1S]12]2011 research methods

1oday we wlll Lalk abouL predlcLlve value LasL Llme we Lalked abouL
speclflclLy and senslLlvlLy
ulsease
resenL AbsenL
uocLors Cllnlcal
LxamlnaLlons
(1esL)
oslLlve
A
1rue poslLlve
b
lalse
poslLlve
negaLlve
C
lalse negaLlve
d
1rue
negaLlve

SenslLlvlLy a/a+c
SpeclflclLy d/b+d
O SenslLlvlLy and speclflclLy are obLalned ln persons known Lo have
or noL have Lhe dlsease
O redlcLlve value of Lhe LesL ls Lhe probablllLy of dlsease glven Lhe
resulLs of a LesL
So glven Lhe resulLs of a LesL whaL ls Lhe probablllLy of Lhe dlsease ln
your paLlenL? And knowlng Lhe speclflclLy and senslLlvlLy of Lhe LesL wlll
glve us an ldea abouL Lhe probablllLy
lor example lf we are dolng a pulp LesL and we know LhaL Lhe senslLlvlLy
ls 99 Lhls wlll glve us an ldea abouL Lhe probablllLy LhaL my paLlenL wlll
have pulplLls And LhaL ls Lhe predlcLlve value
Je have
W oslLlve predlcLlve value
s Lhe probablllLy of dlsease ln a paLlenL wlLh a poslLlve
(abnormal) LesL resulL
W negaLlve predlcLlve value
s Lhe probablllLy of noL havlng Lhe dlsease when Lhe LesL
resulL ls negaLlve (normal)

for Lhe predlcLlve value we go horlzonLally (rows of Lhe Lable)
1he poslLlve predlcLlve value ls a/a+d Lhe (Lrue poslLlve) / (Lrue false
poslLlve) Jhlch ls Lhe probablllLy of people havlng Lhe dlsease and also
have poslLlve LesL on all people wlLh poslLlve resulLs
8egardlng Lhe negaLlve predlcLlve value lL ls Lhose who are Lrue negaLlve
(negaLlve absenL) on all Lhose wlLh negaLlve value (Lrue false
negaLlve)
W f my paLlenL's LesL ls poslLlve whaL are Lhe chances LhaL my
paLlenL does have Lhe dlsease?
Answer poslLlve predlcLlve value
W f my paLlenL's LesL ls negaLlve whaL are Lhe chances LhaL my
paLlenL does noL have Lhe dlsease?
Answer negaLlve predlcLlve value

1he accuracy ls a+d/ a+b+c+d so lL summarlzes Lhe overall value of Lhe
LesL and lL ls Lhe proporLlon of all Lhe LesL resulLs boLh poslLlve and
negaLlve (poslLlve/poslLlve + negaLlve)
Accuracy valldlLy Means how much your readlng ls close Lo Lhe Lrue
readlng Ls dlfferenL from preclslon or rellablllLy because ln rellablllLy
you do Lhe LesL many Llmes and how much your daLa ls close or wlde
spread Lhls ls rellablllLy
Sllde 27
Lxample people who have Lhe dlsease (sLrepLococcus) are 37 eople
who donL have Lhe dlsease are 112
1he senslLlvlLy here ls 27/37 and Lhe speclflclLy ls 77/112
1he +ve predlcLlve value ls 2762
As we sald before we only Lake Lhe poslLlve resulLs Lo calculaLe Lhe
robab|||ty of hav|ng the d|sease
1he ve predlcLlve value lL ls all Lhe people who LesLed negaLlve (second
row) so we calculaLe Lhe robab|||ty of NC1 hav|ng the d|sease Jhlch
ls 77/78
noLe ln Lhe flnal exam Lhere wlll be one or Lwo quesLlons ln whlch we
have Lo calculaLe Lhe speclflclLy senslLlvlLy prevalence and +ve ve
predlcLlve value
1he more senslLlve a LesL ls Lhe beLLer wlll be lLs negaLlve predlcLlve
value as ln Lhe example ln sllde 27 Lhe senslLlvlLy ls 100 whlch affecLs
Lhe negaLlve predlcLlve value (100)
1he more speclflc Lhe LesL ls Lhe beLLer wlll be lLs poslLlve predlcLlve
value as ln Lhe example ln sllde 28 Lhe speclflclLy ls 100 whlch affecLs
Lhe poslLlve predlcLlve value (100)

reva|ence
rev a+c/a+b+c+d lLs Lhe presenL over Lhe presenL and absenL
8ecause predlcLlve value ls also lnfluenced by prevalence lL ls noL
lndependenL of Lhe seLLlng ln whlch Lhe LesL ls used (Lhe docLor dldnL
furLher explaln Lhls we should read all Lhe resL of Lhe slldes alone and
Lhey are requlred ln Lhe exam)
1o a new to|c IkLULNC
Je wlll Lalk abouL prevalence and lncldence whlch are very used ln
denLlsLry for example Lhe research LhaL Lhe docLor dld on cusp of
carabelll he calculaLed Lhe prevalence noL Lhe lncldence because cusp
of carabelll lsnL someLhlng Lhe occurs wlLh Llme lLs presenL when LooLh
erupLs 8uL we can calculaLe Lhe lncldence of cancer because lL ls
someLhlng LhaL occurs wlLh Llme
;uesLlons LhaL cllnlclans need Lo answer ln Lhe care of Lhelr
paLlenLs Lake Lhe form of probablllLy
As cllnlclans we usually use Lhe probablllLy lor example lf a paLlenL
comes and we dlagnose hlm wlLh cancer Lhe paLlenL mlghL ask us whaL
are Lhe chances LhaL he wlll survlve afLer 3 years our answer wlll be
your prognosls or survlval raLe afLer 3 years ls 30 where dld we geL
Lhe 30 from? lrom researches LhaL were conducLed on cancer
paLlenLs 1haL ls why we cannoL do good cllnlcal medlclne or denLlsLry
wlLhouL belng ln Louch wlLh researches
lrequencles obLalned from cllnlcal research are Lhe basls for
probablllLy esLlmaLes ln paLlenL care
robablllLy can be expressed ln words lnsLead of numbers
Avoldlng preclslon when uncerLaln
Sub[ecLlvlLy (usually rarely)
usually we Lry noL Lo glve sharp deLalls lnsLead we use general
probablllLy Lerms Chances hlgh or low Lhese Lerms are beLLer Lo be
used wlLh paLlenLs especlally lf we donL know Lhe exacL probablllLy or
percenLage lor example lf a paLlenL has pulplLls and ask abouL Lhe
probablllLy LhaL Lhe LooLh remalns vlLal we Lell hlm Lhe chances are hlgh
8uL lf we were ln Louch wlLh a researcher and we know Lhe exacL
percenLage we can Lell hlm Lhe chances are 93
So we can rely on researches or our own experlence Lo predlcL Lhe
chances
Measurlng Lhe frequency of an evenL ls expressed by a fracLlon
l8L;uLnC? numeraLor/denomlnaLor
numeraLor no of paLlenLs experlenclng Lhe ouLcome (Cases)
uenomlnaLor 1oLal number of paLlenLs (number of people ln
whom Lhe ouLcome could have occurred)
lor example Lhe docLor wanLs Lo check Lhe frequency of cusp of
carabelll 1he numeraLor ls Lhe number of people who have cusp of
carabelll and Lhe denomlnaLor ls all Lhe people LhaL were sLudled
Je should deflne our populaLlon for example we wanL Lo sLudy Lhe
frequency of cervlcal cancer we should exclude Lhe women who had
hysLerecLomy (removal of Lhe uLerus) from Lhe denomlnaLor because
Lhey can never have cervlcal cancer (Lhe ouLcome)
revalence
ls Lhe proporLlon of a group of people wlLh a cllnlcal
condlLlon aL a glven polnL ln Llme
f Lhe docLor wanLs Lo calculaLe Lhe prevalence of sLudenLs who cheaLed
on Lhe onllne qulz he wlll ask who cheaLed? and Lhose who cheaLed
wlll ralse Lhelr hand f we have medlcal sLudenLs ln Lhe hall we should
exclude Lhem from Lhe denomlnaLor because Lhey dldn'L do Lhe qulz
ncldence
ls Lhe proporLlon of a group of people lnlLlally free of Lhe
condlLlon LhaL develops Lhe condlLlon over a glven perlod of
Llme
Je have Lo follow Lhe sub[ecLs over a perlod of Llme and Lhese sub[ecLs
should be free of Lhe dlsease aL Lhe beglnnlng of Lhe sLudy lor example
lf Lhe docLor wanLs Lo sLudy Lhe lncldence of lung cancer Lhe sub[ecLs
LhaL wlll be sLudled shouldn'L have lung cancer so we do a base llne
examlnaLlon Ls an examlnaLlon LhaL we do ln Lhe beglnnlng of Lhe
sLudy and Lhose who have lung cancer should be excluded from Lhe
sLudy

.
So we follow Lhe sub[ecLs up for 3 years for example and we wlll see Lhe
number of people who developed lung cancer
See sllde 8910 Lo undersLand Lhe followlng more
MeasuremenL of lncldence and prevalence of cancer among a
populaLlon from 19911993 (n100)

Je can sLudy Lhe lncldence and prevalence aL Lhe same Llme
1he clrcle means Lhe onseL of cancer and Lhe llne ls Lhe duraLlon of Lhe
cancer Ls end means LhaL elLher Lhe paLlenL ls dead or he was cured
So Lo calculaLe Lhe prevalence of Lhe dlsease aL Lhe beglnnlng of 1991
we counL Lhose who had Lhe dlsease whlch are 4 (box A) 4 wlll be ln Lhe
numeraLor and Lhe denomlnaLor wlll be 100 So lL wlll be 4/100
now leLs calculaLe Lhe prevalence of Lhe dlsease aL Lhe beglnnlng of
1992 Je counL Lhose who had Lhe dlsease aL LhaL Llme whlch are 3 (box
8) alLhough here Lhe denomlnaLor ls dlfferenL because we can see LhaL
parL of Lhe sub[ecLs dropped from Lhe sLudy whlch are 4 ( marked by
sLars) So Lhe prevalence wlll be 3/(1004) 3/96 (correcL Lhls ln Lhe
sllde)
1he prevalence of Lhe dlsease aL Lhe beglnnlng of 1993 we counL Lhose
who have Lhe dlsease aL LhaL Llme whlch are 7 (box c) and Lhls ls Lhe
numeraLor Je can see LhaL 4 sub[ecLs had dropped ln Lhe flrsL year
(sLars) and anoLher 4 had dropped ln Lhe second year (marked by Lhe
Lrlangles) so we have overall 8 sub[ecLs who dropped from Lhe sLudy So
Lhe prevalence wlll be 7/ (1008) 7/92 (correcL Lhls ln Lhe sllde)
now for Lhe lncldence you have Lo deflne a sLarLlng polnL and an endlng
polnL and calculaLe Lhe cases LhaL occurred so from Lhe beglnnlng of
1991 Lo Lhe end of 1991 ln Lhls case we have 3 new cases ln Lhls perlod
noLlce LhaL ln Lhe base llne examlnaLlon Lhere are 4 sub[ecLs who
already have cancer (box A) and ln Lhe lncldence we have Lo exclude
Lhem So Lhe lncldence of cancer beLween Lhe beglnnlng of 1991 and Lhe
end of 1991 ls 3/ (1004) 3/96
1o calculaLe Lhe lncldence of Lhe dlsease from Lhe beglnnlng of 1992
(end of 1991) Lo Lhe end of 1992 we have 6 new cases buL we have 4
sub[ecLs who had dropped from Lhe sLudy (sLars) and 3 sub[ecLs who
already had Lhe dlsease aL Lhe beglnnlng of 1992 (box 8) so we should
exclude Lhem Loo So Lhe lncldence here ls 6/ (1009) 6/91
now Lo calculaLe Lhe lncldence from 1991 Lo 1993 we have 11 new
cases and as we know we should exclude Lhe flrsL 4 sub[ecLs (box A)
from Lhe denomlnaLor so Lhe lncldence here wlll be 11/ (1004) 11/96



1he docLor [usL read Lhe nexL sllde as lL ls




nc|dence reva|ence
Numerator
new cases durlng a
perlod of Llme
All cases counLed on a
slngle examlnaLlon
Denom|nator
All suscepLlble persons aL
Lhe beglnnlng of Lhe
perlod
All people examlned
lncludlng cases and
noncases
1|me uuraLlon of Lhe perlod
Slngle polnL (cross
secLlon of Llme)
now measured
CohorL sLudy (cohorL a
group havlng someLhlng
ln common when
assembled)
Cross secLlonal sLudy

Done y
manda Saffoury Iares Nasra||ah