New Math: Taking on Overdiagnosis Waste and Harm Flipped Classroom: Pre-work
|
|
- Myron Pierce
- 6 years ago
- Views:
Transcription
1 New Math: Taking on Overdiagnosis Waste and Harm Flipped Classroom: Pre-work IHI Forum, Session C24 Faculty: Dr. James Leo, Helen Macfie
2 Session Objectives Understand the difference between absolute and relative risk reduction and the numbers needed to treat or harm, as well as the relationship between NNT and value versus waste Describe the impact of publication bias on evidence-based medicine evaluations Identify clinical decision support tools to alert practitioners to overdiagnosis and overtreatment and develop a strategic focus and tools to reduce resulting harm and waste
3 Flipped Classroom Pre-Work Please review the definitions on slide 4-7, review the attached abstract/article and then answer the questions on slide 8
4 Absolute Risk Reduction Wikipedia In epidemiology, the absolute risk reduction, risk difference or absolute effect is the change in the risk of an outcome of a given treatment or activity in relation to a comparison treatment or activity. It is the inverse of the number needed to treat. In general, absolute risk reduction is the difference between one treatment comparison group's event rate (EER) and another comparison group s event rate (CER). The difference is usually calculated with respect to two treatments A and B, with A typically a drug and B a placebo. For example, A could be a 5-year treatment with a hypothetical drug, and B is treatment with placebo, i.e. no treatment. A defined endpoint has to be specified, such as a survival or a response rate. For example: the appearance of lung cancer in a 5- year period. If the probabilities p A and p B of this endpoint under treatments A and B, respectively, are known, then the absolute risk reduction is computed as (p B p A )
5 Relative Risk Reduction Wikipedia In epidemiology, the relative risk reduction is a measure calculated by dividing the absolute risk reduction by the control event rate Like many other epidemiological measures, the same equations can be used to measure a benefit or a harm (although the signs may need to be adjusted, depending upon how the data was collected)
6 Number Needed to Treat Wikipedia The number needed to treat (NNT) is an epidemiological measure used in communicating the effectiveness of a healthcare intervention, typically a treatment with medication. The NNT is the average number of patients who need to be treated to prevent one additional bad outcome (e.g. the number of patients that need to be treated for one to benefit compared with a control in a clinical trial). It is defined as the inverse of the absolute risk reduction. It was described in The ideal NNT is 1, where everyone improves with treatment and no one improves with control. The higher the NNT, the less effective is the treatment. NNT is similar to number needed to harm (NNH), where NNT usually refers to a therapeutic intervention and NNH to a detrimental effect or risk factor. NNT is an important measure in pharmacoeconomics. If a clinical endpoint is devastating enough (e.g. death, heart attack), drugs with a high number needed to treat may still be indicated in particular situations. If the endpoint is minor, health insurers may decline to reimburse drugs with a high NNT.
7 Sample Math Mortality in Control Group = 4% Mortality in Treatment Group = 1% Answer Math RRR: Relative Risk Reduction the relative reduction in adverse outcome with a given treatment RRR = 75% (4%-1%) 4% ARR: The absolute reduction in likelihood of the adverse outcome ARR = 3% (4% - 1%) NNT: How many patients you have to treat to achieve the desired outcome, or to avoid the undesired outcome/harm (NNTB, NNTH) NNT = ARR =
8 Now You Try It Understanding Study Results: Questions re: the IMPROVE-IT Trial Please review the attached abstract from the IMPROVE-IT Trial. The full study can be accessed and downloaded for free from or by Googling IMPROVE-IT Trial and clicking on the first website listed Questions to review/answer What is the Absolute Risk Reduction for the primary endpoint for patients receiving the study drug vs. control drug? ARR: For the reader perusing the Conclusion section of the abstract, do the conclusions over-generalize the results? YES/NO If so, how so? Assuming a monthly cost of the study drug (simvastatin 40 mg ezetemibe 10 mg) of $290 (current price as of November, 2016 per in Southern California) vs. $8 per month for simvastatin 40 mg, what is the cost per primary end point avoided? Cost: What is the impact of generalizing the results of this trial on the cost per avoided event?
9 Extra Credit Review the attached Editorial from JAMA: Evolving Approaches for Statins in Primary Prevention Progress, but Questions Remain. JAMA, November 15, 2016 Evolving Approaches for Statins in Primary Prevention Progress, but Questions Remain Ann Marie Navar, MD, PhD; Eric D. Peterson, MD, MPH
New Math: Taking on Overdiagnosis Waste and Harm
New Math: Taking on Overdiagnosis Waste and Harm Stewards of Precious Resources Helen Macfie, Pharm.D., FABC Chief Transformation Officer James D. Leo, MD, FACP, FCCP Chair, Physician Society Board of
More informationGLOSSARY OF GENERAL TERMS
GLOSSARY OF GENERAL TERMS Absolute risk reduction Absolute risk reduction (ARR) is the difference between the event rate in the control group (CER) and the event rate in the treated group (EER). ARR =
More informationCritical Appraisal of Evidence A Focus on Intervention/Treatment Studies
Critical Appraisal of Evidence A Focus on Intervention/Treatment Studies Bernadette Mazurek Melnyk, PhD, CPNP/PMHNP, FAANP, FAAN Associate Vice President for Health Promotion University Chief Wellness
More informationCritical Appraisal of Evidence
Critical Appraisal of Evidence A Focus on Intervention/Treatment Studies Bernadette Mazurek Melnyk, PhD, CPNP/PMHNP, FNAP, FAAN Associate Vice President for Health Promotion University Chief Wellness Officer
More informationJournal Club: Fairfax Internal Medicine. Stephanie Shin PGY-2 Bianca Ummat PGY-2 July 27, 2012
Journal Club: Fairfax Internal Medicine Stephanie Shin PGY-2 Bianca Ummat PGY-2 July 27, 2012 S Objective Review EBM basic principles Learn how to apply the principles in critically appraising the article.
More informationHow to Interpret a Clinical Trial Result
How to Interpret a Clinical Trial Result Edward V. Loftus, Jr., M.D. Professor of Medicine Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine Rochester MN CP123456-1 Are results
More informationCritical Appraisal of a Meta-Analysis: Rosiglitazone and CV Death. Debra Moy Faculty of Pharmacy University of Toronto
Critical Appraisal of a Meta-Analysis: Rosiglitazone and CV Death Debra Moy Faculty of Pharmacy University of Toronto Goal To provide practitioners with a systematic approach to evaluating a meta analysis
More informationConsider the following hypothetical
Nurse Educator Nurse Educator Vol. 32, No. 1, pp. 16-20 Copyright! 2007 Wolters Kluwer Health Lippincott Williams & Wilkins How to Read, Interpret, and Understand Evidence-Based Literature Statistics Dorette
More informationSPECIAL COMMUNICATION
Evidence-Based Medicine, Part 2. An Introduction to Critical Appraisal of Articles on Therapy Roberto Cardarelli, DO, MPH Richard F. Virgilio, DO Lockwood Taylor, MPH This article provides an introductory
More informationGlossary of Practical Epidemiology Concepts
Glossary of Practical Epidemiology Concepts - 2009 Adapted from the McMaster EBCP Workshop 2003, McMaster University, Hamilton, Ont. Note that open access to the much of the materials used in the Epi-546
More informationOutline. What is Evidence-Based Practice? EVIDENCE-BASED PRACTICE. What EBP is Not:
Evidence Based Practice Primer Outline Evidence Based Practice (EBP) EBP overview and process Formulating clinical questions (PICO) Searching for EB answers Trial design Critical appraisal Assessing the
More informationEvidence Based Medicine
Course Goals Goals 1. Understand basic concepts of evidence based medicine (EBM) and how EBM facilitates optimal patient care. 2. Develop a basic understanding of how clinical research studies are designed
More informationCARDIOVASCULAR HEALTH LIVING A HEART HEALTHY LIFE. Matt Handley MD Group Health Physicians
CARDIOVASCULAR HEALTH LIVING A HEART HEALTHY LIFE Matt Handley MD Group Health Physicians WILLIE SUTTON Add together your risk of dying from breast cancer and colon cancer (women), or prostate cancer and
More informationTHERAPY WORKSHEET: page 1 of 2 adapted from Sackett 1996
THERAPY WORKSHEET: page 1 of 2 adapted from Sackett 1996 Citation: Are the results of this single preventive or therapeutic trial valid? Was the assignment of patients to treatments randomised? -and was
More informationQuantifying the Benefits and Harms of Interventions: Relative vs. Absolute Risk
JOURNAL CLUB LECTURE SERIES: Quantifying the Benefits and Harms of Interventions: Relative vs. Absolute Risk Tuesday, May 12 th, 2015 Anil N. Makam, MD MAS Oanh K. Nguyen, MD MAS Division of General Internal
More informationDr. Engle has received an unrestricted educational grant for the MD Anderson Pain Medicine Fellowship.
Mitchell Engle, MD, PhD Dr. Mitchell Engle earned his medical degree and a Ph.D. in Pharmacology from the University Of Iowa Carver College Of Medicine. His Ph.D. research examined the role of the spinal
More informationthe standard deviation (SD) is a measure of how much dispersion exists from the mean SD = square root (variance)
Normal distribution The normal distribution is also known as the Gaussian distribution or 'bell-shaped' distribution. It describes the spread of many biological and clinical measurements Properties of
More informationCLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM
CLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM Principles of Decision Making Knowing the patient s true state is often unnecessary Does my patient
More informationJournal Club Handbook
Illingworth Library Supporting your Knowledge for Healthcare Journal Club Handbook Sarah Massey Dr Charlotte Elder 0 Contents 1. Introduction 2. What is Journal Club? 3. How is Journal Club organised?
More informationUnderstanding NNT- Patient s and Physicians Perspective
Understanding NNT- Patient s and Physicians Perspective A K Ghosh, K Ghosh Department of Internal Medicine Mayo Clinic Rochester, Minnesota, USA Number needed to treat - NNT Useful yardstick to describe
More informationJAMA. 2011;305(24): Nora A. Kalagi, MSc
JAMA. 2011;305(24):2556-2564 By Nora A. Kalagi, MSc Cardiovascular disease (CVD) is the number one cause of mortality and morbidity world wide Reducing high blood cholesterol which is a risk factor for
More informationPrevention Strategies: Wisdom and Folly
Prevention Strategies: Wisdom and Folly Victoria Maizes MD Executive Director Arizona Center for Integrative Medicine Professor of Medicine, Family Medicine and Public Health University of Arizona \ What
More informationDo Women Benefit From Statins for Primary Prevention?: Controversy, Challenges and Consensus
Do Women Benefit From Statins for Primary Prevention?: Controversy, Challenges and Consensus C. Noel Bairey Merz MD, FACC, FAHA Professor and Women s Guild Endowed Chair Director, Barbra Streisand Women
More informationIntegrating Effectiveness and Safety Outcomes in the Assessment of Treatments
Integrating Effectiveness and Safety Outcomes in the Assessment of Treatments Jessica M. Franklin Instructor in Medicine Division of Pharmacoepidemiology & Pharmacoeconomics Brigham and Women s Hospital
More informationTREATING THE MANY TO BENEFIT THE FEW : USING EXAMPLES FROM HEALTHCARE TO MAKE STATISTICS EXCITING AND RELEVANT
TREATING THE MANY TO BENEFIT THE FEW : USING EXAMPLES FROM HEALTHCARE TO MAKE STATISTICS EXCITING AND RELEVANT Taiwo Amoo, Department of Business Management, Murray Koppelman School of Business Brooklyn
More informationBiostatistics 2 - Correlation and Risk
BROUGHT TO YOU BY Biostatistics 2 - Correlation and Risk Developed by Pfizer January 2018 This learning module is intended for UK healthcare professionals only. PP-GEP-GBR-0957 Date of preparation Jan
More informationThe Engaged Patient: Understanding and Participating in Shared Health Decisions
The Engaged Patient: Understanding and Participating in Shared Health Decisions By Tom Bartol, NP Richmond Area Health Center HealthReach Community Health Centers bartolnp@gmail.com Twitter: @tombartol
More informationEBM, Study Design and Numbers. David Frankfurter, MD Professor OB/GYN The George Washington University
EBM, Study Design and Numbers David Frankfurter, MD Professor OB/GYN The George Washington University 1978? 1978 Best Picture of 1978 The Deer Hunter Universal Studios The 50th Academy Awards were held
More informationExpressions and illustra0ons of treatment effect. Ka$e Program Dalhousie University
Expressions and illustra0ons of treatment effect Ka$e Program Dalhousie University The following slides demonstrate how data from clinical trials can be expressed. Slides provide insights regarding how
More informationDisclosures No relationships (not even to an employer) No off-label uses. Cholesterol Lowering Guidelines: What now?
Disclosures No relationships (not even to an employer) No off-label uses Cholesterol Lowering Guidelines: What now?, FACP 1 2 65-year-old white woman Total cholesterol 175mg/dL HDL 54 mg/dl LDL 96 mg/dl
More informationCritical Appraisal Series
Definition for therapeutic study Terms Definitions Study design section Observational descriptive studies Observational analytical studies Experimental studies Pragmatic trial Cluster trial Researcher
More informationMEASURING THE SIZE OF A TREATMENT EFFECT: RELATIVE RISK REDUCTION, ABSOLUTE RISK REDUCTION, AND NUMBER NEEDED TO TREAT
MEASURING THE SIZE OF A TREATMENT EFFECT: RELATIVE RISK REDUCTION, ABSOLUTE RISK REDUCTION, AND NUMBER NEEDED TO TREAT Hussein Hollands, MD, MS (epid) Peter J. Kertes, MD, CM, FRCS(C) 72 The purpose of
More informationNovel PCSK9 Outcomes. in Perspective: Lessons from FOURIER & ODYSSEY LDL-C. ASCVD Risk. Suboptimal Statin Therapy
LDL-C Novel PCSK9 Outcomes Suboptimal Statin Therapy ASCVD Risk in Perspective: Lessons from FOURIER & ODYSSEY Jennifer G. Robinson, MD, MPH Professor, Departments of Epidemiology & Medicine Director,
More informationLipids What s new? Meera Jain, MD Providence Portland Medical Center
Lipids 2016- What s new? Meera Jain, MD Providence Portland Medical Center 1 Can I trust the ASCVD risk calculator? Do harms outweigh benefits in primary prevention? Is there anything besides a statin?
More informationDatabase of treatment effects user guide
Database of treatment effects user guide The following is a manual for how to use the database of treatment effects. The first section explains how the spreadsheet works. The second section explains some
More informationDr. Lancelot Mui, MPH Post-doctoral Fellow School of Public Health and Primary Care The Chinese University of Hong Kong
A randomized controlled trial to evaluate the efficacy of an automated behavioural informatics system to increase physical activity level of family members of diabetes patients in China Dr. Lancelot Mui,
More informationDeprescribing: A Practical Guide
Deprescribing: A Practical Guide The information in this booklet should be used as a pragmatic decision aid, in conjunction with other relevant patient specific data. Useful resource links http://www.derbyshiremedicinesmanagement.nhs.uk/assets/clinical_guidelines/clinical_guidelines_fr
More informationRecommendations on Screening for Lung Cancer 2016
Recommendations on Screening for Lung Cancer 2016 Canadian Task Force on Preventive Health Care (CTFPHC) Putting Prevention into Practice Canadian Task Force on Preventive Health Care Groupe d étude canadien
More informationDyslipidemia: Lots of Good Evidence, Less Good Interpretation.
Dyslipidemia: Lots of Good Evidence, Less Good Interpretation. G Michael Allan Evidence & CPD Program, ACFP Associate Professor, Dept of Family, U of A. CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure
More informationTreatment costs and insurance
Treatment costs and insurance The Dutch health care system is rather complicated, and probably works differently from the system you are used to in your home country. It is a legal obligation for everyone
More informationACR OA Guideline Development Process Knee and Hip
ACR OA Guideline Development Process Knee and Hip 1. Literature searching frame work Literature searches were developed based on the scenarios. A comprehensive search strategy was used to guide the process
More informationProviding High Value Cost-Conscious Care:
Providing High Value Cost-Conscious Care: Biostatistical Concepts You Need to Know 2012-2013 Presentation #5 0f 10 http://hvc.acponline.org/ Learning Objectives Understand that a working knowledge of basic
More informationA Fundamental 4 Letter Word for Compliance Professionals
RISK Speaker: Frank Ruelas Facility Compliance Professional, SJHMC/DH Session 309 Risk: A Fundamental 4 Letter Word for Compliance Professionals Break down risk into its fundamental components to better
More informationIs Lower Better for LDL or is there a Sweet Spot
Is Lower Better for LDL or is there a Sweet Spot ALAN S BROWN MD, FACC FNLA FAHA FASPC DIRECTOR, DIVISION OF CARDIOLOGY ADVOCATE LUTHERAN GENERAL HOSPITAL, PARK RIDGE, ILLINOIS DIRECTOR OF CARDIOLOGY,
More informationRISK 2/24/2017. Session 309 Risk: A Fundamental 4 Letter Word for Compliance Professionals. How. Who. Why. What
RISK Speaker: Frank Ruelas Facility Compliance Professional, SJHMC/DH Session 309 Risk: A Fundamental 4 Letter Word for Compliance Professionals Break down risk into its fundamental components to better
More informationDisclosures. May 15 th, Influenza Vaccination as Secondary Prevention for Acute Coronary Events Where do we need to go in clinical practice?
Influenza Vaccination as Secondary Prevention for Acute Coronary Events Where do we need to go in clinical practice? May 15 th, 2014 Robi Goswami, MD Cardiologist Piedmont Heart Institute Disclosures None
More informationHow to Make Sense of Statistics Reported in the Medical Literature
How to Make Sense of Statistics Reported in the Medical Literature Colin P. West, MD, PhD Division of General Internal Medicine Division of Biomedical Statistics and Informatics Denise M. Dupras, MD, PhD
More informationJournal Club September 29, Vanessa AKIKI PGYlII Internal Medicine
Journal Club September 29, 2017 Vanessa AKIKI PGYlII Internal Medicine AUBMC 2017 Case Presentation 41-year-old man who was diagnosed with type 1 diabetes 21 years ago presents to your clinic. He believes
More informationIs Lisdexamfetamine Dimesylate Safe and Effective in Reducing ADHD Symptoms?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 12-2016 Is Lisdexamfetamine Dimesylate Safe
More informationTORCH: Salmeterol and Fluticasone Propionate and Survival in COPD
TORCH: and Propionate and Survival in COPD April 19, 2007 Justin Lee Pharmacy Resident University Health Network Outline Overview of COPD Pathophysiology Pharmacological Treatment Overview of the TORCH
More informationMeasuring the Impact of Improved Coverage for Obesity Treatment. Ted Kyle, RPh, MBA
Measuring the Impact of Improved Coverage for Obesity Treatment Ted Kyle, RPh, MBA Disclosures Consulting Fees 3D Communications Eisai EnteroMedics HealthLogiX Novo Nordisk Sentara Healthcare St Luke s
More informationSESSION 3 11 AM 12:30 PM
SESSION 3 11 AM 12:30 PM for the Primary Prevention of Cardiovascular Disease: A Personalized Approach SPEAKER Samia Mora MD, MHS Presenter Disclosure Information The following relationships exist related
More informationGarvan Ins)tute Biosta)s)cal Workshop 7/5/2015. Tuan V. Nguyen. Garvan Ins)tute of Medical Research Sydney, Australia
Garvan Ins)tute Biosta)s)cal Workshop 7/5/2015 Tuan V. Nguyen Tuan V. Nguyen Garvan Ins)tute of Medical Research Sydney, Australia What I am going to cover... Randomized controlled trial (RCT) Concept
More informationBiosta's'cs Board Review. Parul Chaudhri, DO Family Medicine Faculty Development Fellow, UPMC St Margaret March 5, 2016
Biosta's'cs Board Review Parul Chaudhri, DO Family Medicine Faculty Development Fellow, UPMC St Margaret March 5, 2016 Review key biosta's'cs concepts Understand 2 X 2 tables Objec'ves By the end of this
More informationUse of Sacubitril/Valsartan in Heart Failure
Use of Sacubitril/Valsartan in Heart Failure & the PARADIGM-HF trial Sarah Mackenzie, PharmD student, University of Toronto Presentation Outline Overview of: Entresto PARADIGM-HF trial Critical Appraisal
More informationCalculating RR, ARR, NNT
Calculating RR, ARR, NNT In a trial RR = Event rate (eg # of people with one stroke/ total people) in treatment group/event rate in the control group. ARR = Event rate in control group minus the event
More informationThe comparison or control group may be allocated a placebo intervention, an alternative real intervention or no intervention at all.
1. RANDOMISED CONTROLLED TRIALS (Treatment studies) (Relevant JAMA User s Guides, Numbers IIA & B: references (3,4) Introduction: The most valid study design for assessing the effectiveness (both the benefits
More informationexposure/intervention
Kathleen A. Kennedy, MD, MPH University of Texas Medical School at Houston Medical School Most clinical research evaluates an association between exposure/intervention outcome. 1 Does the investigator
More informationIs Rabeprazole A Safe Treatment for Gastroesophageal Reflux Disease in Children Ages 1-16 years?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2015 Is Rabeprazole A Safe Treatment for Gastroesophageal
More informationClinical Epidemiology for the uninitiated
Clinical epidemiologist have one foot in clinical care and the other in clinical practice research. As clinical epidemiologists we apply a wide array of scientific principles, strategies and tactics to
More informationNo relevant financial relationships
MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu
More informationModule 5. The Epidemiological Basis of Randomised Controlled Trials. Landon Myer School of Public Health & Family Medicine, University of Cape Town
Module 5 The Epidemiological Basis of Randomised Controlled Trials Landon Myer School of Public Health & Family Medicine, University of Cape Town Introduction The Randomised Controlled Trial (RCT) is the
More informationEvaluating Effectiveness of Treatments. Elenore Judy B. Uy, M.D.
Evaluating Effectiveness of Treatments Elenore Judy B. Uy, M.D. OUTLINE 1. Why evaluate effectiveness 2. How to acquire evidence 3. How to appraise evidence Directness Validity Results 4. Our Case WALA
More informationIs Asenapine More Effective than Other Interventions in the Treatment of Adult Patients with Bipolar I Disorder?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2012 Is Asenapine More Effective than Other
More informationDemands and Perspectives of Hadron Therapy
Demands and Perspectives of Hadron Therapy Alexander Lin, M.D. Assistant Professor University of Pennsylvania Direction of Operations Roberts Proton Therapy Center Disclosures Teva Pharmaceuticals: Advisory
More informationCost-effectiveness of tolvaptan (Jinarc ) for the treatment of autosomal dominant polycystic kidney disease (ADPKD)
Cost-effectiveness of tolvaptan (Jinarc ) for the treatment of autosomal dominant polycystic kidney disease (ADPKD) The NCPE has issued a recommendation regarding the cost-effectiveness of tolvaptan (Jinarc
More informationTo fully participate in this session: Please obtain a Framingham Risk Calculator google: My Health Alberta Risk Calculator click: Heart Disease Risk
To fully participate in this session: Please obtain a Framingham Risk Calculator google: My Health Alberta Risk Calculator click: Heart Disease Risk Calculator Worksite Screening and the Unknown Burden
More informationCost-effectiveness of ondansetron for postoperative nausea and vomiting
Cost-effectiveness of ondansetron for postoperative nausea and vomiting M. R. Tramèr, 1 * C. Phillips, 2 D. J. M. Reynolds, 3 H. J. McQuay 1 and R. A. Moore 1 1 Pain Research, Nuffield Department of Anaesthetics,
More informationDisclosure. No relevant financial relationships. Placebo-Controlled Statin Trials
PREVENTING CARDIOVASCULAR DISEASE IN WOMEN: Current Guidelines for Hypertension, Lipids and Aspirin Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial
More informationCost-effectiveness of evolocumab (Repatha ) for hypercholesterolemia
Cost-effectiveness of evolocumab (Repatha ) for hypercholesterolemia The NCPE has issued a recommendation regarding the cost-effectiveness of evolocumab (Repatha ). Following NCPE assessment of the applicant
More informationPrimary Prevention of Cardiovascular Disease (CVD) Events with Statins. 1 Primary Prevention of Cardiovascular Disease (CVD) Events with Statins
Primary Prevention of Cardiovascular Disease (CVD) Events with Statins 1 Primary Prevention of Cardiovascular Disease (CVD) Events with Statins 2 Welcome by Michael Pignone, MD, MPH Hi, my name is Dr.
More informationWho cares about fractures! is more important. October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor Grey Nuns Hospital
Isn t Osteoporosis just a T Score less than 2.5?? Who cares about fractures! is more important. Why do I need to know this? October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor
More informationThe JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009
The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 Learning Objectives 1. Understand the role of statin therapy in the primary and secondary prevention of stroke 2. Explain
More informationHEALTH ECONOMICS WORKSHOP
HEALTH ECONOMICS WORKSHOP Mai 2010 Le Caire 21 Mai 2010 Health Economics: a Field Between Clinical Research and Marketing Studies Prof. Robert LAUNOIS Paris University http://www.rees-france.com LE CAIRE
More informationA LOOK AT CGRP INHIBITORS FOR MIGRAINE PREVENTION JUNE 2018
JUNE 2018 Overview: About Migraine WHAT IS MIGRAINE? Migraine is a common, recurrent headache disorder that affects approximately 20% of women and 6-10% of men in the US. Migraine attacks are characterized
More informationLIPITOR AND YOU HELPFUL INFORMATION FOR UNDERSTANDING CHOLESTEROL AND RISKS
LIPITOR AND YOU HELPFUL INFORMATION FOR UNDERSTANDING CHOLESTEROL AND RISKS Learn what your cholesterol levels actually mean, and how you may save money on your prescription each month with the LIPITOR
More informationEvidence Based Medicine
Hamadan University of medical sciences School of Public Health Department of Epidemiology Evidence Based Medicine Amin Doosti-Irani, PhD in Epidemiology 10 March 2017 a_doostiirani@yahoo.com 1 Outlines
More informationQuick-Start Guide. UnitedHealthcare of Minnesota, North Dakota and South Dakota.
Quick-Start Guide. UnitedHealthcare of Minnesota, North Dakota and South Dakota. Welcome. Thank you for joining us! As a new payer in Minnesota, North Dakota and South Dakota, we have an extraordinary
More informationPrevention: When Do Benefits Start and End? What Do They Have in Common?
Prevention: When Do Benefits Start and End? Providence Internal Medicine Spring Symposium April 14, 2016 Mari Kai, MD What Do They Have in Common? 82 year old female 62 year old male Estimated Life Expectancy
More informationHowever, if instead, CHD risk is plotted on a doubling scale (as in slide 2) then there is a
Slides 1 and 2: These two illustrative slides (based on notionaldata) were used in my presentation to Dr Godlee at our meeting on 2 December 2013 to show that, if the risk of coronary disease (CHD) is
More informationSolihull Safeguarding Adults Board & Sub-committees
Solihull Safeguarding Adults Board & Sub-committees 2016 Safeguarding Adults Board Solihull Safeguarding Adults Board [SSAB or the Board] was established in 2008. It is a multi-agency partnership comprising
More informationDisclosure. No relevant financial relationships. Placebo-Controlled Statin Trials
MANAGEMENT OF HYPERLIPIDEMIA AND CARDIOVASCULAR RISK IN WOMEN: Balancing Benefits and Harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial
More informationLecture 4. Analytical Interventional Studies
Lecture 4 Analytical Interventional Studies By the end of this lecture the student will be able to : Identify the concept of analytical Interventional studies Identify the concept of clinical trials and
More informationDoes the Relationship between Motivation and Performance Differ with Ability?
James Madison University JMU Scholarly Commons Department of Graduate Psychology - Faculty Scholarship Department of Graduate Psychology 4-1999 Does the Relationship between Motivation and Performance
More informationHypertension Management Controversies in the Elderly Patient
Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No
More informationCAT FOR TREATMENT. Clinical Scenario:
CAT FOR TREATMENT Clinical Scenario: A 30-year old male footballer presented at surgical OPD with clinical of painful, reducible groin hernia. I advice him for surgical management and gave him the possible
More informationEcon C07: Economics of Medical Care. Marginal and Average Productivity
Econ C07: Economics of Medical Care Notes 3: The Productivity of Medical Care By Deepasriya Sampath Kumar February 17, 2000 Marginal and Average Productivity Def. The marginal product with an increase
More informationEvolving Concepts on Lipid Management from Ezetimibe (IMPROVE IT) to PCSK9 Inhibitors
Evolving Concepts on Lipid Management from Ezetimibe (IMPROVE IT) to PCSK9 Inhibitors Sidney C. Smith, Jr. MD, FACC, FAHA, FESC Professor of Medicine/Cardiology University of North Carolina at Chapel Hill
More informationCHL 5225 H Advanced Statistical Methods for Clinical Trials. CHL 5225 H The Language of Clinical Trials
CHL 5225 H Advanced Statistical Methods for Clinical Trials Two sources for course material 1. Electronic blackboard required readings 2. www.andywillan.com/chl5225h code of conduct course outline schedule
More informationThe Academy of Nutrition and Dietetics Evidence Analysis Library: Leveraging This Resource to Maximize Your Efficacy
NUTRI-BITES Webinar Series The Academy of Nutrition and Dietetics Evidence Analysis Library: Leveraging This Resource to Maximize Your Efficacy September 21, 2017 Presenter: Alison Steiber, PhD, RDN Chief
More informationUpdates in Therapeutics 2015: The Pharmacotherapy Preparatory Review & Recertification Course
Updates in Therapeutics 2015: The Pharmacotherapy Preparatory Review & Recertification Course Study Designs: Fundamentals and Interpretation Kevin M. Sowinski, Pharm.D., FCCP Purdue University, College
More informationOverview. Goals of Interpretation. Methodology. Reasons to Read and Evaluate
Overview Critical Literature Evaluation and Biostatistics Ahl Ashley N. Lewis, PharmD, BCPS Clinical Specialist, Drug Information UNC Hospitals Background Review of basic statistics Statistical tests Clinical
More informationHypertension Guidelines: Lessons for Primary Care. Paul A James MD Professor and Chair Department of Family Medicine University of Washington
Hypertension Guidelines: Lessons for Primary Care Paul A James MD Professor and Chair Department of Family Medicine University of Washington Disclaimer and Financial Disclosure I have no financial interests
More informationSafety, Tolerability, Pharmacokinetics,and Pharmacodynamics of Multiple Rising Doses of Empagliflozin in Patients with Type 2 Diabetes Mellitus
Safety, Tolerability, Pharmacokinetics,and Pharmacodynamics of Multiple Rising Doses of Empagliflozin in Patients with Type 2 Diabetes Mellitus Journal Club (May 2013) Sara Al-Sharhan, Pharm D intern-
More informationAnesthetic Gases in Veterinary Clinics
Anesthetic Gases in Veterinary Clinics As an owner or employee of a veterinary clinic, we have all had questions regarding the safety of anesthetic gases. (1) Are these agents toxic? (2) Are there consequences
More informationOrderConnect/InfoScriber New Diagnosis Functionality March 22, 2014
OrderConnect/InfoScriber New Diagnosis Functionality March 22, 2014 Background On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10
More informationManagement of Lipid Disorders and Hypertension: Implications of the New Guidelines
Management of Lipid Disorders and Hypertension Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine
More informationJournal Club Critical Appraisal Worksheets. Dr David Walbridge
Journal Club Critical Appraisal Worksheets Dr David Walbridge The Four Part Question The purpose of a structured EBM question is: To be directly relevant to the clinical situation or problem To express
More informationLia Hotchkiss: I'm Lia Hotchkiss and I'm with the Agency for Healthcare. Research and Quality. We are one of the 12 agencies part of the Department of
Lia Hotchkiss, MPH, PMP, Comparative Effectiveness Research, Center for Outcomes and Evidence, Agency for Healthcare Research and Quality (AHRQ), Rockville, MD Lia Hotchkiss: I'm Lia Hotchkiss and I'm
More informationCochrane Bone, Joint & Muscle Trauma Group How To Write A Protocol
A p r i l 2 0 0 8 Cochrane Bone, Joint & Muscle Trauma Group How To Write A Protocol This booklet was originally produced by the Cochrane Renal Group to make the whole process of preparing a protocol as
More information