Transcript Introduction

Section 230, Row F, G, H Seats
1-8
Who are we?
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Michael Kohn, Emergency Medicine
Tom Newman, General Pediatrics
Mark Pletcher, General Internal Medicine
George Sawaya, Obstetrics/Gynecology
John Stein, Emergency Medicine
Josh Galanter, Pulmonary/Critical Care
Who are you?
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Breakdown of ≈ 36 participants
First Name
Last Name
Degree
Specialty
City
Christian
Apfel
MD, PhD
Anesthesiology
San Francisco
Nicole
Appelle
MD
Internal Medicine
San Francisco
Arpi
Bekmezian
MD
Pediatrics
San Francisco
Dennis
Bleakley
MD
Internal Medicine
Claremont
Christopher
Carpenter
MD, MSC
Emergency Medicine
Wildwood
Maria
Carriedo-Ceniceros
MD
Family Practice
Bonita
George
Cembrowski
MD
Lab Medicine
Edmonton
Chatkanok
Dumavibhat
MD
Cardiology
Bangkok
Miranda
Dunlop
MD
Internal Medicine
San Francisco
Victor
Ettinger
MD
Endocrinology/Diabetes
Bakersfield
Nola
Hylton
PhD
Radiology
San Francisco
Adam
Jung
MD, PhD
Radiology
Mill Valley
Renata
Kiefier
MD
Pediatrics
San Francisco
Kurt
Landauer
MD
Family Practice
Minocqua
Eugene
Lee
MD, MPH
Internal Medicine
San Francisco
Alan
Levin
MD, JD
Pathology
Incline Village
Andrew
Michaels
MD, FACC,
FAHA
Cardiology
Eureka
Cecily
Miller
MPH
Infectious Disease
San Francisco
First Name
Last Name
Degree
Specialty
City
Pauline
Mysliwiec
MD
Gastroenterology
San Francisco
Tim
Nicholls
MD
Pediatrics
Berkeley
Godfrey
Oakley
MD, MSPM
Pediatrics
Atlanta
Matthew
Olsen
DO
Internal Medicine
Seattle
Luke
Perkocha
MD
Pathology
San Francisco
Cody
Reeves
MD
Anesthesiology
Nevada City
Max
Robinowitz
MD
None
Bethesda
Saad
Shakir
MD
Psychiatry and Neurology
Los Gatos
Ruth
Shelton-Pryor
MD
Family Practice
Vallejo
Alvin
Silva
MD
Radiology
Scottsdale
Jutta
Skogberg
MD
Occupational Medicine
Espoo
Thomas
Steffen
MD
Family Practice
Decatur
Sara
Swenson
MD
Internal Medicine
San Francisco
Daniel
Theodoro
MD, MSCI
Emergency Medicine
Saint Louis
Kara
Timmins
PA-C
Hospital Medicine
Syracuse
Anastasia
Toles
MD, MPH
Internal Medicine
San Francisco
Andrea
Wickremasinghe
MD
Pediatrics
San Francisco
Antonio
Westphalen
MD
Radiology
San Francisco
Evidence-Based Medicine
Level
EBM Level
Count
%
Advanced
5
25%
Intermediate
11
55%
Beginner
4
20%
Responded
20
No Response
15
Total
35
Familiar with Threshold Model
-- C/(C+B)?
Threshold Model
Count
NO
16
67%
YES
8
33%
Responded
24
No Response
11
Total
35
Familiar with ARR and NNT =
1/ARR?
ARR and NNT
Count
%
NO
7
29%
YES
17
71%
Responded
24
No Response
11
Total
35
Interest in Screening
Interest In Screening (vs.
Diagnosis and
Prognosis)
Count
%
High
6
25%
Intermediate
9
38%
Low
9
38%
Responded
24
No Response
11
Total
35
Thursday Morning
9:15-9:55 Dichotomous Tests (Tom)
9:55-10:35 Multilevel and Continuous Tests
(Michael)
10:35-10:45 Break (Confirm small group
assignments and locations.)
10:45-12:30 Small Groups
12:30-1:30 Buffet Lunch
Book will be here tomorrow
If you won’t be here tomorrow or you
plan to use the book tonight, we have a
few copies.
Thursday Afternoon
1:30-2:15 Studies and Systematic Reviews
of Diagnostic Test Accuracy (Tom)
2:15-3:00 Prognostic and Genetic Tests
(Mark)
3:00-3:45 Combining Tests (Michael)
3:45-4:00 Break
4:00-6:00 Small Groups
6:00 Meet in 6702 to head to Giants game
Evidence Based Medicine
I.
II.
Diagnosis: How to evaluate a test and
then use it to estimate the probability
that a patient has a given disease.
Treatment: How to determine if a
treatment is beneficial in patients with a
given disease, and if so, whether the
benefits outweigh the costs and risks.
Basic Evidence-Based
Diagnosis
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Evaluate and compare dichotomous
tests using sensitivity and specificity
Update pre-test probability of disease
using LR(+) and LR(-).
Checklist for evaluating studies of
diagnostic test accuracy
Advanced Evidence-Based
Diagnosis
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Determining and using likelihood ratios
for the results of non-dichotomous tests
Understanding biases in studies of
diagnostic tests and predicting their
effect on study results.
Combining results of multiple tests
allowing for non-independence of tests
Diagnosis vs. Test Utilization
Diagnosis: Assigning a name to
the patient’s illness
Test Utilization: Using tests to
guide a treatment decision
Diagnosis vs. Test Utilization
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Should we do a test to diagnosis a disease
with no effective treatment?
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SLUBI
Voiding cystourethrogram (VCU) for vesicoureteral
reflux (VUR)
Should we do a test to distinguish between
two diseases with the same treatment?
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Kidney biopsy in child with nephrotic syndrome
Dichotomous Tests (Tom)