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biostats

© All Rights Reserved

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Incidence rate=ratio of the number of new cases of a disorder to the number of

potential new cases

# new of cases/# of people in pop set

Prevalence rate=ratio of number of present cases of disorder to the number of

potential cases

# of total cases/# of people in pop set

Point Prevalence=# of people that have an illness at a specific point (like

on a specific date) divided by the people that could have it on that date ie the

population of the sample

# ill at point in time / # of people in pop set

Period Prevalence=# of people that have an illness during a specific time

period (like during a specific year)/# of people that could have it during that period

(the pop of the sample)

# ill during time period / # of people in pop set

Prevalence=incidence rate * average duration of the disease process

If disease lasts long time then Prevalence>Incidence (ex. HIV) (Influenza

Prevalence = Incidence)

Health intervention that prevent disease dec incidence and thus prevalence

In case of HIV if new drug inc live expectancy the prevalence will inc

Relative Risk (RR)=compares incidence rate of a disorder among people exposed

to risk factor with the incidence rate of those not exposed

Data collected via cohort study

((#exposed + disease)/pop) / ((#not exposed + disease)/pop)

Example the risk of lung cancer is X times higher for smokers than

nonsmokers

Attributable risk=incidence rate of illness in exposed incidence rate of not

exposed

Data collected via cohort study

Used to determine how many cases can be attributed to the exposure

((#expose + disease):pop) ((#not exposed + disease):pop)

Example X cases of lung cancer can be attributed to smoking

Odds Ratio= Tells the risk of a disease for those exposed as compared to those not

exposed

Data collected via case-control study

Can estimate the relative risk in this type of study

(Exposed + disease * not exposed disease) / (not exposed + disease *

exposed disease)

Example the risk of lung cancer is X times higher for smokers than

nonsmokers

Number Needed to Harm= # of people that must be exposed to a risk factor for

one person to be harmed that wouldnt have otherwise been harmed

1 / attributable risk (inverse of attributable risk)

Number needed to treat (NNT)= # of people who need to be treated for one

person to benefit from a treatment

1 / absolute risk reduction

Absolute risk= # w/ disease / pop

Absolute risk reduction= absolute risk of placebo group absolute risk of

treatment group

Biased test/study= constructed so one outcome is more likely that the other to

occur

Selection Bias=if subjects or investigator allowed to choose group assignments

Sampling Bias= subjects to not represent the population being studied- results

may not be generalizable

Recall Bias= knowledge of the presence of a disorder alters the way the subject

remembers his/her history (ex mothers of children w/ cleft palate ay over estimate

how much meds they took during preg..can lead to false finding that certain meds

related to cleft palate)

Lead-time Bias=early detection of disease is confused with inc survival or inc

incidence rate

Surveillance bias=people that are aware they are being followed for the

development of a disease are more likely to seek testing and thus be identified

early

Late-look Bias=people who already died from the disease are not included in the

sample. symptoms of disease seem less severe

Single blind=subject doesnt know if getting treatment or not

Double Blind=neither subject nor evaluator knows the assignments

switch

Each person can act as their own control

Reliability= reproducibility / dependability of results

Interrater reliability=are the results the same when administered by

different rater/examiner

Test-retest reliability=are results same when person tested repeatedly

Validity=does the test what is was designed to assess

Sensitivity=ability of test to id people that have disorder

#TP / total disease positives

Total disease positives = #TP + #FN (TP= + result + w/ disease FN= result w/ disease)

Specificity=can test id people that do not have the disorder

#TN / total disease negatives

Total disease negatives= #TN +#FP (TN= - result no disease FP= + result no

disease)

Predictive value=measure of % of results that match the actual diagnosis

Positive predictive value=likelihood that + test = actually diseased

TP / (TP + FP) = TP / Total positives

Negative predictive value=likelihood that test = actually well

TN / (TN + FN) = TN / total negatives

Receiver operating characteristic curve= graphic of the relationship of

sensitivity and specificity

Plotted as true positive rate (sensitivity) as a function of the false positive

rate (1-specificity)

Each point corresponds to a sensitivity/specificity pair at a certain decision

threshold

Perfect discrimination between ill and well has curve that hugs the Y axis

(100% sensitivity, 100% specificity)

Curve closer to the diagonal has less discriminating ability

occurs / # times event can occur

Attack Rate= incidence rate used to

describe disease outbreaks

# that become ill during study period /

# at risk during study period

Cohort Study= begin with id ppl w/out

disease of interestassess exposure to

risk factorassess incidence rates btwn

exposed and not look at how health

changes over time as result of exposure

or not

Prospective (concurrent)

cohort study= taking place now

Historical (no concurrent) cohort study= happened in the past

Clinical Treatment trial= some members in cohort given treatment others

given other treatment or placebo

Case-control study=begin with group of people that have illness and group that is

well

Look at prior exposure to risk factors in both groups

Cross-Sectional study= provides a snapshot in time of the disease

Provide info on relationship btwn risk factors and health status at a specific

time

Can be used to calc the prevalence of a disease in a pop

Standard Deviation= average distance of observations from their mean

1)

2)

3)

4)

Add all squared deviations together

Divide that number by the total number of scores -1

Take the square root of this value

z Score (standard normal value)= difference btwn individual score and the pop

mean in units of standard deviation

Standard Error= estimate of the quality of the sample

standard deviation / sqrt of # of scores in the sample

Confidence Interval= specifies the limits btwn which a given % of the pop should

fall

For example with a CI = 95% if conduct the clinical trail 100 times 95% of

results will fall within the calculated range

Narrower intervals give greater preision

Limits calc by mean of sample +/- z score * standard error

@ 95% CI z score=2

@99% CI z score =2.5

@99.7% CI z score=3

Normal distribution= bell curve/ Gaussian curve theoretical distribution of

scores in which the mean, median and mode are equal. ~68% of pop falls w/in 2 SD

of the mean; ~95% of scores w/in 2 SD of mean; ~99.7% of scores w/in 3 SD of

mean

Highest pt in distribution of scores is the modal peak

Precision=degree to which the mean is resistant to random variation

Accuracy=likelihood of bias

Skewed distribution=model peak shifts to one side

Positive skew(right skew)= tail towards right, peak towards left=scores cluster

at lower end

left, peak towards right=scores cluster at high end

Bimodal= 2 peaks=2 distinct populations

Hypothesis=statement based on inference,

existing lit, or preliminary studies that suggests

diff btwn 2 groups

Null Hypothesis=says no difference exists btwn

2 groups

Rejected or not rejected after stat analysis

Type 1 () error=null hypoth rejected

when true

Type 2 () error=null hypoth not rejected

when false

Probability=chance of at type 1 error occurring

P .05, reject null

IE of 100 outcomes 5 happened by chance

(type 1 error)

Considered stat significant

Power=(1-) the ability to detect a difference

btwn groups if there truly is one

Larger sample size gives more power to

detect difference

Statistically significant doesnt always mean clinically significant

reject the null

Parametric Statistical test=used to id presence of statistically sig diff

btwn groups when distribution of scores in pop is normal and sample size large

Ex) t-tests-difference between means of 2 samples

Independent (nonpaired) test=test mean diff of 2 groups on

one occasion

Dependent (paired) test=test mean diff of same people

sampled on 2 occasions

Ex)ANOVA (Analysis of variance)=diff btwn means of more than 2

samples

One way analysis=tests diff in mean of 1 variable taken in 3 or

more groups

Two way analysis=examines the influence of 2 different

categorical independent variables on 1 continuous dep variables

Ex)Linear correlation=degree of

relationship btwn 2 contiuous variables

Assessed using linear correlation

coefficients (r) ranging btwn -1 and +1

If 2 variables move in the same

direction r = + ex) height inc weight inc

If 2 variables move in opposite

direction r = - ex) time exercising inc weight dec

Non parametric statistical tests=evaluate

the presence of stat sig diff btwn groups then

distribution of scores isnt normal or sample size is

small

Ex) Wilcoxons (rank sum & signed-rank),

Mann-Whitney and Kruskal-Wallis tests

Chi-square=diff btwn frequencies in a samples

Fishers Exact tests=diff btwn frequencies in a small sample

with the best available external clinical evidence, patient values

EBM Process

1) Assess the patient

2)

3)

4)

5)

Acquire the evidence

Appraise the evidence

Apply/talk with the patient

P=Patient problem

I=intervention, prognostic factor or exposure

C=Comparison (alternatives to the treatment)

O=outcome

Type of clinical question

Diagnosis-how to select and interpret

diagnostic tests

Therapy-how to select treatment that

does more good than harm and worth

effort and cost

Prognosis-how to estimate patients

likely clinical course over time (based

on factors other than intervention) and

anticipate likely complications of the

disease

Harm/Etiology-how to id causes for

disease

Prospective, blind comparison to a gold

standard or cross-sectional

Randomized controlled trial>cohort

study

Cohort study> case control> case

series

Study designs from least rigorous and most bias to most rigorous and

least bias

Case series and Case reports-made of collection of reports on treatment of

individual patients or report on a single patient.

No control group

Little statistical validity

Case Control Studies-patients that already have a specific condition are

compared with people that do not have the condition

Look back to identify risk factors and exposures

Rely on records and/or patient recall

Statistical relationship doesnt mean 1 factor caused the other

Cohort Studies- use group of patients already taking a particular treatment or

have an exposurefollow them over timecompare their outcomes with similar

group not affected by the treatment or exposure

variable

Randomized controlled clinical trials-introduce treatment or exposure to study

effect in real patients

Control who receives treatment or exposure

Use methods to minimize bias

Use control and treatment group

Can provide cause and effect data

Systemic Reviews=extensive literature search to identify studies with sound

methodologyresults summarized according to the criteria of the review question

Studies reviewed and assessed for quality

Goal is to answer a specific clinical question

Meta-analysis=examines many valid studies on a topic and mathematically

combine the results

Cross-sectional studies= describe the relationship btwn disease and other

factors at one point in time in defined pop

No info on timing of exposure or outcome relationships

Only include prevalent cases

Often used to compare diagnostic tests (prospective, blind

comparison to the gold standard)

Sensitivity and specificity of the new test are compared to that of the gold

standard to determine potential usefulness

Qualitative research=used to describe, explore and explain health related

phenomena being studies

Answers wide variety of questions related to human responses to actual or

potential health problems

Retrospective Cohort (historical)-same direction as cohort. Subjects being w/ or

w/out exposure or risk factor and are followed until outcome of interest is observed.

PubMed/MEDLINE give access to primary lit

ACP Journal Club, Essentail Evidence, FRIN Clinical Inquireies and Clinical

Evidence give assessment of original studies

Cochrane Library gives systematic reviews that help summarize results from

many studies

Evaluating Validity

2) Was group allocation concealed?

3) Were patients in the study groups similar with respect to known prognostic

variables?

4) To what extent was the study blinded

5) Was follow-up complete?

6) Were patients analyzed in the groups to which they were fist allocated?

7) Aside from the experimental intervention, were the groups treated equally

Experimental Event Rate(EER)= Outcome present/total in experimental group

Control Event Rate(CER)= outcome present/total in control group

Absolute Benefit Increase(ABI)= inc of a good even as a result of the

intervention

EER CER

Absolute Risk Reduction(ARR)=decrease of a bad event as a result of the

intervention

EER CER

Relative Risk= with treatment vs no treatment

EER / CER

Relative Benefit increase= proportional inc in benefits btwn rates of events in

control and experimental group

(EER CER) / CER

Likelihood Ratios(LR)=

(+)=positive test in patients with disease/positive test in patient without

disease

(-)=negative test in patients with disease / negative test in patients without

disease

10 < LR < .1 cause large changes

LR 5-10 or .1-.2 cause moderate changes

LR 2-5 or .2-.5 cause small changes

LR<2 or LR>.5 cause tiny changes

LR = 1 cause not change

Relative Risk for Random Control Trials and Cohort Studies=how much more

often does the outcome occur in those exposed vs those not exposed

( exposed + disease / all exposed) / (not exposed + disease / all not exposed)

Odds Ratio=those with the outcome are X times more likely to have been exposed

than where those in the control group

(exposed + disease / not exposed + disease) / (exposed disease/ not

exposed disease)

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