20151123 lecture9 exam2review(1)
TRANSCRIPT
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Exam 2 Review
November 23, 2015
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Topics from first half of course
• Study designs
• Confidence intervals – statistical significance andclinical significance
• Sensitivity, specificity, PPV, NPV
• Likelihood ratios
• Ruling in and ruling out disease
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Rule in or Rule Out
• Rule In• SpPin: with high specificity, positive result rules in
diagnosis
• Large LR (+)• LR+ = sensitivity / (1-specificity)
• Rule Out
• SnNout: with high sensitivity, negative test rules out diagnosis
• Small LR (-)
• LR- = (1-sensitivity) / specificity
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Topics from second half of course
• Workshop 1 (10/26)
• Lecture 6 (11/2)
•
Lecture 7 (11/9)• Lecture 8 (11/16)
• Lecture 9 (today)
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Lecture 6: Examining Synthesizing
and Communicating the Evidence
• Evaluating the strength and applicability ofevidence
• Types of evidence
• Bradford Hill’s guidelines
• Communicating with patients about evidence
• Statistical literacy / numeracy
• Systematic reviews and meta analysis• Forest plots
• Publication bias
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Lecture 7: Decision Making Under
Conditions of Uncertainty
• Clinical decision analyses• Decision trees
• Sensitivity analysis
• Economic evaluations• Average cost effectiveness ratio
• Incremental cost effectiveness ratio
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Average cost-effectiveness ratio
• Average cost effectiveness ratio• = Net Cost / Net Health Benefit
• = $/QALY
Program Net
Cost
Net
Benefit
Average Cost
Effectiveness Ratio
A $4500 20 days $225 per dayB $10,000 35 days $286 per day
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Incremental cost effectiveness
ratio
• Determine the incremental cost for an additionalunit of health benefit when you are choosingbetween different interventions
• Incremental costeffectiveness ratio =
Program Incremental
Costs
Incremental
Benefits
Incremental Cost
Effectiveness Ratio
B vs. A $5500 15 days $367 per day
Cost B - Cost AOutcome B - Outcome A
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Cost effectiveness practice
questions
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Lecture 8: Patient-reported outcomes
and health-related quality of life
• Health outcomes research• Safety
• Equity
•
Effectiveness• Efficiency
• Timeliness
• Patient-Centeredness
• Measuring health• QALY, DALY
• Rating scales
• Continuous quality improvement
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Lecture 9: Putting it all together
• Harmful effects in health care
• Shared decision making
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Adherence/compliance
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Exam 2 - IMPORTANT
• November 30th from 10:00 AM to 11:50 AM
• Pen or pencil
• Calculator
•Please bring unmarked copies of the following threepapers from Workshop 1 with your name on them (wewill collect them with the exam):
• The International Early Lung Cancer Action Program Investigators.Survival of patients with stage I lung cancer detected on CTscreening. N Eng J Med. 2006; 355: 1763-1771.
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Bach PB, Jett JJ, Pastorino U, Tockman MS, Swensen SJ, Begg CB.Computed tomography screening and lung cancer outcomes. JAMA.2007; 297: 953-961.
• The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening.N Eng J Med. 2011; 365: 395-409.
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Workshops 2 and 3
• December 7: Workshop 2 on Statins and CVD• Presentation (7.5% of final grade)
• December 14: Workshop 3 on Treating Acute Otitis
Media with Antibiotics• Presentation (10% of final grade)
• Written Assignment (12% of final grade)
• All guidelines are available on Blackboard