Always Start with PECO
|
|
- Mark Rose
- 7 years ago
- Views:
Transcription
1 Goals of This Course Be able to understand a study design (very basic concept) Be able to understand statistical concepts in a medical paper Be able to perform a data analysis Understanding: PECO study design Randomized Controlled Trials (RCT) Observational studies Cohort study Case control study Cross sectional study
2 Always Start with PECO Population Exposure Comparison Outcome
3 Population? Patients with an echo for possible coronary disease Exposure? Use of Aspirin at the index visit (baseline) Control? No use of Aspirin at the index visit (baseline) Outcome? Long term mortality (median FU of 3.1 years)
4 Types of Epidemiologic Studies Experimental Studies Randomized Clinical Trials Non-Randomized Clinical Trials Observational Studies Cross-Sectional Studies Cohort Studies Case-Control Studies 4
5 Criteria for Study Design Sampled data or Census data? Timing of data collection
6 Classification of study by timing and sampling. Prospective cohort Retrospective cohort Cross-sectional Retrospective case control Prospective case control Past Current Future 6
7 Cross sectional Exposure (E) and Outcome (O) at one moment in time Prevalence of disease Prevalence of exposure Efficient But Often biased for questions involving time between exposure and outcome.
8 Cross-sectional Study: example Asanuma Y, Oeser A, Shintani A and Stein CM. Premature Coronary Artery Atherosclerosis in Systemic Lupus Erythematosis. N Engl J Med (2003) 349: Sampled data or Census data? Samples: Patients with Lupus vs Healthy controls Timing of data collection Only this matters! Past Current Future Exposure: Lupus Cardiovascular risk factors Outcomes: Coronary Atherosclerosis Cross sectional 8
9 Cross sectional 9
10 Cohort Study 1. Define a cohort without disease at T0 2. Document baseline factors which may associate a study outcome 3. Follow up for a period time to the outcome Also called as a follow-up, incidence or prospective study. Target Population Exposure No Exposure Outcome No outcome Outcome No outcome Current Future Prospective Cohort 10 Past Current Retrospective Cohort
11 Advantage of a cohort study Rare exposure (exposures) Several diseases Exposure precedes disease Less sensitive for selection bias Less sensitive for information (recall) bias Dis advantage of a cohort study Costly and time consuming due to census approach If cohort: loss of subjects due to migration, death, etc (selection bias) Inefficient when Rare disease (e.g. side effects of therapies)
12 Cross sectional study can be a part of a cohort study. Cross-sectional Cohort study A. Initially identify a population: Defined population Prevalent cases B. Determine who has the disease and who does not: Had the disease Did not have the disease C. Follow up only those who did not have the disease at baseline Did not have the disease Incidence cases D. Re-screen these individuals at one year Developed disease Did not developed disease At Baseline 12
13 Case control Study Sampled data based on outcome Sampled data or Census data? Timing of data collection Key feature = Sampling (no census) more efficient 1. Select subjects with outcome (cases) 2. Sample from the population where cases emerge from subjects without outcome (controls) 3. Assess an exposure(s) in both cases and controls Note: exposure conceptually happens before outcome
14 Case Control study Advantages: * Efficient due to sampling approach * Rare disease (e.g. side effects) * When exposure measurements are expensive Blood measurements Radiographic readings Disadvantages: One disease Rare exposure CI (Risk) cannot be estimated More sensitive to selection bias More sensitive to information (recall) bias
15 Example: Cohort Study In Framingham study, the association of smoking with coronary heart disease (CHD) is investigated by selecting a group of 3,000 smokers (exposed) and a group of 5,000 non-smokers who are free of CHD at baseline. The incidence of CHD in both groups is compared. Status CHD No CHD Total Smokers 84 2,916 3,000 Nonsmokers 87 4,913 5,000 Total 171 7,829 8,000 Cumulative incidence (risk) of CHD among smokers = 84/3000 = Cumulative incidence (risk) of CHD among non-smokers = 87/5000 = RR=0.028/ =
16 Examle: Case control Study Assume that we conducted a case-control study, 100 cancer cases were identified, and we randomly chose 100 subjects without the cancer. We then retrospectively identify there smoking status before there were diagnosed with cancer. Prostate Cancer Yes No Total Smokers Non-smokers Total Now can you compute cumulative incidence proportion (risk) of Cancer for each group of exposure? Risk of Cancer = 49% vs 37%, are they too high? Odds of smoking (among Cancer) = 49/51 RR =49%/37% =1.32 Odds of smoking (among Non-Cancer) = 37/63 Odds Ratio (OR) of PSA = 49/51 / (37/63) =
17 Analytical Challenge in an Observational Study Case study in an Observational Study Case study in a Randomized Controlled Trial
18 Analytical Challenge in an Observational Study Case study in an Observational Study Case study in a Randomized Controlled Trial
19 Observational Studies Prospective cohort study, Cleveland Clinic Mean follow up 3.1years 6174 patients undergoing stress echocardiography for evaluation of known or suspected coronary disease
20 Results?? Patients using aspirin had 8% increased risk of death, though no statistical significance was achieved. Some thing not right?????
21 Baseline Characteristics Confounding Patients with aspirin has reasons to use the medication, which often biases toward worsening prognosis. Thus we do not know if the observed difference is due to the effect of aspirin or due to the difference in prognosis.
22 Dealing with confounding Randomization Statistical Adjustment (Regression Analysis, ie Multivariable Analysis)
23 Dealing with confounding Randomization Statistical Adjustment (Regression Analysis, ie Multivariable Analysis)
24 Result
25 Analytical Challenge in an Observational Study Case study in an Observational Study Case study in a Randomized Controlled Trial
26 RCT Example THE LANCET Vol 357 January 13, 2001
27 RCT:Baseline Characteristics
28 RCT: Results
29 Why RCT is optimal? RCT is considered the best study design to study causation (Gold Standard of all research design) Because of randomization, not only observed but unobserved factors are thought to be balanced between comparison groups. Statistical adjustment can deal only with imbalance only in observed factors. Thus, RCT is recommended whenever possible.. 29
30 Feasibility Randomization is not feasible in many cases. More costly, longer duration Not suitable for disease with rare outcomes Generalizability (External validity) Many exclusion or Inclusion criteria make patients population skewed which does not reflect general population. Self selection to study enrollment (Healthy worker s effect). Hawthorneeffects makes prognosis better than unmonitored population. Confounding (Internal Validity) Patients with no adherence Intention to Treat RCT Problems
31 Feasibility Randomization is not feasible in many cases. More costly, longer duration Not suitable for disease with rare outcomes Generalizability (External validity) Many exclusion or Inclusion criteria make patients population skewed which does not reflect general population. Self selection to study enrollment (Healthy worker s effect). Hawthorneeffects makes prognosis better than unmonitored population. Confounding (Internal Validity) Patients with no adherence Intention to Treat RCT Problems
32 Feasibility Randomization is not feasible in many cases. More costly, longer duration Not suitable for disease with rare outcomes Generalizability (External validity) Many exclusion or Inclusion criteria make patients population skewed which does not reflect general population. Self selection to study enrollment (Healthy worker s effect). Hawthorneeffects makes prognosis better than unmonitored population. Confounding (Internal Validity) Patients with no adherence Intention to Treat RCT Problems
33 Exclusion and Inclusion Criteria Inclusion criteria were defined as: old age (65 years); hypertension (systolic blood pressure [SBP] 160 mm Hg or diastolic blood pressure [DBP] 95 mm Hg on at least three separate occasions); hypercholesterolaemia (total blood cholesterol 6 4 mmol/l on at least two separate occasions); diabetes mellitus (fasting venous plasma glucose concentration 7 8 mmol/l on at least two separate occasions [chronic drug treatment for any of the three latter conditions was also a criterion for inclusion]); obesity (body mass index 30 kg/m2); and family history of myocardial infarction before 55 years of age in at least one parent or sibling. Exclusion criteria were: treatment with antiplatelet drugs (history of vascular events or diseases); chronic use of anti inflammatory agents or anticoagulants; contraindications to aspirin; diseases with predictable poor short term prognosis; and predictable psychological or logistical difficulties affecting compliance with the trial requirements.
34 RCT difficulty in generalizability Healthy Workers effect, Hawthorne effect 1.0 Proportion Surviving Randomized (n=5051) Non-randomized (n=12217) Years after Randomization Fiore LD et al. Department of Veterans Affairs Cooperative Studies Program Clinical Trial comparing combined warfarin and aspirin with aspirin alone in survivors of acute myocardial infarction: primary results of the CHAMP study. Circulation Feb 5;105(5):
35 Feasibility Randomization is not feasible in many cases. More costly, longer duration Not suitable for disease with rare outcomes Generalizability (External validity) Many exclusion or Inclusion criteria make patients population skewed which does not reflect general population. Self selection to study enrollment (Healthy worker s effect). Hawthorneeffects makes prognosis better than unmonitored population. Confounding (Internal Validity) Patients with no adherence Intention to Treat RCT Problems
36
37 37
38
39 Likelihood of Truth by Study Design
40 Summary of this lecture Observational studies are easier to conduct than an experimental studies such as RCT s Such observational study is classified with (sampling vs census, timing of data collection) and they include: Cross sectional Cohort Case control * Risk cannot be referred in a case control study nor in a cross sectional study An observational study faces a challenge in statistical analysis > Typically using multivariable analysis with a regression method to control for confounding > RCT may be OK with univariable analysis (unadjusted analysis) Don t rely on Likelihood of Truth by Study Design, trust your own judgment!
Cohort Studies. Sukon Kanchanaraksa, PhD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes
ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Effects of a fixed combination of the ACE inhibitor, perindopril,
More informationSystolic Blood Pressure Intervention Trial (SPRINT) Principal Results
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and
More informationIntroduction to study design
Introduction to study design Doug Altman EQUATOR Network, Centre for Statistics in Medicine, NDORMS, University of Oxford EQUATOR OUCAGS training course 4 October 2014 Objectives of the day To understand
More informationCase-control studies. Alfredo Morabia
Case-control studies Alfredo Morabia Division d épidémiologie Clinique, Département de médecine communautaire, HUG Alfredo.Morabia@hcuge.ch www.epidemiologie.ch Outline Case-control study Relation to cohort
More informationGuide to Biostatistics
MedPage Tools Guide to Biostatistics Study Designs Here is a compilation of important epidemiologic and common biostatistical terms used in medical research. You can use it as a reference guide when reading
More informationClinical Study Design and Methods Terminology
Home College of Veterinary Medicine Washington State University WSU Faculty &Staff Page Page 1 of 5 John Gay, DVM PhD DACVPM AAHP FDIU VCS Clinical Epidemiology & Evidence-Based Medicine Glossary: Clinical
More informationClinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D.
Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Associate Investigator Palo Alto Medical Foundation Research Institute Consulting Assistant
More informationThe Cross-Sectional Study:
The Cross-Sectional Study: Investigating Prevalence and Association Ronald A. Thisted Departments of Health Studies and Statistics The University of Chicago CRTP Track I Seminar, Autumn, 2006 Lecture Objectives
More informationBasic Study Designs in Analytical Epidemiology For Observational Studies
Basic Study Designs in Analytical Epidemiology For Observational Studies Cohort Case Control Hybrid design (case-cohort, nested case control) Cross-Sectional Ecologic OBSERVATIONAL STUDIES (Non-Experimental)
More informationStatins and Risk for Diabetes Mellitus. Background
Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration
More informationAbsolute cardiovascular disease risk assessment
Quick reference guide for health professionals Absolute cardiovascular disease risk assessment This quick reference guide is a summary of the key steps involved in assessing absolute cardiovascular risk
More informationProspective, retrospective, and cross-sectional studies
Prospective, retrospective, and cross-sectional studies Patrick Breheny April 3 Patrick Breheny Introduction to Biostatistics (171:161) 1/17 Study designs that can be analyzed with χ 2 -tests One reason
More informationDISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
More informationGuidelines for the management of hypertension in patients with diabetes mellitus
Guidelines for the management of hypertension in patients with diabetes mellitus Quick reference guide In the Eastern Mediterranean Region, there has been a rapid increase in the incidence of diabetes
More informationSafety & Effectiveness of Drug Therapies for Type 2 Diabetes: Are pharmacoepi studies part of the problem, or part of the solution?
Safety & Effectiveness of Drug Therapies for Type 2 Diabetes: Are pharmacoepi studies part of the problem, or part of the solution? IDEG Training Workshop Melbourne, Australia November 29, 2013 Jeffrey
More informationThe Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery
The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery Michael E. Farkouh, MD, MSc Peter Munk Chair in Multinational Clinical Trials Director, Heart and Stroke
More informationAppendix: Description of the DIETRON model
Appendix: Description of the DIETRON model Much of the description of the DIETRON model that appears in this appendix is taken from an earlier publication outlining the development of the model (Scarborough
More informationIntroduction to Observational studies Dr. Javaria Gulzar Clinical Research Associate SCRC.
Introduction to Observational studies Dr. Javaria Gulzar Clinical Research Associate SCRC. Observational Study A study in which a researcher simply observes behavior in a systemic manner with out any active
More informationThe Canadian Association of Cardiac
Reinventing Cardiac Rehabilitation Outside of acute care institutions, cardiovascular disease is a chronic, inflammatory process; the reduction or elimination of recurrent acute coronary syndromes is a
More informationWhat are observational studies and how do they differ from clinical trials?
What are observational studies and how do they differ from clinical trials? Caroline A. Sabin Dept. Infection and Population Health UCL, Royal Free Campus London, UK Experimental/observational studies
More informationMortality Assessment Technology: A New Tool for Life Insurance Underwriting
Mortality Assessment Technology: A New Tool for Life Insurance Underwriting Guizhou Hu, MD, PhD BioSignia, Inc, Durham, North Carolina Abstract The ability to more accurately predict chronic disease morbidity
More informationTITLE AUTHOR. ADDRESS FOR CORRESPONDENCE (incl. fax and email) KEYWORDS. LEARNING OBJECTIVES (expected outcomes) SYNOPSIS
TITLE AUTHOR ADDRESS FOR CORRESPONDENCE (incl. fax and email) KEYWORDS LEARNING OBJECTIVES (expected outcomes) SYNOPSIS Types of Epidemiological Studies: Basic Knowledge Enver Roshi, MD, MPH Genc Burazeri,
More informationRandomized trials versus observational studies
Randomized trials versus observational studies The case of postmenopausal hormone therapy and heart disease Miguel Hernán Harvard School of Public Health www.hsph.harvard.edu/causal Joint work with James
More informationPsoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis
Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic
More informationConfounding in health research
Confounding in health research Part 1: Definition and conceptual issues Madhukar Pai, MD, PhD Assistant Professor of Epidemiology McGill University madhukar.pai@mcgill.ca 1 Why is confounding so important
More informationQuantifying Life expectancy in people with Type 2 diabetes
School of Public Health University of Sydney Quantifying Life expectancy in people with Type 2 diabetes Alison Hayes School of Public Health University of Sydney The evidence Life expectancy reduced by
More informationPrognostic impact of uric acid in patients with stable coronary artery disease
Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,
More informationTHE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT
THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological
More informationNew Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine
New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine Disclosures & Relevant Relationships I have nothing to disclose No financial conflicts Editor,
More informationEXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA
EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA A CASE STUDY EXAMINING RISK FACTORS AND COSTS OF UNCONTROLLED HYPERTENSION ISPOR 2013 WORKSHOP
More informationBasic of Epidemiology in Ophthalmology Rajiv Khandekar. Presented in the 2nd Series of the MEACO Live Scientific Lectures 11 August 2014 Riyadh, KSA
Basic of Epidemiology in Ophthalmology Rajiv Khandekar Presented in the 2nd Series of the MEACO Live Scientific Lectures 11 August 2014 Riyadh, KSA Basics of Epidemiology in Ophthalmology Dr Rajiv Khandekar
More informationMeasure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care
Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
More informationJournal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University
More informationDIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE
DIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE 40 yo woman, BMI 36. Motivated to begin diet therapy. Which of the following is contraindicated: Robert B. Baron MD MS Professor and
More information25-hydroxyvitamin D: from bone and mineral to general health marker
DIABETES 25 OH Vitamin D TOTAL Assay 25-hydroxyvitamin D: from bone and mineral to general health marker FOR OUTSIDE THE US AND CANADA ONLY Vitamin D Receptors Brain Heart Breast Colon Pancreas Prostate
More informationCARDIOVASCULAR PROBLEMS IN SURVIVORS OF CHILDHOOD CANCER AND THEIR SIBLINGS
Swiss Childhood Cancer Registry (SCCR) CARDIOVASCULAR PROBLEMS IN SURVIVORS OF CHILDHOOD CANCER AND THEIR SIBLINGS Julien Caccia, Corina S. Rueegg, Eva-Maria Hau, Nicolas X. von der Weid, Gisela Michel,
More informationScottish Diabetes Survey 2014. Scottish Diabetes Survey Monitoring Group
Scottish Diabetes Survey 2014 Scottish Diabetes Survey Monitoring Group Contents Table of Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 21 Duration
More informationDiabetes Prevention in Latinos
Diabetes Prevention in Latinos Matthew O Brien, MD, MSc Assistant Professor of Medicine and Public Health Northwestern Feinberg School of Medicine Institute for Public Health and Medicine October 17, 2013
More informationHow To Write A Systematic Review
Formulating the Review Question & Writing a Protocol Madhukar Pai, MD, PhD Associate Professor Department of Epidemiology & Biostatistics McGill University, Montreal, Canada Email: madhukar.pai@mcgill.ca
More informationBasic research methods. Basic research methods. Question: BRM.2. Question: BRM.1
BRM.1 The proportion of individuals with a particular disease who die from that condition is called... BRM.2 This study design examines factors that may contribute to a condition by comparing subjects
More informationIsabella Sudano & Franco Muggli
Swiss Hypertension Guidelines Isabella Sudano & Franco Muggli CoLaus, Swisshype ESC 2005 Dokumentenname Datum Seite 1 European Journal of Cardiovascular Prevention and Rehabilitation 2009 Guideline...
More informationIntervention and clinical epidemiological studies
Intervention and clinical epidemiological studies Including slides from: Barrie M. Margetts Ian L. Rouse Mathew J. Reeves,PhD Dona Schneider Tage S. Kristensen Victor J. Schoenbach Experimental / intervention
More informationMedical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South
Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains
More informationMetabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007
Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering
More informationAtherosclerosis of the aorta. Artur Evangelista
Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis
More informationBig data size isn t enough! Irene Petersen, PhD Primary Care & Population Health
Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health Introduction Reader (Statistics and Epidemiology) Research team epidemiologists/statisticians/phd students Primary care
More informationEUROASPIRE II. European Action on Secondary and Primary Prevention through Intervention to Reduce Events
II European Action on Secondary and Primary Prevention through Intervention to Reduce Events Euro Heart Survey Programme European Society of Cardiology-ESC 1 2 Priorities of Coronary Heart Disease Prevention
More informationDiabetes Complications
Managing Diabetes: It s s Not Easy But It s s Worth It Presenter Disclosures W. Lee Ball, Jr., OD, FAAO (1) The following personal financial relationships with commercial interests relevant to this presentation
More informationCritical Appraisal of Article on Therapy
Critical Appraisal of Article on Therapy What question did the study ask? Guide Are the results Valid 1. Was the assignment of patients to treatments randomized? And was the randomization list concealed?
More informationCardiovascular risk assessment: Audit findings from a nurse clinic a quality improvement initiative
Cardiovascular risk assessment: Audit findings from a nurse clinic a quality improvement initiative Sarah Waldron RN, PG Dip (Adv Ng); Margaret Horsburgh RN, EdD, MA (Hons), Dip Ed, FCNA(NZ) School of
More informationChapter 6. Examples (details given in class) Who is Measured: Units, Subjects, Participants. Research Studies to Detect Relationships
Announcements: Midterm Friday. Bring calculator and one sheet of notes. Can t use the calculator on your cell phone. Assigned seats, random ID check. Review Wed. Review sheet posted on website. Fri discussion
More informationRandomized Clinical Trials. Sukon Kanchanaraksa, PhD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationScottish Diabetes Survey
Scottish Diabetes Survey 2011 Scottish Diabetes Survey Monitoring Group Foreword The Scottish Diabetes Survey 2011 data reflects many aspects of the quality of diabetes care across the whole of Scotland.
More informationGlossary of Methodologic Terms
Glossary of Methodologic Terms Before-After Trial: Investigation of therapeutic alternatives in which individuals of 1 period and under a single treatment are compared with individuals at a subsequent
More informationMain Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
More informationCenters for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244
March 7, 2014 Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Re: Dear Sir or Madam: On behalf of the American Heart Association (AHA), including the American Stroke
More informationUnderstanding Retrospective vs. Prospective Study designs
Understanding Retrospective vs. Prospective Study designs Andreas Kalogeropoulos, MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine Emory University Center for
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented National Quality Strategy Domain: Community / Population Health 2016 PQRS OPTIONS F INDIVIDUAL MEASURES:
More informationSUMMARY OF CHANGES TO QOF 2015/16 - ENGLAND CLINICAL
SUMMARY OF CHANGES TO QOF 2015/1 - ENGLAND KEY No change Retired/replaced Wording and/or change Point or threshold change Indicator ID change 14/15 QOF ID 15/1 QOF ID NICE ID Indicator wording Changes
More informationC-Reactive Protein and Diabetes: proving a negative, for a change?
C-Reactive Protein and Diabetes: proving a negative, for a change? Eric Brunner PhD FFPH Reader in Epidemiology and Public Health MRC Centre for Causal Analyses in Translational Epidemiology 2 March 2009
More informationTechnology Assessment
Technology Assessment Lifestyle Interventions for Four Conditions: Type 2 Diabetes, Metabolic Syndrome, Breast Cancer, and Prostate Cancer Technology Assessment Program Prepared for: Agency for Healthcare
More informationROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE
ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.
More informationChapter 4. Study Designs
Chapter 4 58 Study Designs The term study design is used to describe the combination of ways in which study groups are formed, and the timing of measurements of the variables. Choosing a study design appropriate
More informationPRACTICE PROBLEMS FOR BIOSTATISTICS
PRACTICE PROBLEMS FOR BIOSTATISTICS BIOSTATISTICS DESCRIBING DATA, THE NORMAL DISTRIBUTION 1. The duration of time from first exposure to HIV infection to AIDS diagnosis is called the incubation period.
More informationAVOIDING BIAS AND RANDOM ERROR IN DATA ANALYSIS
AVOIDING BIAS AND RANDOM ERROR IN DATA ANALYSIS Susan Ellenberg, Ph.D. Perelman School of Medicine University of Pennsylvania School of Medicine FDA Clinical Investigator Course White Oak, MD November
More informationRefugees with diabetes mellitus have higher prevalence of latent tuberculosis infection
Refugees with diabetes mellitus have higher prevalence of latent tuberculosis infection Matthew Magee Division of Epidemiology and Biostatistics School of Public Health, Georgia State University Saturday,
More informationEvidence-Based Secondary Stroke Prevention and Adherence to Guidelines
Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Mitchell S.V. Elkind, MD, MS Associate Professor of Neurology Columbia University New York, NY Presenter Disclosure Information Mitchell
More informationImproving cardiometabolic health in Major Mental Illness
Improving cardiometabolic health in Major Mental Illness Dr. Adrian Heald Consultant in Endocrinology and Diabetes Leighton Hospital, Crewe and Macclesfield Research Fellow, Manchester University Metabolic
More informationAUSTRALIAN VIETNAM VETERANS Mortality and Cancer Incidence Studies. Overarching Executive Summary
AUSTRALIAN VIETNAM VETERANS Mortality and Cancer Incidence Studies Overarching Executive Summary Study Study A u s t ra l i a n N a t i o n a l S e r v i c e V i e t n a m Ve t e ra n s : M o r t a l i
More informationBarriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness
Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität
More informationTips for surviving the analysis of survival data. Philip Twumasi-Ankrah, PhD
Tips for surviving the analysis of survival data Philip Twumasi-Ankrah, PhD Big picture In medical research and many other areas of research, we often confront continuous, ordinal or dichotomous outcomes
More informationSecure Messaging Evidence Table
APPENDIX E. Evidence Tables Secure Messaging Evidence Table Health Outcomes Simon, 2011 9 RCT; N=208 patients; 04/09-10/09 Elkjaer, 2010 1 Zhou, 2010 2 Harris, 2009 3 Ralston, 2009 6 Tuil, 2007 4 RCT;
More informationAfter acute myocardial infarction, diabetes CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS
CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS By Deborah Chyun, RN, PhD, Viola Vaccarino, MD, PhD, Jaime Murillo, MD, Lawrence H. Young, MD, and Harlan M. Krumholz,
More informationData Management. Shanna M. Morgan, MD Department of Laboratory Medicine and Pathology University of Minnesota
Data Management Shanna M. Morgan, MD Department of Laboratory Medicine and Pathology University of Minnesota None Disclosures Objectives History of data management in medicine Review of data management
More informationCan I have FAITH in this Review?
Can I have FAITH in this Review? Find Appraise Include Total Heterogeneity Paul Glasziou Centre for Research in Evidence Based Practice Bond University What do you do? For an acutely ill patient, you do
More informationResearch Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources
Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources James Floyd, MD, MS Sep 17, 2015 UW Hospital Medicine Faculty Development Program Objectives Become more
More informationCilostazol versus Clopidogrel after Coronary Stenting
Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background
More informationJNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates. January 30, 2014
JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates January 30, 2014 GOALS Review key recommendations from recently published guidelines on blood pressure and cholesterol management Discuss
More informationAfrican Americans & Cardiovascular Diseases
Statistical Fact Sheet 2013 Update African Americans & Cardiovascular Diseases Cardiovascular Disease (CVD) (ICD/10 codes I00-I99, Q20-Q28) (ICD/9 codes 390-459, 745-747) Among non-hispanic blacks age
More information4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH
METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE?
More informationDesign and principal results
International Task Force for Prevention Of Coronary Heart Disease Coronary heart disease and stroke: Risk factors and global risk Slide Kit 1 (Prospective Cardiovascular Münster Heart Study) Design and
More informationCardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg
Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate
More informationESCMID Online Lecture Library. by author
Do statins improve outcomes of patients with sepsis and pneumonia? Jordi Carratalà Department of Infectious Diseases Statins for sepsis & community-acquired pneumonia Sepsis and CAP are major healthcare
More informationUnderwriting Critical Illness Insurance: A model for coronary heart disease and stroke
Underwriting Critical Illness Insurance: A model for coronary heart disease and stroke Presented to the 6th International Congress on Insurance: Mathematics and Economics. July 2002. Lisbon, Portugal.
More informationHow To Know If You Have Microalbuminuria
3 PREVALENCE AND PREDICTORS OF MICROALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL OBSERVATIONAL STUDY Dr Ashok S Goswami *, Dr Janardan V Bhatt**; Dr Hitesh Patel *** *Associate
More informationData Analysis, Research Study Design and the IRB
Minding the p-values p and Quartiles: Data Analysis, Research Study Design and the IRB Don Allensworth-Davies, MSc Research Manager, Data Coordinating Center Boston University School of Public Health IRB
More informationChi Squared and Fisher's Exact Tests. Observed vs Expected Distributions
BMS 617 Statistical Techniques for the Biomedical Sciences Lecture 11: Chi-Squared and Fisher's Exact Tests Chi Squared and Fisher's Exact Tests This lecture presents two similarly structured tests, Chi-squared
More informationCompetency 1 Describe the role of epidemiology in public health
The Northwest Center for Public Health Practice (NWCPHP) has developed competency-based epidemiology training materials for public health professionals in practice. Epidemiology is broadly accepted as
More information6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology
Objectives Acute Coronary Syndromes Epidemiology and Health Care Impact Pathophysiology Unstable Angina NSTEMI STEMI Clinical Clues Pre-hospital Spokane County EMS Epidemiology About 600,000 people die
More informationTherapeutic Approach in Patients with Diabetes and Coronary Artery Disease
Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,
More informationWith Big Data Comes Big Responsibility
With Big Data Comes Big Responsibility Using health care data to emulate randomized trials when randomized trials are not available Miguel A. Hernán Departments of Epidemiology and Biostatistics Harvard
More informationCoronary Heart Disease (CHD) Brief
Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs
More informationMenthol cigarettes and smoking cessation behavior Authors: Allison C. Hoffman, FDA CTP; Donna Miceli, DLM Writing Services
Not yet peer-reviewed submitted for publication Menthol cigarettes and smoking cessation behavior Authors: Allison C. Hoffman, FDA CTP; Donna Miceli, DLM Writing Services Abstract Although much is known
More informationXarelto (Rivaroxaban)
Xarelto (Rivaroxaban) Hightly selective, reversible, direct oral FXa inhibitor Maxium concentratiion after 2 to 4 hrs High bioavailability(66%),increase with food ( suggest with food) 1/3 from renal excretion,
More informationKomorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group
Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Lotte Holm Land MD, ph.d. Onkologisk Afd. R. OUH Kræft og komorbiditet - alle skal
More informationScottish Diabetes Survey 2013. Scottish Diabetes Survey Monitoring Group
Scottish Diabetes Survey 2013 Scottish Diabetes Survey Monitoring Group Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 18 Duration of Diabetes... 18
More informationSTROKE April 2011 Dr Amer Jafar A delay in recognizing early warning signs (WS) and risk factors (RF) of ischemic stroke causes a delay in treatment Evaluated: knowledge of RF and WS and the impact of
More informationLow diabetes numeracy predicts worse glycemic control
Low diabetes numeracy predicts worse glycemic control Kerri L. Cavanaugh, MD MHS, Kenneth A. Wallston, PhD, Tebeb Gebretsadik, MPH, Ayumi Shintani, PhD, MPH, Darren DeWalt, MD MPH, Michael Pignone, MD
More informationFULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES
FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES Niteesh K. Choudhry, MD, PhD Harvard Medical School Division of Pharmacoepidemiology and Pharmacoeconomics
More information