Evidence-Based Medicine 2
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Transcript of Evidence-Based Medicine 2
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Evidence-Based Medicine 2
More Knowledge and Skills for Critical Reading
Karen Schetzina, MD, MPH
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Purposes of Epidemiologic Studies
Identify new diseasesIdentify populations at risk for a
diseaseIdentify possible causative agents of
a diseaseIdentify factors or behaviors that
increase risk of disease and their relative importance
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Purposes of Epidemiologic Studies (continued)
Rule out factors or behaviors as contributing to a disease
Evaluate therapies for a diseaseGuide in the development of
effective public health measures and preventive strategies
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Reading Epidemiologic Studies
Become familiar with medical terminology (but you don’t need to know every word)
Have some prior knowledge of the pathophysiology of the disease of interest
Understand principles of study design, analysis, and interpretation
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Review - DefinitionsHypothesis or research questionPopulation – Collection of units from which
a sample may be drawnSample – A selected subset of a
populationVariable - “Any quantity that varies. Any
attribute, phenomenon, or event that can have different values.”
Predictor Variable – Risk factorOutcome Variable – Disease or condition
of interestAssociation or Correlation – Degree to
which variables change together
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Review - Definitions
Estimate – Incorporates some degree of errorPrevalence - “The number of events in a given
population at a designated time” Incidence – “The number of new events in a
defined population within a specified period of time”
Mean – averageVariance – A measure of dispersion or variationStandard Deviation/Error – Square root of the
variance
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Hill’s Causal Criteria
StrengthConsistencySpecificityTemporalityBiologic gradientPlausibilityCoherence
Experimental evidence
Analogy
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Study Designs
Observational, Descriptive
Observational, Analytic
Experimental
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Study Designs
Observational, Descriptive Describe the amount and distribution of
disease Useful for generating hypotheses
Observational, Analytic Designed to test one or more specific
hypothesesExperimental
The exposure and the persons to be exposed are determined by the investigator
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Study DesignsObservational, descriptive
Case reports, case series Ecological Cross-sectional
Observational, analytical Case control Cohort
Experimental Randomized clinical trial Community Intervention Trial
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Case report or series
Describe patients or a series of patients with an interesting presentation of disease
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Ecological Studies
Studies correlating two or more characteristics of populations – unit of analysis is the group, not the individual Per capita consumption of cigarettes
correlates with national mortality from lung cancer in countries throughout the world.
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Ecological Studies
Advantages Quick, easy, and cost-effective
Disadvantages Cannot be extrapolated to individuals Correlations can be misleading
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Cross-Sectional Study
Measures exposure to suspected risk factors and the presence of a disease or condition in people in a population at the same time In a school survey, children who had
disciplinary problems were found to spend more hours in front of the television at home.
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Cross-Sectional Study
Advantages Relatively quick and inexpensive
Disadvantages Difficult to assess temporal associations
between risk factor and disease (tough to differentiate cause and effect)
See over-representation of diseases of long duration (because measuring prevalence)
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Study Designs
Observational, descriptive Case reports, case series Ecological Cross-sectional
Observational, analytical Case control Cohort
Experimental Randomized clinical trial Community Intervention Trial
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Case Control Study
People with and without a disease or condition of interest are identified and their prior exposure to suspected risk factors is measured. The proportion of smokers among lung
cancer patients admitted to a hospital was found to be much higher than the proportion of smokers among patients admitted for other reasons
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Source:Bambang Sutrisna, MD, MHS, DrPH, University of Indonedia, http://www.pitt.edu/~super1/index.htm
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Case Control Study
Advantages Relatively quick and inexpensive Good for rare diseases
Disadvantages Information on suspected risk factors
may be incomplete Potential problem of recall bias Selection of an appropriate control
group can be difficult
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Cohort Study
People with and without exposure to a suspected risk factor are identified and followed to determine whether they develop the disease(s) or condition(s) of interest. In the Framingham Heart Study, a cohort
of disease-free individuals were evaluated for blood pressure levels, cholesterol levels, and other characteristics, and followed for over 40 years for the development of coronary heart disease.
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Cohort Study
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Cohort Study
Advantages Can better establish temporality (because
measure the risk factor before the disease is diagnosed)
Can get incidence rates Can study many diseases
Disadvantages Take a long time to complete, require large
sample size, and are expensive Loss-to-follow-up bias may occur Inefficient for studying rare diseases
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Analysis of Results
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Study Designs
Observational, descriptive Case reports, case series Ecological Cross-sectional
Observational, analytical Case control Cohort
Experimental Randomized clinical trial Community Intervention Trial
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Experimental Study
Basically a prospective cohort study in which the exposure and the persons to be exposed are determined by the investigator. The randomized controlled trial is the strongest method to determine cause and effect in human subjects.
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Source:Bambang Sutrisna, MD, MHS, DrPH, University of Indonedia, http://www.pitt.edu/~super1/index.htm
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Source:Bambang Sutrisna, MD, MHS, DrPH, University of Indonedia, http://www.pitt.edu/~super1/index.htm
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Is having a regular source of medical care important for lowering the risk of cardiovascular disease among Mexican Americans?
IntroductionStudy DesignPopulation of InterestPrediction & Outcome VariablesCriteria for Inclusion of ArticlesSummary of FindingsStrengths & LimitationsConclusions & Future Research