ETHER Senior Resident Stats Talk 29 Jan 2016
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Transcript of ETHER Senior Resident Stats Talk 29 Jan 2016
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ETHER 29 Jan 2016
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His Greatness,NSY
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I hate stats
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Medutainment
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#ih8stats
ih8stats
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https://www.sli.do/event/qt6qioy3/wall
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Why use statistics?
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But is the Truth true?
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An Example
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Asiana Flight 214
AmTrak
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Why not ask bus drivers instead?
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Type of Paper
Intervention
Drug Trial
RCT Observational
Case reportCase series
Case control
Cohort
Meta-analysisSystematic Review
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Type of Paper
Intervention
Drug Trial
RCT Observational
Case reportCase series
Case control
Cohort
Meta-analysisSystematic Review
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What is the question?
Why this question?
How to answer this question?
Inclusion / Exclusion
Methodology
Actual stats calculation
Conclusions and relevance
RCT - Intervention
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Interim analysis
No control group.
Significant conflict of interest
COD: Fudgy terminology
Small numbers
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Politics
Fame
Money
True Truth
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Define a “good” journal
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Industry sponsored trialBMJ 7%
NEJM 32%
CitationsIndustry sponsored > other source of funding
Reduction in Impact Factor1%15%
Reprints
Oct 2010
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Nov 2009
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May 2015
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…half baked ……tendentious …
…ill advised …
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Politics
Fame
Money
True Truth
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https://www.sli.do/event/qt6qioy3/wall
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What to make of negative studies?
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risk
of d
eath
untreated risk of death
redu
ctio
n of
risk
of d
eath
untreated risk of death redu
ctio
n of
risk
of d
eath
untreated risk of death
A B C
redu
ctio
n of
risk
of d
eath
untreated risk of death
adverse effectsris
k of
dea
th
untreated risk of death
treatmentris
k of
dea
th
untreated risk of death
no treatment
ABC
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Why ask this question?How to answer this question?
Is meta-analysis the right method to answer this question?
Meta-analysis
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What’s the result?How do we know the results
valid?
Meta-analysis
G.I.G.O
Garbagedata
Garbageresult
Garbage analysis
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Where How Quality
DataReproducible Robust
Meta-analysisHow do we know the results
valid?
Search databases / termsIndependent extractionPredefined data formAgreeing how to disagree
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Meta-analysisHow do we know the results
valid?
Publication biasFunnel Plot
DataReproducible Robust
Problem of negative studies
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“Perfect”data
Garbageresult
Garbage analysis
Observation vs intervention
Heterogeneity
Random vs fixed effect
Sensitivity Analysis
Meta-analysis
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Meta-analysis
Heterogeneity - I2
Lower = less heterogeneityHigher = more heterogeneity
describes the percentage of variation across studiesthat is due to heterogeneity rather than chance
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Meta-analysis
Random vs Fixed Effect
One true effect size shared by all the studies
True effect vary so each study estimates a different effect size(when significant
heterogeneityexist)
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Sensitivity Analysis
Meta-analysis
Performing analysis with different assumptionsto see if result remains the same
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How to apply the results?
“Perfect”data Result“Perfect”
analysis
Meta-analysis
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Take home messages
Medutainment is realand here to stay.
Paper critique is about logic.
If you are worried about Exit Paper critique,you are probably suffer from imposter syndrome.
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PerfectExcellence
Good enough
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https://www.sli.do/event/qt6qioy3/infographic