ADVANCED EPIDEMIOLOGY -Active space
Evidence-based Medicine [Link]
Studies on previously conducted studies.
Levels of study:
Systematic revieus meta-analysis (better
Preliminary studies to review Systematic study t statistical
[Link]°tudies. approach.
" To And the efect of an " To And the Anal effect of an
intevention or risk factor on intervention, drug, or risk Pactor.
outcome. Approach through Porest plot.
median
median
Anal odds rotio
median
Gmedian of medians)
1.0 2.0 3.0 median of medians
OR
Forest plots
Steps of evidence-based medicine / meta-analysis :
*DeRning the research question iusability { Peasibility
Literoture search.
" Choice of the effect size measure.
" Choice of anolutical method used.
Choice of sotusare, Cochrane :
BCoding of effect sizes. Online collection oft
gArnalysis. systematic revieus.
Reporting resuts.
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----Active space ----- Concept of publication bias:
ASsessed by Purnel plot.
"Prelerence of one type of research by a certain journals.
Funnel plot
yaxis
(ve)
0.2
0.4
0.6
0.8
[Link] @gnail,com
X-axis
X 2X 3% -2 1 0 1 2
ES
Generie unnel plot
Funnel-shaped implies no bias tve publication bias (positive >negative reports).
LEVELS OF EVDENCE :
meta
Analyses
(Best)
Randomized
Controlled Trials
Cohort studies
Case-control Studies
Case-Series or Case-Reports
editorials and Expert opinion
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Interpretation of experimental designs [Link]
----Active space
Intention to treat vs Per protocol analysis :
Intention to treat (TT analysis) (Better) Per protocol (P) analysis
Randomisation Accounted for Not accournted for
Example Total stucy population a00
Randomisation
medical mx Surgical m
(oo) (o0)
[Link] @[Link]
Contaminants/cross over
I00- I0 + a5 IO0- aS + I0
= 85
Complications Cured Complications Cured
IO 77
Aternatively, intention to
Rx with medical mx (o0)
No eross over
Cured Complications
89
nalyss No. of people with complication in those intended No. of people with complications
for medical mx : d/t medical mx :
Complications d/t medical mx Complications d/t medical mx
Totol population Rx witth medical mx Total population Rx wth medical mx
(nocross-over)
= /i00
Assessment of signikcant risk factor using oR qC:
95% CA
Value I not included Value Iincluded in
Fedback the interval
in the interval
Neaotive Positive Signitcart Non-signileant
Signihcant risk
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-----Active space ----- OR 95% CI Signifcant risk factor
O4 O.O-L09
4.7 O,8- 9.5
0.5 O.O-O,95
S.o La -9,5
|,2 0.95-ai
O.7 O,oa- 0.13
1,5 - 3.8
5.O1 4.85 - o.3
Number Needed to Treat or Harm [Link]
[Link] @[Link]
Non-event (cured, Event (2x failure, no Total
complication, disease) complication, no disease)
Experimental group X
Control group d
Event rate:
Control aroup event rate ceR):dy
xperimental qroup event rate EER): bx
Absolute risk reduction (AR caR -EER
No. needed totreat
ARR
ho. of people needed to
be treoted to avoid death
[Link]
Other Study Designs
multifactorial study designs :
AKA erossover study designs
Group Administer Wash out period Ist Acminister and
D
Fedback no drug/placebo
A Drug Placebo
Placebo drug
Advontoge i No ethical issues.
Disodvantagei Not used # drug is curative
disease is short l acute/lethal
Long wash out period
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Deductive, Inductive research: -Active space ----
Inductive research Deductive research
Develop theories " Test theories
Exploratory studies *Contrmatory studies
Focused qroup discussion
eottom-up approach Top-down approach
e Quantitative methods
Qualitative methods
Surgical trials :
Advantage i Improve surgical techniques.
Limitations :
" Ethicoal clearance.
"Standardization of procedure.
Biologjcal, individual variations.
Timina, anatomical variation, comorbidities of patient.
Nested case control study:
Formulation of a control group within oa cohort during the progression of study
Type of cohort study
"Better analysis.
Study of choice Ror rare/expensive investigation.
+Associated with time trend
Advantage : Odds ratio, risk ratio, incidence, attributable risk can be calculated
eg: Study for mi over io years. Inferior Equivalency Superior
No. of people with mi during the initial Range Range Range
progression of study i controls AV
Superiority trials
Superiorty equivalerey and non inferiority trials : A
experimental drug Av
- much eiective than control drug Non-Inferiority trials
A
Superiorty
D
Fedback Same efect but lesser side effects
thon control drug don-inferiority
- less cost but equal efficacy as control
drug 'equolerey
Equivalence trials
A
A
Ó(detto)iallouwed effect measure of
difference in effects between new -A +A
standord drug).
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----ACctive space Operations research:
" Health sustem research
National program implementation (the process, means f duration of
programs).
- Remove bottleneck effect, cutural hindrances.
Improve eflectivity of the national health probler.
Standards iguidelines in epidemiological methods :
Randomized Control CONSORT Consolidated Standards of Reporting Trials
Trials
Observational studies STROBE Strengthening the Reporting of oeservational
studies in epidenioloqy
Systematic reviews PRISMA Preterred eporting Items for Systematic
Reviews and meta Analyses
Case reports CARE CAse REpOrt
Qualitative research SROR Standards for Reporting Qualitative Research
Diagnostic/prognostic STARD Standards for Reporting of Diagnostic
studies AcCuracy
Quality improvement SQUIRE Standards or Quality Improvement Reporting
studies Excellence
Quasitrial : 'Quasi = partial
Non-randomised trials.
65805afccbeaecO c250d7fe6
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