15/12/2011

research methods

Today we will talk about predictive value. Last time we talked about specificity and sensitivity. Disease Present Absent b False positive d True negative

a Positive Doctors Clinical Examinations (Test) Negative False negative True positive

Sensitivity= a/a+c Specificity= d/b+d Sensitivity and specificity are obtained in persons known to have or not have the disease. Predictive value of the test is the probability of disease, given the results of a test. So given the results of a test, what is the probability of the disease in your patient? And knowing the specificity and sensitivity of the test will give us an idea about the probability. For example, if we are doing a pulp test and we know that the sensitivity is 99%, this will give us an idea about the probability that my patient will have pulpitis. And that is the predictive value.

We have: Positive predictive value Is the probability of disease in a patient with a positive (abnormal) test result. Negative predictive value Is the probability of not having the disease when the test result is negative (normal).

for the predictive value we go horizontally (rows of the table). The positive predictive value is a/a+b, the (true positive) / (true & false positive). Which is the probability of people having the disease and also have positive test on all people with positive results. Regarding the negative predictive value, it is those who are true negative (negative & absent) on all those with negative value (true & false negative). If my patients test is positive, what are the chances that my patient does have the disease? Answer: positive predictive value If my patients test is negative, what are the chances that my patient does not have the disease? Answer: negative predictive value

The accuracy is a+b/ a+b+c+d. so it summarizes the overall value of the test and it is the proportion of all the test results, both positive and negative (positive/positive + negative). Accuracy= validity. Means how much your reading is close to the true reading. It's different from precision or reliability, because in reliability

you do the test many times, and how much your data is close or wide spread- this is reliability. Slide 27: Example: people who have the disease (streptococcus) are 37, People who don't have the disease are 112. The sensitivity here is 37/37 and the specificity is 77/112. The +ve predictive value is 37/72= 51% (72= 35+37). As we said before, we only take the positive results to calculate the probability of having the disease. The ve predictive value, it is all the people who tested negative (second row), so we calculate the probability of NOT having the disease. Which is 77/77=100%. Note:- in the final exam there will be one or two questions in which we have to calculate the specificity, sensitivity, prevalence and +ve & -ve predictive value. The more sensitive a test is, the better will be its negative predictive value, as in the example in slide 27, the sensitivity is 100% which affects the negative predictive value (100%). The more specific the test is, the better will be its positive predictive value, as in the example in slide 28, the specificity is 100% which affects the positive predictive value (100%).

Prevalence Prev = a+c/a+b+c+d . it's the "present" over the "present and absent". Because predictive value is also influenced by prevalence, it is not independent of the setting in which the test is used. (the doctor didn't further explain this, we should read all the rest of the slides alone and they are required in the exam).

. big thanx to them for doing the script fast Done by Amanda Saffoury and ^_^