EBM Review

7/24/2019 EBM Review

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COMM H exam reviewGroup 1

Heterogeneity or homogeneity- Homogeneitysmall diamond

Statistically Significant/ Insignificant?- Diamond is touching line insignificant

- elia!le "not touching line#

andom $xcer%ts&- 'he () recruited %ts were allocated to one of the two clinical trial grou%s through coded

randomi*ation with +, %ts in each grou% 'his randomi*ation %rocess was controlled !y the

senior %harmacist in our institution- .hat are they trying to tell us?

- llocation/concealment

Group 2

uling out De%ression

- OD is a com%licated issue 'he most common tool re0uires 1 0uestions "and lots of time#"nhedonic lost interest in fun things SI2$C3S#

- ecent tool only as4s 5 0uestions&

o During the %ast month6 have you often !een !othered !y feeling down6 de%ressed6 or

ho%eless?

o During the %ast month6 have you often !een !othered !y little interest or %leasure in

doing things?- 7ecause this is a ruling out test6 what is more im%ortant&

o High sensitivity? S%ecificity?

o Sensitivitydon8t miss anyone

o

'he sensitivity is 91)6 s%ecificity is 9:;o


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o 91-59(#

o .hat does this mean? Is it statistically significant? es from confidence intervals

"> is the line of no effect#

o How would you ex%lain Cl? Smo4ing does slightly increase your ris4

- If the study was re%eated >99 times6 1: times would !e !etween >91 and 59(

Group 5

CO3D and life-ex%ectancy- a :( yo severe CO3D %t "ust out of hos%ital# is in to see w/ his daughter He still smo4es

and 3'8s are !ad "$F> is A :9E#

- He wants to 4now what his life ex%ectancy is com%ared to others? 3rognosis- Is cohort study o4ay for this 0uestion? 'H$ study for %rognosis@

- .hat would you tell the daughter "and %t6 if he listens?#

o >9 year life ex%ectancy is )9E com%ared to 19E for no CO3D

andom excer%t ,- 2rou% assignment were designated in se0uence using sealed o%a0ue envelo%es that were

concealed to %ts6 data collectors6 and staff at the study site

- llocation concealment

Group 6

3O$Ms vs G- 3t w/o 4nown heart disease 'otal cholesterol ")5# and '2 ":>#

- Drug re% advises that nothing decreases '2 li4e li%idil Su%ra %romises a =+9E

reduction in '2

- ecent meta-analysis shows that fi!rates effect on mortality in %rimary %revention %t is&

o > more death in every >,+ %eo%le "In ++ years#

- .hat would you do? Don8t give it

- '2 is a surrogate mar4er

o

2etting rid of them doesn8t seem to decrease mortality

Group 7

3-values

- a study finds that there is :E a!solute reduction in CF mortality "% value 99># yes6 statistically

significant

>E change that the finding is flu4e6 no reduction in mortality

"not this# 'here is 99>E chance that the finding is flu4e and there is no reduction in mortality


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andom excer%t +

- censored women from assessment if a defined end%oint associated with H3F >)/>(

occurred .e also censored women if an incident infection assoc with any other high-ris4H3F ty%e had !een detected

- what are they trying to tell us? nalysis

- 'hey didn8t do intention to treat

Group 7

- you are on the wards One of the 4ids wants to 4now how Santa8s going to get in- I thin4 one study loo4ed at a tool to diagnose if a child was a santa !eliever

- 'wo studies are im%ortant&

o ge A(

o 3arents !elieved in SC = >9 yo

- $ither if %ositive6 gives an 9E

Group 8

andom $xcer%t :

- %atients assigned to , tx grou%s !y randomi*ation !ox .hich contained 19 notes& >: mgwas written on ,9 notes6 :9 mg was written on ,96 and >:9 was written on ,9 .hen a new

%atient was enrolled in the study6 the %hysician involved too4 out a folded note from the !ox

and o%ened it

o .hat are they trying to tell us? Bo allocation "randomi*ation# concealment

Confusing intervals

- the a!stract of a small study6 authors re%ort Drug resulted in :E less hos%itali*ations than

%lace!o in the actual ta!le of results "with 1:E confidence intervals# it reads&Hos%itai*ations -:E "->>E to N5E#

o 'his finding is not statistical !ecause the Cl crosses 9

o Drug may actually increase hos%itali*ations !y 5E

o Drug may actually decrease hos%itali*ations !y as much as >>E

- BO' S''IS'IC


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> we conduct a retros%ective cohort 55 (19 %ts =): yo w/ drug insurance !enefits "cohort#

5 'otal >9> male %ts recruited =;9 yo randomi*ed 3CI or exercise "C'#

, Mailed survey as4ed a!out costs of 5, investigations and 5, thera%ies andom sam%le of)99 doctors was as4ed to re%ort their awareness "survey6 cross-sectional#

7est one "56 >6 ,#

Group 10

andom exerce%t )- immediately after !aseline assessment !y !linded assessor6 the treating %hysiothera%ist

accessed the allocation schedule from a centrally located loc4ed ca!inet

- llocation !ad

uling in or out dementia

'est >& Nve 6 ,#

Group 13

Mar4 'wain& acts are stu!!orn6 !ut statistics are more %lia!le- C' 599 %ts6 divided them into 5 grou%s of >99 In the %lace!ow grou%6 59 died In the

treatment6 >9 died

- .hat is the control event rate? ,9/>99,9E

- .hat is the ex%erimental event rate?>9E


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- .hat is the a!solute ris4 different "reduction#? 59E

- How many %eo%le do you need to treat to %revent one death? :@

%%lication

- at a lecture6 a %resenter 0uoted S'I of )9E 3a%er has to do with female refugees in frica

o Can8t a%%ly to your %o%ulation

andom $xcer%ts ;

- efficacy !ased analysis on all randomi*ed %ts and im%uting of worst ran4 scores for early

exclusions !ecause of %rotocol violations "such as not ta4ing the study drug#

o intention to treat

Fitamin story

- in trial of vit vs %lace!o6 mortality !enefit not there "MI6 stro4e6 cancer#

- 7ased on significant reduction in on-fatal MI ">+ vs +># & we conclude that vit txsu!stantially reduces non-fatal MI

- However6 there was a non-significant increase in Fit grou% for CF deaths"5; vs 5,# and

all-cause mortality ",) vs 5;#- ll cause mortality was later shown to increase

- If you loo4 at too many things:E chance of finding things !y flu4e "%-values#

- 'oo many su!-grou% analysis

Group 14

Screening and 3revention- ::yo %resents to your office for annual 3H$

- .hat do you %ic4 on ray form and la!?

o BO& C6 C7C6 $C26 urinalysis6 !one density "only if you meet 5 minor or > maor

criteria#6 3S6 'SH

o es& mammogram6 !lood sugar6 33 test "single !est test for cancer %revention@#6

hemoccult x , "%oo@#6 cholesterol- .hat would change for males? $S& 3S6 BO& 33 and mammogram

- Change for smo4ers? 3ro!a!ly nothing "may!e !one density#

- Change for %erson in 59s? Beeds to !e sexually active

Group 15

Screening and %revention

- Lrinalysis has limitations6 in a 59 yo male6 N> hematuria&

o ># cancer 5# ne%hritis ,# li4ely !enign

o Is this test s%ecific? Bo Sensitive? es

- ou did a C7C on a 5: yo female .7C >>

o B'HIB2@ lmost no hel% to us@

- 'he 3H$ is a time for health %romotion

- How useful is the review of systems?- .hat elements of the o/e are %roven? 736 etc 7ut do the stuff theyGex%ect

- .hat advice is %roven to hel% %atients live longer a/o healthier?


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Canada8s health history

- don8t 4now names and dates@

- 3rinci%les&

o Lniversality

o ccessi!ility

o unding

o fforda!ility

o Conflict over administration

$xtra !illing

o 2et an ideaGoh dearG

Group 18

Healthcare costs- in negotiations for funding6 a large num!er of techni0ues "or features# may influence funders

o what did we see used?

7ri!ery@ elationshi%s

o .hat was least effective? Over estimate

o .hat seemed to have the most influence?

o How im%ortant was need?

The Wrap-up

2eneral -,-: 0uestions %er session

3u!lic Health K 59 0uestions ">: minute of6 %ower %oint slides#

Health Care organi*ation- >9 0uestions

-, each ">st/5nd& 5 lecture6 > class# N > movie- , on game-show thing on health care organi*ation

$vidence !ased medicine K 5+ 0uestions

- 0uestions overla% !/w small grou%/lecture

- no content on Info3O$MS or clinical 0uestions

- ny needed formulas/nomograms will !e %rovided

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