Embed Size (px)
Citation preview
Inde 201POM Q1 (Fall quarter) 2015
September 28, 2015
Practice of MedicineQuantitative Medicine:
Epidemiology & Biostatistics
1
Objectives for today
Introductions
Epidemiology in medicine
Course overview, review of the syllabus
2
Course Instructor & TAs
Rita Popat, PhD (QM Topic Lead)Clinical Associate Professor
Dept. of Health Research & Policy (HRP)
Division of Epidemiology
Justin Norden, M.Phil. (Course TA)2nd yr medical student
3
Introduction to epidemiology
What is epidemiology?
Why should you care?
5
What is epidemiology?
What does the word mean?From Greek: epi=upon + demos=people“upon the people”
Epidemic: describes a disease that quickly and severely affects lots of people and then subsides
6
John Snow and the cholera epidemic in the 1850s
1813-1858
7
What is epidemiology? “Epidemiology is the study of the distribution and
determinants of health-related states or events in populations and the application of this study to control health problems”
- Last JM
8
Aims of Epidemiology
1. Determine risk factors of various diseases
2. Identify segments of the population with highest risk to target prevention and intervention opportunities
3. Evaluate the effectiveness of health programs and services in improving health of the population
9
What does the array below represent?
1. High blood pressure
2. High blood cholesterol
3. Smoking
4. Obesity
5. Diabetes
6. Physical inactivity
10
Risk factors for cardiovascular disease
“The concept of CVD risk factors has become an integral part of the modern medical curriculum and has led to the development of effective treatment and preventive strategies in clinical practice.”
More than 50 million US adults take aspirin regularly for long-term prevention of cardiovascular disease, typically either 81 mg/d or 325 mg/d
?
Acetylsalicylic acid C9H8O4 [2-(acetyloxy)benzoic acid]
Clinical Epidemiology
Clinical epidemiology is the application of epidemiologic principles and methods to problems encountered in clinical medicine.
- Fletcher RH, Fletcher SW, Wagner EH
In “Clinical Epidemiology: the essentials”
14
Why should you care?
15
Methods in Quantitative medicine
relevant for other foundations of
medical care (population health,
EBP, nutrition, policy…)
Step 1 exam! OK, relevant…but
the reasons that really matter…
- Better advocate for your patient
- Better doctor
Why should you care?Epidemiology/clinical research informs all of the following:
What diseases should you be looking for in patients?
Which patients should you screen for disease?
How are diseases diagnosed?
What conditions cause the disease (risk factors)?
How to prevent disease in your patients?
How to treat diseases in your patients?
What is disease prognosis?
Public health policy/standard of practice.16
Why should you care?
Clinical issues in the practice of medicine
Birth Diagnosis Death
SusceptibilityPreventionScreening and diagnosis
Clinical progressionPrognosis
TreatmentPrognosisPrevention of complications
X X X
Why should you care?
Think about the patient interview you observed on Friday, Sept. 25th
19
Why should you care?Epidemiology/clinical research informs all of the following:
What diseases would you be looking for in this patient?
How are diseases diagnosed?
What conditions cause the disease (risk factors)?
Which patients should you screen for disease?
How to prevent disease in your patients?
How to treat diseases in your patients?
What is disease prognosis?
20
Source: http://www.health.gov.on.ca/english/providers/pub/cancer/psa/psa_guide/faq.html
Source population
Open repair
Endovascular repair
Outcome +
Outcome -
Outcome +
Outcome -
TIME
24
?
Randomize or Observe?
Observational vs. Experimental Studies
Experimental studies – the investigator tries to control the environment in which the hypothesis is tested (the randomized, double-blind clinical trial is the gold standard)
Observational studies – the population is observed without any interference by the investigator
25
Why Observational Studies?
Cheaper Faster Can examine long-term effects Hypothesis-generating Sometimes, experimental studies are not ethical (e.g.,
randomizing subjects to smoke) Sometimes, experimental studies are not possible
26
Cohort study: Basic design
Source population
Open repair
Endovascular repair
27
Outcome +
Outcome +
Outcome -
Outcome -
Endovascular vs Open Repair of Renal Artery Aneurysms: Outcomes of Repair and Long-Term Renal Function. J Am Coll Surg 2013;217:263-269
Prospective Retrospective
Case-control studies
Cohort studies
Case seriesCross-sectional
studiesEcologic studies
Descriptive AnalyticRandomized Clinical
Trials
Experiments
Studies of human subjects
Observational
28
Experimental (Intervention) Studies
29
Cross-sectional studies
Case-control studies
Cohort studies
RCTs
Evidence for causality
Strong
Weak
Epidemiology and medicine: Why should you care?
Keeping up with the medical literature will make you a better doctor
You risk being misled if you aren’t savvy to study design and statistics
You have to understand risk in order to help patients understand risk
30
“Ultimately, treatment decisions are made by patients, not
practitioners and not policy makers. Patients rely on
physicians and other health care professionals to deliver the
most amount of information possible about treatment risks
and benefits. Patients then can consider these issues in the
context of their own individual preferences. Policy makers
Should not interfere with this process unless the evidence
they use to mandate care is substantial.”
JAMA editorial (August 17, 2011—Vol 306, No. 7)
Summary: Applications of epidemiology to medicine
Disease surveillance
Discovering causes
Evaluating diagnostic tests
Evaluating screening programs
Determining the natural history of disease
Finding prognostic factors
Testing treatments
32
Objectives for today!
Introductions
Epidemiology in medicine
Course overview, survey, review of the syllabus.
33
Primary Course Objectives
To understand the research methods needed to create and synthesize a body of knowledge that can be applied to patient care.
To feel confident in interpreting and implementing existing information related to diseases of humans, patient care, and public health.
34
Class survey!
Please complete Qs 1 through 6 (resting pulse) Group assignment (if birthday is an odd number – 15 squats, if
birthday is an even number – 15 arm raises)Redcap link:
35
You may open the survey in your web browser by clicking the link below:
If the link above does not work, try copying the link below into your web browser:
POM class survey 2015
https://redcap.stanford.edu/surveys/?s=F38J8HFEYC
Course overview
36
Blended course (motivations)9-modules: pre-recorded online series on
epidemiology and biostatistics 3 small-group sessions Reading: Medical Epidemiology, Greenberg et.
al, (editions 2-4 are all acceptable) Quizzes Review sessions and Office hours Integrated POM final exam
Course overview
37
IMPORTANT: relevant materials and information for QM can be found on the homepage:
F15-INDE-201-01 Materials / Quantitative Medicine: STUDENTS PLEASE USE THIS
This is all you need to access QM materials
Teacher Learner
Content
Context
Interactions in Education: Reflections
Lecture
Blended
Courtesy Dr. Kelley Skeff
Statistical concepts we will cover include…
46
fundamental concepts of measurement scales of measurement distribution, central tendency, variability, probability disease prevalence and incidence health impact (eg, risk differences and ratios) sensitivity, specificity, predictive values
fundamental concepts of hypothesis testing and statistical inference confidence intervals statistical significance and Type I error statistical power and Type II error
Use of statistical tests for different types of data (e.g., comparing means, proportions).
This is not a statistics course!
47
If you want to learn more about research
methodology or statistics….
Research methodology
HRP 225**Fall quarter
HRP 226Winter quarter
HRP 251Spring
*http://med.stanford.edu/epidemiology/epiProgram_2006.pdf
Biostatistics
HRP 258**Spring quarter
HRP 261Winter quarter
HRP 262Spring quarter
HRP 259Fall quarter
Clinical Epidemiology*
** core requirements for clinical research scholarly concentration
48
Course requirements
49
Satisfactory completion of the quizzes and the final exam
Office hours Rita Popat Wednesday 1:30-2:20 pm Location: LKSC 203/4 Tel: 650-498-5206 E-mail: [email protected]
Justin Norden
Office hour: Tuesday 12:30-1:20 pm,
Location: LKSC Cafe
E-mail: [email protected]
50
PLEASE CONTACT US!
