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Lab Manual for Moffitt-Long and Mount Zion

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Clinical Epidemiology Core Curriculum

Academic Year 2006-2007

taught by Enrique Terrazas, MD, MS, William Karlon, MD, PhD
based on the text by Sackett, Haynes, Guyatt and Tugwell


8:30-10:00 a.m.
Site Specific Locations*

Lect#

Day

Date

Lecture Title

Faculty

1 Mon Feb 25 Introduction to course, the diagnostic process, mean, SD, SEM, Kappa, coefficient of variation, correlation coefficient. E. Terrazas
2 Tue Mar 04 Sensitivity, specificity, 2x2 table method for predictive value, test independence, ROC curves E. Terrazas
3 Mon Mar 10 Odds and probability, likelihood ratios, treatment thresholds E. Terrazas
4 Mon Mar 17 Screening and prognostic tests E. Terrazas
5 Mon Mar 24 Evaluating therapies: risk ratios, odds ratios, number needed to treat, power, blinding, etc. Annals of Internal Medicine User's Guide to Evidence-Based Practice E. Terrazas

*Site Specified Locations: Mondays

  • For those presenting at Moffitt-Long it will be held in L-551A.
  • At China Basin (please go to L-551A).
  • At SFGHTC in the room with the plasma screen in the Clin Lab.
  • At the VAH (please go to L-551A).

*Site Specified Locations: Tuesdays

  • For those presenting at Moffitt-Long it will be held in L-551A
  • At China Basin in the large conference room
  • At SFGHTC in the room with the plasma screen in the Clin Lab.
  • At the VAH (please go to L-551A).

 

This is a short course, with reading and homework, to provide a brief introduction to clinical epidemiology. We'll cover topics important for people interested in diagnostic testing, including inter-rater reliability, likelihood ratios, ROC curves, and evaluation of screening tests, prognostic tests, and treatments. (It's important to understand how to evaluate treatments because the value of diagnostic tests depends partly on the efficacy of treatments for the disease!)

Clinical Epidemiology Course Objectives

A. Attitudes

  1. Increased confidence and comfort approaching journalarticles

  2. Preference for evidence over authority

  3. Desire for independent learning

  4. Appreciation of the difficulty of clinical medicine andclinical research

B. Knowledge

  1. Good and bad reasons tests are done

  2. Diagnostic tests

    • Reliability

    • Precision

    • Accuracy (sensitivity and specificity)

    • Independence of diagnostic tests

    • ROC Curves

    • Likelihood ratios

    • Test and treatment thresholds

  3. Screening and prognostic tests; confidence intervals

  4. Measuring the efficacy of treatments; relevance of that information to selection of diagnostic tests and test thresholds

C. Skills:

  1. Calculation of and complete comfort with sensitivity, specificity, positive and negative predictive value

  2. Calculation of posterior probability for dichotomous and nondichotomous tests using likelihood ratios

  3. Critical appraisal of clinical research articles

  4. Ability to review an abstract of a clinical research article and decide whether the article is worth pulling, and if so what to look for.

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