20151123 Lecture9 Exam2Review(1)

8/18/2019 20151123 Lecture9 Exam2Review(1)

1/13

Exam 2 Review

November 23, 2015


2/13

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


3/13

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


4/13

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)


5/13

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


6/13

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


7/13

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


8/13

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


9/13

Cost effectiveness practice

questions


10/13

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


11/13

Lecture 9: Putting it all together

• Harmful effects in health care

• Shared decision making

•

Adherence/compliance


12/13

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.

•

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.


13/13

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

Documents

20151123 Lecture9 Exam2Review(1)