Download Guiding Neurosurgery by Evidence (Progress in Neurological by Bruce E. Pollock PDF

By Bruce E. Pollock

ISBN-10: 3805581300

ISBN-13: 9783805581301

"Guiding Neurosurgery through proof" presents its readers with a succinct overview of up to date neurosurgical perform whilst evaluated by way of evidence-based drugs criteria. It starts off with an creation of the concept that and ideas of evidence-based drugs. the next chapters handle the subjects of mind tumor epidemiology, benign grownup mind tumors, pediatric neurosurgery, endovascular therapy of cerebrovascular problems, lumbar backbone surgical procedure, minimally invasive backbone surgical procedure, stereotactic radiosurgery, trauma, and the therapy of power soreness issues through neurostimulation. each one bankruptcy summarizes the to be had literature and grades it in accordance with the standard of the facts. moreover, this e-book highlights not just the usefulness of evidence-based medication in neurosurgical perform, but in addition its obstacles in regards to neurosurgical issues which are usually infrequent and as a result most unlikely to judge in randomized medical trials. Neurological surgeons and neurologists, either working towards physicians and citizens in education, will locate during this booklet beneficial information regarding the perform of the various neurosurgical subspecialties by way of evidence-based drugs criteria.

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Extra resources for Guiding Neurosurgery by Evidence (Progress in Neurological Surgery Vol 19)

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G. 30–50% reductions in undesirable endpoints). Once standard of care (SOC) is established by RCT, alternative treatments for the same disease are usually tested against SOC rather than natural history or placebo. g. e. those based on a coherent pathophysiologic rationale, those that have stood the test of time in accepted clinical practice, and those which have a basic science research foundation) [217]. As a result, clinical studies of additional or newer treatments are more likely to require megaRCTs to demonstrate improved outcomes, or to result in null studies in smaller RCTs, and thus are less likely to be published or to be recognized as at least equivalent therapies (when in fact they may be superior).

There is a major difference between strength of effect for an intervention and strength of evidence supporting the use of that intervention [55]. Indeed there are interventions where the magnitude of effect is so strong with lower methodology analysis that the effect is very unlikely to be accountable by bias, and where failure to act on an individual case level or strongly recommend at a clinical practice parameter level is probably inappropriate. The introduction of penicillin in the 1930s and 1940s is a classic example.

However, while excellent for studying therapeutic interventions, the RCT is a poor methodology for studying other epidemiological questions. Furthermore, there may be an inflection point where strength of effect should outweigh strength of methodology in assessing the level of evidence, or where the quality of a given study should lead it to carry more weight than a study of poor quality utilizing a less biased methodology. RCT design is a poor methodology for answering or exploring epidemiological questions of potential disease etiology, pathophysiologic causality, therapeutic side effects, or describing new diseases [211].

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