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Comprehensive Review > Epidemiology > Flashcards

Epidemiology Flashcards

1
Q

National Clinical Trials (NCT) number

A
  • unique ID # given by clinicaltrials.gov once research protocol is submitted prior to study initiation
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2
Q

Positive vs Negative Kurtosis

A

Positive - more cluster around mean

Negative - less cluster around mean

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3
Q

Type 1 error

A

NOT ACCEPTING null hypothesis when it was actually true, and you should have accepted it

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4
Q

Type 2 error

A

Accepting the null hypothesis when it is actually FALSE, and you should not have accepted it

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5
Q

p-value

A

probability of making a Type 1 error if the Null Hypothesis is rejected

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6
Q

Nominal, 2 groups, Independent

A

Pearsons Chi squared test

Fishers Exact

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7
Q

Nominal, 2 groups, Related

A

McNemar

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8
Q

Nominal 3+ groups, Independent

A

chi squared test of independence

Fishers Exact (less than 5 people)

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9
Q

Nominal 3+ groups Related

A

Cochran

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10
Q

Nominal Survival

A

Log Rank

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11
Q

Nominal Correlation

A

Contingency Coefficient

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12
Q

Nominal Prediction/Association (Regression)

A

Logistics Regression

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13
Q

Ordinal 2 groups Independent

A

Mann Whitney

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14
Q

Ordinal 2 groups Related

A

Wilcoxon Sign Rank

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15
Q

Ordinal 3+ groups Independent

A

Kruskal Wallis

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16
Q

Ordinal 3+ groups Related

A

Friedman

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17
Q

Ordinal Post-Hoc tests

A

Student Newman Keul
Dunnett
Dunn

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18
Q

Nominal Post-Hoc test

A

Bonferroni Correction

adjusts p value for # of comparisons being made

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19
Q

Ordinal Survival

A

Cox-Proportional Hazard

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20
Q

Survival Tests

A

compares proportion of events over time, or time-to events, between groups

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21
Q

Correlation tests

A

provides a quantitative measure of the strength and direction of a relationship between variables

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22
Q

Regression tests

A

predict the likelihood of some event

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23
Q

Ordinal Correlation

A

Spearman Correlation

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24
Q

Ordinal Regression

A

Multinominal Logistics Regression

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25
Q

Interval 2 groups Independent

A

student t test

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26
Q

Interval 2 groups Related

A

paired t test

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27
Q

Interval 3+ groups Independent

A

ANOVA

confounders = ANCOVA

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28
Q

Interval 3+ groups Related

A

Repeated Measures ANOVA

confounders = RP ANCOVA

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29
Q

Interval Survival

A

Kaplan Meier

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30
Q

Interval Correlation

A

Pearson Correlation

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31
Q

Interval Regression

A

Linear Regression

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32
Q

Student Newman Keul

A

compares all pairwise comparisons possible

all groups equal in size

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33
Q

Dunnett

A

compares all pairwise comparisons against single control

all groups must be equal in size

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34
Q

Dunn

A

compares all pairwise comparisons possible

all groups are NOT equal in size

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35
Q

Tukey and Scheffe tests

A

compares all pairwise comparisons possible

Tukey MORE conservative than Student NK
Scheffe - most conservative

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36
Q

Interventional vs Observational Studys

A

Interventional = forced allocation

Observational = NO forced allocation
- most observational study designs not able to prove causation

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37
Q

Simple Random Sampling

A

assign random numbers, then take randomly selected numbers

38
Q

Systemic Random Sampling

A

assign random numbers, randomly sort, select highest/lowest number, then take every Nth number to get sample size

39
Q

Stratified Simple Random Sampling

A

stratify sampling by characteristic (gender) then use Simple random sampling

40
Q

Stratified Disproportionate Random Sampling

A

disproportionately use stratified random sampling when baseline population is not at the desired proportional percentages to the referent population

41
Q

Cluster Multi-Stage Random sampling

A

same as multi stage random sampling but ALL elements clustered together are selected for inclusion

42
Q

Multi-Stage Random sampling

A

uses simple random sampling at multiple-stages towards patient selection

43
Q

Convenience Sampling

A

decided on what fraction of population is to be sampled and how they will be sampled

there is some known or unknown order to the sample generated by the selected scheme which may introduce SELECTION BIAS

44
Q

4 key principles of bioethics (ABJN)

A

Autonomy - self rule/self determination
Beneficence - do good for patient, not society
Justice - equal/fair treatment of patient
Nonmaleficence - do no harm

45
Q

IRB Review Lvls: Full Board, Expedited, Exempt

A

Full - used for ALL interventional trials w/more than minimal risk to patients

Expedited - minimal risk and/or no patient identifiers

Exempt - no patient identifiers, environmental studies, use of existing data/specimens (de-identified)

46
Q

Increasing Strength of Evidence (lowest to highest)

A

test tube –> animal –> case report –> case series –> ecological –> cross sectional –> case-control –> cohort –> interventional –> systemic reviews

47
Q

Interventional Phase 0

A

assess drug-target actions, healthy volunteers, very small N (<20), very short duration (single dose to few days)

48
Q

Interventional Phase 1

A

assess safety/tolerance and pharmacokinetics of doses, healthy/disease volunteers, small N (20-80), short duration (few weeks)

49
Q

Interventional Phase 2

A

assess effectiveness, diseased volunteers (narrow inclusion criteria), larger N (100-300), short-medium duration (weeks to months)

50
Q

Interventional Phase 3

A

assess effectiveness, diseased volunteers (expanded inclusion criteria), larger N (500-3000), longer duration (few months to years)

LAST PHASE BEFORE FDA Approval

51
Q

Interventional Phase 4

A

assess long-term safety, effectiveness, optimal use, diseased volunteers, population N, wide range of durations

52
Q

Simple, blocked, Stratified Randomization

A

Simple - equal prob for allocation into one of groups

Blocked - ensure balance within each interventional group

Stratified - ensures balance with known confounding variables

53
Q

Epidemiology Definition

A

public health basic science which studies the DISTRIBUTION and DETERMINANTS of health-related states or events in specific populations to control disease and illness and promote health

54
Q

Epidemic, Outbreak, Endemic, Pandemic`

A

Epidemic - occurrence of disease in excess of normal compared to baseline

Outbreak - epidemic limited to localized increase (Cluster)

Endemic - constant presence of disease within an area above normal (constant epidemic)

Pandemic - world-wide epidemic

55
Q

Incidence (Risk or Attack Rate)

A

of new cases of illness / # of people at risk of illness

subtract out number of people that already have the disease

56
Q

Incidence Rate

A

of new cases of illness / person-time at risk for disease

57
Q

Prevalence

A

of existing cases of disease / # of persons in population

58
Q

Crude Morbidity Rate

A

persons w/disease / total population

59
Q

Crude Mortality Rate

A

of deaths (all) / total population

60
Q

Cause-Specific Morbidity Rate

A

persons w/specific illness / total population

61
Q

Cause-Specific Mortality Rate

A

deaths by specific illness / total population

62
Q

Case-Fatality Rate

A

deaths by specific illness / total # of cases

63
Q

Cause-Specific Survival Rate

A

of cause-specific cases alive / # cases of disease

64
Q

Proportional Mortality Rate (PMR)

A

of illness specific deaths / total # deaths in population

65
Q

Maternal Mortality Rate

A

of female deaths related to pregnancy / 100,000 live births

66
Q

Risk Ratio

A

Risk of Outcome (Exposed) / Risk of Outcome (Non-Exposed)

A/(A+B)) / (C/(C+D)

67
Q

Odds Ratio

A

Risk of Exposure (Diseased) / Risk of Exposure (Non-Diseased)

(A/C) / (B/C)

68
Q

If there is a 15% difference between crude and adjusted measures of association…

A

a confounder is present

Crude = OR/RR
Adjusted = RR/OR
69
Q

Three Requirements for Confounders

A
  1. independently associate with exposure
  2. independently associate with outcome
  3. not directly in causal-pathway
70
Q

What is a confounder?

A

a 3rd variable that distorts an association between the Exposure and the Outcome

71
Q

Confounding Control: Randomization, Restriction, Matching, Stratification, Mutivariate

A

Random - allocate equal # of known confounders between groups

Restriction - use only subjects without predetermined confounder

Matching - selected in matched pairs

Stratification - evaluate association between within various strata

Multivariate - mathematically factor out effects of confounder(s)

72
Q

Effect Modification

A

a 3rd variable that, when present, modifies the magnitude of effect of a TRUE association by varying it within different strata

73
Q

Hawthorne Effect

A

individuals alter/modify their behavior because they are part of a study and know they are under observation

74
Q

Hill’s Criteria

A

Strength - size of the measure of association (bigger = better)

Consistency - repeated observations in different populations under different circumstances in different studies

Temporality - cause precede the effect/outcome in time (closeness is better)

Biologic Gradient - presence of gradient of risk associated with the degree of Exposure (more good = inc. health)

Plausibility - presence of biological feasibility to the association, which can be understood and explained

75
Q

Belmont Report (3 guiding principles)

A
  1. Respect for persons - research should be voluntary, subjects autonomous
  2. Beneficence - research risks are justified by potential benefits
  3. Justice - risk and benefits of research are equally distributed
76
Q

When is cohort design useful?

A

When studying a rare exposure

  • typically retrospective
77
Q

Sensitivity

A

how well a test can detect presence of disease which in fact disease is present

  • proportion of time that a test is positive in a patient that DOES have the disease
78
Q

Sensitivity Equation

A

True Positive (A) / (True Positive + False Negative (C)) x 100%

79
Q

Specificity

A

how well a test can detect the absence of disease when in fact the disease is absent

  • proportion of time that a test is negative in a patient that does not have the disease
80
Q

Specificity Equation

A

True Negative (D) / (True Negative + False Positive (B)) x 100%

81
Q

Positive Predictive Value

A

how accurately a positive test predicts the presence of disease

  • proportion of True Positive’s in patients with a positive test
82
Q

Positive Predictive Value Equation

A

True Positive / (True Positive + False Positive (B)) x 100%

83
Q

Negative Predictive Value

A

how accurately a test predicts the absence of disease

  • proportion of True Negatives in patients with a negative test
84
Q

Negative Predictive Value Equation

A

True Negative / (True Negative + False Negative) x 100%

85
Q

Reasons to pick Case Control (4)

A
  1. unable to force group allocation
  2. limited resources
  3. disease is rare
  4. exposure data is difficult/expensive to obtain an/or very time inappropriate
86
Q

Case Control Strengths

A
  • good at assessing multiple exposures of ONE outcome
  • used when diseases are rare
  • determine association (NOT CAUSATION)
  • less expensive
87
Q

Case-Control Study

A
  • observational studies allowing passive observation of natural events occurring in individuals with disease of interest compared to people without disease of interest
  • groups assigned based on DISEASE STATUS
88
Q

Cohort Study

A
  • observational studies allowing passive observation of a natural events occurring in naturally-exposed and unexposed groups
  • group allocation based on EXPOSURE-status or GROUP MEMBERSHIP
89
Q

Reasons to pick Cohort (4)

A
  1. Unable to force group allocation
  2. limited resources
  3. exposure of interest is RARE
  4. more interested in incidence rates or risks for outcome of interest
90
Q

Prospective, Retrospective, Ambidirectional Cohort Studies

A

Prospective - exposure group selected on post or current exposure, both groups followed into future

Retrospective - exposure and outcome have already occurred, groups allocated on past history of exposure

Ambidirectional - use retrospective design to asses past differences but also adds future data collected on additional outcomes prospectively from start of study

Comprehensive Review (7 decks)

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