Comparative Observational Studies Major types of these designs are cross-sectional studies, case-control studies, and cohort studies (both retrospective and prospective)
Experimental Epidemiology
1st Clinical trial
Basic steps in RCT
Randomization & its method
Manipulation/ Intervention
Types of RCT
Phases in Clinical trial
Hierarchy of epidemiological study
The Randomized Controlled Trial: The Gold Standard of Clinical Science and a ...marcus evans Network
Tim Fayram, St. Jude Medical Inc. - Speaker at the marcus evans Medical Device R&D Summit Fall 2013, held in Palm Beach, FL delivered his presentation entitled The Randomized Controlled Trial: The Gold Standard of Clinical Science and a Barrier to Innovation?
Comparative Observational Studies Major types of these designs are cross-sectional studies, case-control studies, and cohort studies (both retrospective and prospective)
Experimental Epidemiology
1st Clinical trial
Basic steps in RCT
Randomization & its method
Manipulation/ Intervention
Types of RCT
Phases in Clinical trial
Hierarchy of epidemiological study
The Randomized Controlled Trial: The Gold Standard of Clinical Science and a ...marcus evans Network
Tim Fayram, St. Jude Medical Inc. - Speaker at the marcus evans Medical Device R&D Summit Fall 2013, held in Palm Beach, FL delivered his presentation entitled The Randomized Controlled Trial: The Gold Standard of Clinical Science and a Barrier to Innovation?
Journal Article Analysis: Medication Errors in Overweight and Obese Pediatric...Paul Pasco
A journal article analysis ("journal club") I completed during an internship/Advanced Pharmacy Practice Experience (APPE) in medication safety at a hospital.
Homeopathic and conventional treatment for acute respiratory and ear complain...home
This comparative cohort study, involving more than
1,500 patients in primary care practices of at least 6 different
European countries, demonstrates that homeopathic
treatment for acute respiratory and ear complaints was not
inferior to conventional treatment. Although no firm conclusions
can be drawn about the efficacy of homeopathic
treatment, these results certainly contribute to the growing
evidence that homeopathy is a safe and beneficial
treatment strategy for acute diseases in primary care settings.
Homeopathic and conventional treatment for acute respiratory and ear complain...home
Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H) and 720
conventional (C) treatment. The majority of patients in both groups reported their outcome after 14 days of treatment
as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing). In the perprotocol
set (H: 576 and C: 540 patients) similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019). Further
subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C:
84.5%) and adults (H: 85.6%; C: 86.6%). The unadjusted odds ratio (OR) of the primary outcome criterion was 1.40
(0.89–2.22) in children and 0.92 (0.63–1.34) in adults. Adjustments for demographic differences at baseline did not
significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both
treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon
homeopathic treatment both in children (p = 0.0488) and adults (p = 0.0001). Adverse drug reactions occurred more
frequently in adults of the conventional group than in the homeopathic group (C: 7.6%; H: 3.1%, p = 0.0032), whereas in
children the occurrence of adverse drug reactions was not significantly different (H: 2.0%; C: 2.4%, p = 0.7838).
Excelsior College PBH 321 Page 1 EXPERI MENTAL E.docxgitagrimston
Excelsior College PBH 321
Page 1
EXPERI MENTAL E PIDE MIOLOGICAL STUDIE S
Epidemiologic studies are either observational or experimental. Observational studies, including ecologic,
cross-sectional, cohort, and case-control designs, are considered “natural” experiments, but experimental
studies are considered true experiments. We will spend the next 2 modules discussing these designs.
Before we begin to discuss study designs, we need a brief introduction to a concept that we will spend more
time discussing in later modules -- bias. The definition of bias is:
“Deviation of results or inferences from the truth, or processes leading to such deviation. Any trend in the
collection, analysis, interpretation, publication, or review of data that can lead to conclusions that are
systematically different from the truth.” (Last, J.M., A Dictionary of Epidemiology, 4th ed.)
Epidemiologists are naturally concerned whether the results of an epidemiologic study are biased, since many
important public health decisions are often drawn from epidemiologic research. The severity of the bias, that
is - how much it influences or distorts the results, is related to the study design as well as how information is
analyzed.
Experimental Studies
The defining feature of experimental studies is that the investigator assigns exposure to the study subjects.
Experimental studies most closely resemble controlled laboratory experiments and serve as models for the
conduct of observational studies, thus they are the “gold standard” of epidemiologic research. Experimental
studies have high validity (i.e., less bias), and can identify even very small effects. The most well known type of
experimental study is a randomized trial (sometimes referred to as a randomized controlled trial), where the
investigator randomly assigns exposure to the study subjects. In this type of study, the only expected
difference between the experimental and control groups is the outcome variable being studied.
Experimental designs like the randomized trial can assess both preventive interventions, where a prophylactic
agent is given to healthy or high-risk individual to prevent disease, or can assess effects of therapeutic
treatment, such as those given to diseased individuals to reduce their risk of disease recurrence, or to improve
their survival or quality of life.
Preventive intervention: Does tamoxifen lower the incidence of breast cancer in women with high risk profile
compared to high risk women not given tamoxifen?
Therapeutic intervention: Do combinations of two or three antiretroviral drugs prolong survival of AIDS
patients as well as regimens of single drugs?
The investigator can assign exposures (or allocate interventions) to either individuals or to an entire
community.
Individual-level assignment: Do women with stage I breast cancer given a lumpectomy alone survive as long
without recurrence of disease as women given a lumpec ...
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
2. 1. Are the results of trial valid?
2. Was the learning curve taken into consideration?
3. Were the subjects randomized?
4. The randomization concealed?
5. Were subject aware of group allocation?
6. Were surgeons and outcome assessors aware of group allocation?
7. Were the experimental and control group similar in terms of prognostic factors?
8. Were subjects analyzed in the group they were initially randomized into at enrolment?
9. Was follow-up complete?
10. What are the results of the trial?
11. How were the results of the trial being measured?
12. How significant is the treatment effect?
13. Are the results applicable to clinical practice?
14. How similar is your patient to the subjects included in the study?
15. Do the benefits of the treatment outweigh the potential risks and costs?
3. 1. Are the results of trial valid?
Result: The incidence of early age related
macular degeneration (early AMD 3) was 8.6%
in those receiving vitamin E versus 8.1% in those
on placebo (relative risk 1.05, 95% confidence
interval 0.69 to 1.61). For late disease the
incidence was 0.8% versus 0.6% (1.36, 0.67 to
2.77). Further analysis showed no consistent
differences in secondary outcomes.
Yes, the results are valid.
2. Was the learning curve taken into
consideration?
Yes.
3. Were the subjects randomized?
Yes. Study numbers were allocated sequentially
by the study coordinator as participants were
enrolled in the study. Participants were then
randomly allocated to treatment group. This
random allocation was performed by using a
“permuted blocks” allocation scheme. The
allocation list was stored at a remote site.
4. The randomization concealed?
Yes.
4. 5. Were subject aware of group allocation?
6. Were surgeons and outcome assessors
aware of group allocation?
Neither study staff nor examiners or participants
were aware of the treatment allocation,
although all knew that participants would be
randomly assigned to receive either vitamin E or
placebo
7. Were the experimental and control
group similar in terms of prognostic
factors?
Yes. The eligible participants were those aged
between 55 and 80 years in whom the lens and
retina of at least one eye could be
photographed.
The groups were highly comparable with no
differences in baseline characteristics except for
a small excess in the number with cortical lens
opacities in the vitamin E group.
8. Were subjects stratified?
Yes, based on the following criteria:
Mean age (years), Women, Current smokers, Ever
smoked, Best corrected visual acuity, Blue iris colour,
Cortical opacity, Nuclear opacity, Any posterior
subcapsular opacity, Early AMD, Late AMD, Family history:
Cataract, Hypertension, Hyperlipidaemia, Ischaemic heart
disease, Diabetes, etc.
9. Was follow-up complete?
Yes, but rendered insufficient by the authors.
5. 10. What are the results of the trial?
Characteristics of participants: The enrolled 1193
participant groups were highly comparable with
no differences in baseline characteristics except
for a small excess in the number with cortical
lens opacities in the vitamin E group.
Early AMD Incidence—There was no difference
in the four year incidence of early AMD in the
two treatment groups over the four years. This
was true for each definition tested and for both
grading of photographs and clinical grading.
Similarly, there was no difference between the
incidence of the separate features of early AMD
and treatment, except for hypopigmentation
11. How were the results of the trial being
measured?
“side by side” comparison of baseline and four
year photographs.
12. How significant is the treatment effect?
• Daily supplement with vitamin E supplement
does not prevent the development or
progression of early or later stages of age
related macular degeneration.
13. Are the results applicable to clinical practice?
• No.
6. 14. How similar is your patient to the
subjects included in the study?
All cases of AMD, geographic atrophy alone, and
neovascular AMD alone. Subgroup analyses included
current smokers, those with a family history of AMD, and
those with a high ocular exposure to visible light or to
ultraviolet-B radiation. In none of these analyses was there
a difference between the two treatment groups. Similarly,
no difference was found when we repeated the analyses
and controlled for the baseline presence of cortical lens
opacities. Finally, a multiple logistic regression analysis that
included potential confounders of incidence or
progression showed no association between the study
intervention and the incidence or progression of early
AMD
15. Do the benefits of the treatment
outweigh the potential risks and costs?
No, because the results are null and no
significant effects were noted.