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Section 230, Row F, G, H Seats 1-8 Who are we? Michael Kohn, Emergency Medicine Tom Newman, General Pediatrics Mark Pletcher, General Internal Medicine.

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Presentation on theme: "Section 230, Row F, G, H Seats 1-8 Who are we? Michael Kohn, Emergency Medicine Tom Newman, General Pediatrics Mark Pletcher, General Internal Medicine."— Presentation transcript:

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2 Section 230, Row F, G, H Seats 1-8

3 Who are we? 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

4 Who are you? Breakdown of 36 participants

5 First NameLast NameDegreeSpecialtyCity ChristianApfelMD, PhDAnesthesiologySan Francisco NicoleAppelleMDInternal MedicineSan Francisco ArpiBekmezianMDPediatricsSan Francisco DennisBleakleyMDInternal MedicineClaremont ChristopherCarpenterMD, MSCEmergency MedicineWildwood MariaCarriedo-CenicerosMDFamily PracticeBonita GeorgeCembrowskiMDLab MedicineEdmonton ChatkanokDumavibhatMDCardiologyBangkok MirandaDunlopMDInternal MedicineSan Francisco VictorEttingerMDEndocrinology/DiabetesBakersfield NolaHyltonPhDRadiologySan Francisco AdamJungMD, PhDRadiologyMill Valley RenataKiefierMDPediatricsSan Francisco KurtLandauerMDFamily PracticeMinocqua EugeneLeeMD, MPHInternal MedicineSan Francisco AlanLevinMD, JDPathologyIncline Village AndrewMichaels MD, FACC, FAHACardiologyEureka CecilyMillerMPHInfectious DiseaseSan Francisco

6 First NameLast NameDegreeSpecialtyCity PaulineMysliwiecMDGastroenterologySan Francisco TimNichollsMDPediatricsBerkeley GodfreyOakleyMD, MSPMPediatricsAtlanta MatthewOlsenDOInternal MedicineSeattle LukePerkochaMDPathologySan Francisco CodyReevesMDAnesthesiologyNevada City MaxRobinowitzMDNoneBethesda SaadShakirMDPsychiatry and NeurologyLos Gatos RuthShelton-PryorMDFamily PracticeVallejo AlvinSilvaMDRadiologyScottsdale JuttaSkogbergMDOccupational MedicineEspoo ThomasSteffenMDFamily PracticeDecatur SaraSwensonMDInternal MedicineSan Francisco DanielTheodoroMD, MSCIEmergency MedicineSaint Louis KaraTimminsPA-CHospital MedicineSyracuse AnastasiaTolesMD, MPHInternal MedicineSan Francisco AndreaWickremasingheMDPediatricsSan Francisco AntonioWestphalenMDRadiologySan Francisco

7 Evidence-Based Medicine Level EBM LevelCount% Advanced525% Intermediate1155% Beginner420% Responded20 No Response15 Total35

8 Familiar with Threshold Model -- C/(C+B)? Threshold ModelCount NO1667% YES833% Responded24 No Response11 Total35

9 Familiar with ARR and NNT = 1/ARR? ARR and NNTCount% NO729% YES1771% Responded24 No Response11 Total35

10 Interest in Screening Interest In Screening (vs. Diagnosis and Prognosis)Count% High625% Intermediate938% Low938% Responded24 No Response11 Total35

11 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

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13 Book will be here tomorrow If you wont be here tomorrow or you plan to use the book tonight, we have a few copies.

14 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

15 Evidence Based Medicine I. Diagnosis: How to evaluate a test and then use it to estimate the probability that a patient has a given disease. II. 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.

16 Basic Evidence-Based Diagnosis 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

17 Advanced Evidence-Based Diagnosis 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

18 Diagnosis vs. Test Utilization Diagnosis: Assigning a name to the patients illness Test Utilization: Using tests to guide a treatment decision

19 Diagnosis vs. Test Utilization Should we do a test to diagnosis a disease with no effective treatment? SLUBI Voiding cystourethrogram (VCU) for vesicoureteral reflux (VUR) Should we do a test to distinguish between two diseases with the same treatment? Kidney biopsy in child with nephrotic syndrome

20 Dichotomous Tests (Tom)


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