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Methodology - CVSE4P0046
Title: Metodologie
Guaranteed by: Department of Epidemiology and Biostatistics 3FM CU (12-EPID)
Faculty: Third Faculty of Medicine
Actual: from 2021
Semester: winter
Points: 1
E-Credits: 1
Examination process: winter s.:
summer s.:
Hours per week, examination: winter s.:4/6, C [HS]
summer s.:0/6, C [HS]
Capacity: winter:unknown / unknown (unknown)
summer:unknown / unknown (unknown)
Min. number of students: unlimited
4EU+: no
Virtual mobility / capacity: no
Key competences:  
State of the course: taught
Language: Czech, English
Teaching methods: full-time
Level:  
Guarantor: MUDr. Eliška Selinger
Examination dates   Schedule   
Annotation -
The aim of the course is to provide students with tools on how to evaluate information from a growing number of scientific publications. The course consists of 2 lectures, which give a general introduction to critical appraisal of methods used in scientific studies. The lectures are followed by 6 practices, which take place during the year in 6 different clinical modules. The practices are more detailed and their goal is to integrate methodological aspects of specific studies into clinical contexts. During the practices, students will apply knowledge from lectures, discuss published studies and get acquainted in more detail with some statistical methods. It is necessary to prepare for the practices in advance.
Last update: Brennan Kearns Pavla, doc. MUDr., Ph.D. (09.09.2020)
Aim of the course -

Students should gain the following

SKILLS: 

  • recognize:
    • study design
    • sources of confounding, selection bias and misclassification
    • possibility for causal interpretation of results
  • analyse:
    • effects of bias on study results
    • internal and external validity of study results 
    • strengths and limitations of studies given their design
  • assess adequacy of:
    • study design utilized for the research question
    • utilized statistical methods
    • interpretation of results given the utilized design and statistical methods
  • demonstrate:
    • orientation in scientific literature
    • ability to prioritize studies of higher quality
    • effective communication of critical appraisal of scientific studies

ATTITUDES

  • understand ethical perspective of research, principles of informed consent, balance between risk and benefits for study participants
  • understand the necessity to apply principle of critical appraisal of scientific literature for health promotion and improvement of health care
  • consider as a priority to integrate adequate scientific data into real clinical setting, given the strentghs and limitations of studies 

KNOWLEDGE

  • demonstrate understanding of the following concepts:
    • association, correlation, causality
    • precision and validity
    • confounding, selection bias, misclassification
  • describe differences between 
    • principles of experimental and observational studies
    • random and systematic errors
    • type I and type II errors
  • list:
    • criteria for determining causality
    • sampling methods
    • basic types of observational and experimental studies
Last update: Brennan Kearns Pavla, doc. MUDr., Ph.D. (09.09.2020)
Course completion requirements -

Credit is awarded for meeting these two conditions: 1) Attendance, which consists of active participation in at least 2 of the total number of 6 practices and 2) solving the so-called "zombie war".

1)     Attendance at practices is controlled by the teacher who will sign the "attendance sheet" after the practice. The attendance sheet is available for download at the "výuka" module (you can print it yourself).

Send a photo or a scan of the attendance sheet by e-mail to zombiewar3lf@gmail.com no later than June 30, 2022.

There is a possibility that some practices will take place remotely, for example via zoom. If you participate in a distance practice, note the date on the attendance sheet, the teacher's signature is not required; the attendance is recorded automatically.

Please log in to the remote environment using your full name.

2)     The principle of the "zombie war" is to solve several tasks in the context of a potential pandemic caused by a planet-spreading Z-pathogen that is transforming humans into zombies. The tasks can be solved from 1.5.2022 to 21.5.2022 on the website http://zombiewar.cz/. The answers will be checked by 21.6.2021. If you do not meet the criteria required for the credit, you will be asked to correct it, a maximum of twice.

 

Credit conditions for outgoing students within the Erasmus program:

All students have a duty to solve the "zombie war". If a student does not fulfill the obligation to attend practices due to an Erasmus stay, they will be assigned a substitute individual task. We therefore ask these students to request an individual assignment at this address: eliska.selingerova@lf3.cuni.cz 

 

 

Last update: Selinger Eliška, MUDr. (29.09.2022)
Literature -

Recommended literature:

Greenhalgh, T.: How to Read a Paper: The Basics of Evidence-based Medicine. Wiley-Blackwell 2006

 

Online sources for critical appraisal:  

https://www.cebma.org/resources-and-tools/what-is-critical-appraisal/

https://casp-uk.net/casp-tools-checklists/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483707/

https://www.unisa.edu.au/research/Health-Research/Research/Allied-Health-Evidence/Resources/CAT/

 

Audiopresentations for the repetition of basic concepts in general epidemiology:  

1) Basic measures

Measures of disease frequency: https://youtu.be/Qi05IwitHF8

Measures of association: https://youtu.be/NNZPto9QVwo

2) Design of studies

Descriptive: https://youtu.be/M9kN35aiHU0

Analytic

     Case-control studies: https://youtu.be/6BjxvktahV4

     Cohort studies: https://youtu.be/BDFNDXrCMNI

     Hybrid studies: https://youtu.be/fh3x5N8ABDk

     Interventional studies: https://youtu.be/dj3rY_pVhdI

3) Causality

Association vs. causality: https://youtu.be/j-2w5FT7s2I

Bradford-Hill criteria: https://youtu.be/sH72rn7Q8B8

Natural experiments: https://youtu.be/aB2VyxVf-es

4) Bias

    Confounding: https://youtu.be/fAquV2EJIxk

    Selection bias: https://youtu.be/3F4Cfoy0A5E

    Information bias: https://youtu.be/lKFC-CHosBU

Last update: Brennan Kearns Pavla, doc. MUDr., Ph.D. (09.09.2020)
Teaching methods -

The course is held is in the form of 2 lectures and 6 practices. 

Last update: Brennan Kearns Pavla, doc. MUDr., Ph.D. (09.09.2020)
Syllabus -

Lecture 1: Introduction to evidence-based medicine

Lecture 2: Introduction to critical appraisal of medical studies

 

Practice in the module Nephrology, Urology, Rheumatology and Geriatrics

Practice in the module Cardiology, Angiology, Cardiac Surgery, Pneumology

Practice in the module Pediatrics, Gynecology and Obstetrics

Practice in the module Orthopedics, Traumatology, Anaesthesiology and Resuscitation

Practice in the module Diabetology, Endocrinology, Gastroenterology and Abdominal Surgery

Practice in the module Neurobehavioral Sciences I

Last update: Selinger Eliška, MUDr. (29.09.2022)
Entry requirements -

It is necessary to prepare for practices in advance. 

1)     Nephrology, Urology, Rheumatology and Geriatrics: Measuring the effect of non-pharmacological interventions in patients with dementia

Preparation for the practice consists of two tasks:

The first task is to read the following two studies, which used different designs and came to different conclusions:

  • Bernat-Carles Serda` i Ferrer, Arantza del Valle. A Rehabilitation Program for Alzheimer’s Disease. Journal of Nursing Research 2014
  • Dong-mei Li, Xiao-xue Li. The effect of folk recreation program in improving symptoms: a study of Chinese elder dementia patients. International Journal of Geriatric Psychiatry 2016

The students are supposed to think about the design of these two studies, their results and to prepare answers to these questions:

  • What are the strengths of this study?
  • What are the limitations of this study?
  • Is it possible to improve cognition with non-pharmacological interventions?

The second task is to fill out the Mini-Mental State Examination (MMSE) with a close person (ideally aged at least 60 years).

The papers and the MMSE form are available in the module „výuka“ under the class „Practice in the module Nephrology, Urology, Rheumatology and Geriatrics“.

 

2)     Neurobehavioral Sciences I: Systematic reviews and metaanalysis

TBD

 

3)     Cardiology, Angiology, Cardiac Surgery, Pneumology: 

TBD

 

4)     Pediatrics, Gynecology and Obstetrics: Cochrane Organization and Home Births

Preparation for the practice consists of reading these 3 publications, which are available in the module „výuka“ under the class „Practice in the module Pediatrics, Gynecology and Obstetrics“:

  • Ole Olsen, Jette A Clausen. Planned hospital birth versus planned home birth. Cochrane Database Syst Rev. 2012 Sep 12; 9 (9): CD000352. 
  • Miranda L Davies-Tuck, Euan M Wallace, Mary-Ann Davey, Vickie Veitch, Jeremy Oats. Planned private homebirth in Victoria 2000-2015: a retrospective cohort study of Victorian perinatal data. BMC Pregnancy Childbirth. 2018 Sep 4; 18 (1): 357. 
  • T A Wiegers, M J Keirse, J van der Zee, G A Berghs. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands. BMJ 1996 Nov 23; 313 (7068): 1309-13.

 

5)     Diabetology, Endocrinology, Gastroenterology and Abdominal Surgery: Vitamin D for covid-19? Intro to nutritional epidemiology

TBD

 

6) Orthopedics, Traumatology, Anaesthesiology and Resuscitation: Glucocorticoid therapy for patients in septic shock

The administration of glucocorticoids in septic shock has been a controversial topic in intensive care since the 1970s. Patients with septic shock have relative adrenal insufficiency and have been observed to improve circulatory function after glucocorticoid administration. However, their administration has its price in a number of side effects, the most significant of which is their immunosuppressive effect. After virtually complete rejection, glucocorticoids are now experiencing a renaissance in the treatment of septic shock, but experts differ on the acceptability of their use…

 The preparation for the practice has two parts:

1)     The first task is to read the following two articles. Both papers deal with the administration of corticoids in septic shock, ran in parallel and both were published in the same issue of the prestigious New England Journal of Medicine. Let´s see how the results turned out!

 ·       APPROCCHS trial: Annane, D., Renault, A., Brun-Buisson, C., Megarbane, B., Quenot, J.-P., Siami, S., . . . Martin, C. (2018). Hydrocortisone plus fludrocortisone for adults with septic shock. New England Journal of Medicine, 378(9), 809-818.

 ·       ADRENAL trial: Venkatesh, B., Finfer, S., Cohen, J., Rajbhandari, D., Arabi, Y., Bellomo, R., . . . Myburgh, J. (2018). Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. N Engl J Med, 378(9), 797-808. doi:10.1056/NEJMoa1705835

 

The papers are available on the module „výuka“ under the class „Practice in Orthopedics, Traumatology, Anaestesiology and Resuscitation“.

While reading the articles, think of the following questions:

-        What were the aims, methods and results?

-        Were „intention-to-treat“ or „per-protocol“ analyses used in these RCTs?

-        What methodological limitations were present in these studies and how could they bias the results?

-        What were the primary and secondary outcomes of these studies? Why do you consider important, whether an outcome was chosen as a primary or a secondary one?

-        How do you think the studies affected clinical practice? Would you administer hydrocortison to patients in septic shock? Or fludrocortison?

 

Studies APPROCCHS and ADRENAL are based on 50 years of research and clinical studies concerning administration of corticoids in sepsis. To fully understand the context, good literature search is necessary.  

 

2)     The second task is to conduct a short literature search concerning the benefits of corticosteroids for patients in septic shock. Online search engines and citation managers enable to perform such a search:

- First, watch a short tutorial (https://youtu.be/rCJUmonNjvI)

- Download the citation manager of your preference (in the tutorial, we chose Mendely + Web plug-in + Word plug-in)

- Conduct a short literature search on the given topic

- Save 4-5 randomized controlled trials into the citation manager (there have been approximately 10 since the 1970´s)

- Do a screen shot and send it to metodologie.ota@gmail.com latest during the day before the practice

 

The most commonly used search engines: Medline/Pubmed, Scopus, Web of Science, Google Scholar

The most commonly used citation managers: Procite, Endnote, Mendeley, Zotero, Connotea

Last update: Selinger Eliška, MUDr. (02.10.2021)
 
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