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    Prospective cohort designs provide measures of risk and incidence

    Prospective cohort designs are needed in the literature

    They yield the highest level of observational evidence

    By far, the prospective cohort design is the most powerful observational design. The design can yield a measure of incidence (number of new cases in a population), longitudinal effects (etiology and disease progression), and the potential for decreased observation bias (more control on study design and data collection).

    Retrospective cohort designs can yield some measures of incidence in patient populations. However, researchers are limited to the variables that have been collected in an objective fashion within homogeneous populations. Incidence is a much more valid measure when generated using a prospective cohort design. Researchers choose in an a priori fashion exactly what variables will be collected in the measured.

    Incidence is a much more precise measure of association versus prevalence. Prospective and experimental designs can yield measures of incidence and establish the relative risk of developing an outcome. Researchers and clinicians also have a better understanding of incidence and relative risk versus prevalence and odds ratios.

    Longitudinal data is data collected over an extended period of time. Longitudinal data is necessary for understanding the etiology and progression of disease states. Survival and time-to-event analyses produce popular measures in medicine such as 1-year, 3-year, and 5-year survival and recurrence. The primary issue with collecting longitudinal data is attrition and loss to follow-up with the prospective sample. As participants fall out of the study or are lost, the validity of the data greatly decreases.

    Again, it is important to state that prospective designs give more control to researchers in regards to what data is collected. Every variable that you find pertinent for establishing causal effects between predictor and outcome variables, when controlling for all important demographic, prognostic, clinical, and confounding variables, can be chosen and collected. Observational biases associated with retrospective research do not apply with these studies because you can collect all of the data on all the variables that you chose, given that there is a theoretical, conceptual, or physiological reason for doing so.
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    Operationalization of constructs and behaviors

    Operationalization leading to understanding

    Measurement of new phenomena

    The term operationalization is very near and dear to my heart since I conducted my dissertation on operationalizing and validating the construct of isomorphism in supervision. Operationalization essentially means defining observable and measurable components of a given construct or behavior.

    The term is used often in the social sciences because scientists in that field have to spend so much time creating and validating their constructs of interest, just to be able to measure for them. From an empirical standpoint, they have to operationalize the construct as it exists within the perception, context, experience, and environment of members of a population.

    Many social scientists use survey methodologies (cross-sectional) to operationalize an abstract, new, or unique construct or behavior. They master the content area related to the construct, create a survey, and then administer it to a sample from a targeted population to see what content areas or items account for the most variance. Principal components analysis and confirmatory factor analysis are used to establish the construct validity of survey instruments.

    Medical professionals use cross-sectional research designs to establish the prevalence of disease states. Operationalization within physiology deals more with using "gold standard" techniques and concrete measures such as lab values.  Treatment protocols are another form of operationalization within medicine.  Certain procedures like a central line insertion require 20+ sequential steps to be conducted by surgical team members, every time.  With the advent of the Affordable Care Act and upcoming clinical pathways, operationalization will play an even larger role in building economical, efficient, and effective standards of care.    
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    Prevalence vs. Incidence

    Prevalence and incidence used correctly

    Difference in important epidemiological measures

    The terms prevalence and incidence are often used interchangeably. However, they are extremely different in their utility and interpretability within epidemiology.

    Prevalence is the proportion of cases or disease states that exist in a population at any given time.  Prevalence is established using cross-sectional research designs.  Measures of prevalence can be used to generate odds ratios for outcomes occurring given an exposure or non-exposure.  It is calculated when data is collected in a retrospective fashion

    Incidence is the number of new cases or disease states that occur in a population.  Incidence is established in cohort designs.  Measures of incidence are used to establish the relative risk of an outcome given treatment or no treatment.  It is calculated when data is collected in a prospective fashion.

    Click on the Epidemiology button below to continue.
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    Positive Predictive Value and Prevalence

    Positive Predictive Value (PPV) and Prevalence

    Increased prevalence of an outcome will lead to more cases being "picked up"

    Positive predictive value (PPV) is the likelihood that a person with a "+" on a diagnostic test actually has the disease state as it is detected using a "gold standard." Another way of defining PPV is how believable a "+" test result is in a given population.
     
    As the prevalence of a disease state in a given population increases, the positive predictive value of a test will increase. This is simply due to the fact that there are more cases or disease states that can be detected.

    If you are working with a rare outcome in a given population, be aware that less prevalent outcomes increase the number of false positives detected by a diagnostic test. By definition, lower prevalence dictates that there are not many true positives or "sick" people in a given population. With so few actual cases and more people being tested, the inherent measurement error associated with diagnostic testing will yield more and more false positives.    

    So, in conclusion, it is very important to know the baseline prevalence of your outcome or disease state in your population of interest when assessing diagnostic tests. Higher prevalence leads to increased PPV and lower prevalence leads to increased false positives.