Exam 2 Review

November 23, 2015

Topics from first half of course

Study designs
Confidence intervals statistical significance and
clinical significance
Sensitivity, specificity, PPV, NPV
Likelihood ratios
Ruling in and ruling out disease

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

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)

Lecture 6: Examining, Synthesizing,

and Communicating the Evidence
Evaluating the strength and applicability of
evidence
Types of evidence
Bradford Hills guidelines
Communicating with patients about evidence
Statistical literacy / numeracy
Systematic reviews and meta analysis
Forest plots
Publication bias

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

Average cost-effectiveness ratio

Average cost effectiveness ratio
= Net Cost / Net Health Benefit
= $/QALY

Program Net
Cost
A
$4500
B
$10,000

Net
Benefit
20 days
35 days

Average Cost
Effectiveness Ratio
$225 per day
$286 per day

Incremental cost effectiveness

ratio
Determine the incremental cost for an additional
unit of health benefit when you are choosing
between different interventions
Incremental cost
Cost B - Cost A
effectiveness ratio = Outcome - Outcome
B

Program Incremental Incremental

Costs
Benefits

Incremental Cost
Effectiveness Ratio

B vs. A

$367 per day

$5500

15 days

Cost effectiveness practice

questions

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

Lecture 9: Putting it all together

Harmful effects in health care
Shared decision making
Adherence/compliance

Exam 2 - IMPORTANT

November 30th from 10:00 AM to 11:50 AM

Pen or pencil
Calculator
Please bring unmarked copies of the following three
papers from Workshop 1 with your name on them (we
will collect them with the exam):

The International Early Lung Cancer Action Program Investigators.

Survival of patients with stage I lung cancer detected on CT
screening. 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 lungcancer mortality with low-dose computed tomographic screening.
N Eng J Med. 2011; 365: 395-409.

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