Medical epidemiology and EBM [MMEDB220]

Learning outcomes

This course consists of two parts. The first part (18 hours of lecture + 10 hours of practical work; 2 credits) deals with medical epidemiology and is part of the curriculum for B2Med, B2Biomed, and B3Pharma students. The second part (8 lecture hours + 5 lab hours; 1 credit) is on evidence-based medicine (EBM), also known as evidence-based medicine, and is intended for B2Med students only. At the end of the medical epidemiology module, the student will be able to: 1. Master the key concepts of medical epidemiology 2. Calculate the most common epidemiological indicators 3. Understanding the strengths and weaknesses of different types of epidemiological studies 4. Critically read scientific articles using standardised analysis grids 5. Determine the performance of a diagnostic or prognostic test, and its usefulness for clinical decision making At the end of the EBM module, the student will be able to : 1. Master the key concepts of evidence-based medicine 2. Identify, locate and extract the scientific information needed to answer a specific clinical question 3. Evaluate the quality of scientific information relating to a specific clinical question Critically understand the process of developing good clinical practice guidelines

Objectives

Based on a pragmatic approach, this course aims to enable the student to integrate the key concepts and tools of medical epidemiology, pharmacoepidemiology and evidence-based medicine. The aim is to make the student capable of a critical analysis of the scientific bases underlying his/her future practice as a student and health professional.

Content

Partim medical epidemiology 1. Introduction : a. Causality and luck ; b. Statistical Inference and Hypothesis Testing ; 2. Formulation of a clinical epidemiology or pharmacoepidemiology question 3. Measures of frequency, association, impact, prediction : a. Frequency: prevalence; incidence; rates (natality, mortality, lethality); attack rate; basic reproduction rate b. Association: risk ratio, absolute risk difference; odds ratio; standardized mortality ratio ; c. Impact: attributable risk; number needed to treat; number needed to harm; d. Prediction: positive/negative predictive value of a test; conclusive/exclusive strength; Fagan nomogram; ROC curves; net reclassification index 4. Bias and confounding factors 5. Types of studies, strengths and limitations : a. Cross-sectional studies ; b. Case-controls ; c. Cohorts ; d. Post-marketing surveillance and evaluation of medicines; e. Diagnostic and prognostic studies ; f. Randomised clinical trials ; g. Systematic literature reviews and meta-analyses 6. Quality analysis of epidemiological studies : a. Non-randomised intervention studies: ROBINS; SIGN grids; b. Diagnostic studies: QUADAS-2 c. Randomised clinical trials: Cochrane risk of bias tool; RoB 2 d. Systematic literature reviews: AMSTAR-2; Partim EBM 1. Components of EBM 2. Identification and retrieval of relevant scientific data on a specific clinical question: a. Bibliographic databases: MEDLINE, Embase, Cochrane library,... b. Other sources: INAHTA, CRD, GIN, EBMPracticenet,... 3. Systematic literature reviews a. Methodology and interpretation of meta-analyses b. Quality analysis of systematic literature reviews: AMSTAR-2 4. Assessment of the quality of the evidence on a specific clinical issue: a. Heterogeneity of results b. Imprecision of results c. Indirectness of the evidence d. Publication and other biases 5. Development of good clinical practice guidelines : a. Quality assessment of clinical guidelines: AGREE Development of recommendations: GRADE