well worth the cost of buy on my own. a very good instance is his bankruptcy on meta-analysis. He reminds the reader why this statistical technique was once invented within the first position and is going directly to talk about major barriers, major historic opinions, and the place the tactic might actually help. His evaluations are good proposal in and out a number of short pages he touches on concerns that appear to be not often mentioned within the literature. this is often a massive bankruptcy for a doctor to learn in the course of a time while progressively more meta-analyses are thought of the gospel and turn out as entrance web page truths.
He additionally presents a "defense and feedback" of facts established drugs. He presents a philosophical context for the dialogue and reminds us of "the cult of the Swan-Ganz catheter". someone who used to be an intern or resident in extensive care settings within the Nineteen Eighties and early Nineties can bear in mind the frequent use of this gadget regardless of the inability of proof in randomized scientific trials (RCTs). It grew to become the normal of care regardless of the shortcoming of facts. He can pay homage to Feinstein his unique observations that the proof for evidence-based medication is going past RCTs.
The ultimate chapters are concise discussions of facts and epidemiology yet they're something yet dry. An instance will be his dialogue of impression estimation and the quantity had to deal with or NNT strategy he describes the calculation and its merits. He is going directly to describe the which means of specific numbers and likewise why the context is critical. He makes use of a well timed instance of the difficulty of antidepressants and whether they bring about suicidality.
This ebook succeeds as a quantity that could speedily carry the clinician and researcher on top of things on most modern subject matters in information and epidemiology in medication. it's not a booklet that studies mathematical conception. It doesn't supply exhaustive calculations and examples. it really is written for clinicians. it's a publication which could offer a foundation for dialogue and seminars during this box for complicated citizens utilizing the various author's references or fresh literature searches to examine particular innovations. it can even be built right into a even more accomplished textual content at the topic. Dr. Ghaemi brings a really distinctive standpoint to the subject material and he has produced a really readable booklet that I hugely recommend.
George Dawson, MD
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Additional info for A Clinician’s Guide to Statistics and Epidemiology in Mental Health: Measuring Truth and Uncertainty
The key weakness is that one cannot correct for multiple confounders simultaneously, but at least one can capture major confounders with this simple method. Also one can use stratification to do sensitivity analyses, looking at whether individual factors change one’s results. Regression What if, as is usually the case, one thinks there might be multiple confounders? For instance, besides rapid-cycling, what if we are concerned about differences in severity of illness, or gender, age, or even things like the therapeutic alliance or patient compliance or other factors.
005). The abstract concludes: “Treatment with ﬂuoxetine or nortriptyline for 12 weeks during the ﬁrst 6 months post stroke signiﬁcantly increased the survival of both depressed and nondepressed patients. ” Now this is quite a claim: if you have a stroke and are depressed, only three months of treatment with antidepressants will keep you alive longer for up to a decade. The observation seems far-fetched biologically, but it did come from an RCT; it should be valid. 16 Chapter 4: Types of bias Once one moves from the abstract to the paper, one begins to see some questions rise up.
Basically, since it is highly likely that confounding factors will be unequal between groups, my view is that small RCTs should be seen as observational studies: they are perhaps slightly better in that they should not be as biased as a standard observational study, yet they are still biased. Hence, they cannot be taken at face value. Even if a Table One showed that some measured variables are equal between groups in a small RCT, unmeasured confounders are still likely that could influence the results.