Prevalence
The number of existing cases in a
population divided by the total
population
Risk = Incidence = Probability
The number of new cases in a population
for a given time period divided by the
total population
Risk Ratio = Relative Risk
The risk of exposed(pre-treated)
developing illness over the risk of
unexposed(untreated) developing illness.
ex. Someone on a B-blocker will have
1/2 the chance of heart failure, RR = .5
Absolute Risk Reduction (ARR) =
Attributable Risk
(Exposed risk - Unexposed risk)
Relative Risk Reduction
(ARR / Unexposed risk)
or
(Exposed risk - Unexposed risk) /
(Unexposed risk)
NNT (Number Needed to Treat)
1/ARR
Number you need to treat to prevent one
event
Number Needed to Harm is the same
thing but with a harmful side-effect
Odds
probability/(1-probability)
Odds ratio
The ratio of two odds.
"Something is x times more likely to
happen today than tomorrow"
Used instead of relative risk when
outcome is rare. Can be expressed as the
cross product of a 2x2 table. Also used
when using logistic regression to control
confounders.
Sensitivity
Probability, if you have the disease, the
test will be +
TP/(TP+FN)
Specificity
Probability, if you are healthy, the test
will be -
TN/(TN+FP)
Positive Predictive Value
Probability, if your test is +, that you
have the disease.
TP/(TP+FP)
Negative Predictive Value
Probability, if your test is -, that you
are truly healthy.
TN/(TN+FN)
Contingency Table
A 2x2 table for calculating Odds Ratio
or Relative Risk, etc.
Likelihood Ratio (+)
Odds of a finding in diseased versus
healthy individuals. How many times
more likely a test result will be found in
diseased versus healthy people.
(sensitivity)/(1-specificity)
(probability present in diseased
pts)/(probability present in non-diseased
pts)
Likelihood Ratio (-)
(probability absent in diseased
pts)/(probability absent in non-diseased
pts)
(1-sensitivity)/(specificity)
Clinical Trial
Experimental study. Prospective.
Interventional.
Cohort study
Observational. Usually prospective.
Identify exposure and observe incidence
of outcome.
Case-Control
Observational. Retrospective. Identify
disease and look for risk factors. Can't
calculate incidence so we calculate odds
ratio.
Cross-sectional
Observational. Retrospective. Measure
exposure and outcome at same
time. Can't measure incidence so
measure prevalence.
Survival analysis (Kaplan-Meier)
Useful when subjects are followed for
different periods of time. Survival ratios
are remaining subjects over subjects at
last event. Subtract drop-outs from
numerator and denominator at each
step. Cumulative survival is product of
survival ratio at each death/event.
Calculate hazard ratio instead of
relative risk.
Hazard ratio
Basically, it's relative risk ratio specific
to Kaplan- Meier survival analysis.
Intention-to-treat analysis
Patient's data analyzed with group
originally assigned to
Bias
Systematic error that skews results
Selection bias
One group under/overrepresented.
Unreasonable exclusion criteria.
Recall bias
In case-control studies, people with an
effect remember more and focus more
on details.
Misclassification
Assigning participants to wrong group.
May be bias if non-random.
Measurement
Data not taken in same way between
groups.
Confounders

An unseen variable that is associated

with both dependent and independent
variables. Three ways to compensate
with design: 1) randomize, 2) limit
enrollment selection to those with or w/o
the confounder, 3) matching each person
with a similar control participant. Three
ways to compensate with analysis: 1)
stratify data based on presence of
confounder, 2) adjustment for one
confounder statistically, 3) multivariate
analysis (linear or logistic) to account
for lots of confounders at once.

Allocation concealment

Opaque envelopes. Researchers have no

knowledge of who will be assigned to
experimental group until all are enrolled.

Logistic regression

Binary outcome. Way to control for

confounders and identify independent
variables associated with outcome.

Parameter

Characteristic of the population

Statistic

Characteristic of the sample

Alpha

The value your P value must be under to

be statistically significant

Beta

The probability of making a Type 2

error, accepting the null hypothesis
erroneously.
Power

(1-Beta)
The Power of the experiment to detect a
difference, rejecting the null hypothesis
correctly.

P value

The probability of making a Type 1

error, erroneously accepting your
experimental hypothesis and rejecting
the null.

Confidence interval

Probability that a value will fall in a

given range. This is not the probability
for a single study. If the CI ranges for
two groups overlap, there is no
significant statistical difference between
the groups.

Evidence-based Medicine

Integration of clinical expertise,

systematic research, and the
circumstances of the patient.

Foreground question

A question that asks for specialized,

specific knowledge. Think original
research study, or PubMed

Background question

A general question about conditions or

illnesses, etc. Think of a textbook.

POEMs (Patient Oriented Outcomes)

Results of a study that pertain to patient's

quality of life, length of life, and
happiness
DOEs (Disease Oriented Outcomes)

Results that may change lab values or

aspects of disease BUT do not change
mortality

Criteria for Causation

1. Temporal
2. Strength of association
3. Dose-response relationship
4. Replication of findings
5. Biologic plausibility
6. Consideration of alternative
explanations
7. Cessation of exposure
8. Consistency with other knowledge
9. Specificity of association

Prevention

Primary - Prevents an outcome

completely (immunizations)
Secondary - Detection early enough to
change outcome (screening)
Tertiary - Intervention that slows disease
or improves quality of life (rehab)

ROC curve

An x,y plot with "true positives" on the

y-axis and "false positives" on the x-
axis. A 45 degree line is where a test
gives as many true positives as false
positives (totally random). The more
exaggerated the hyperbola toward the
top left corner, the more accurate the
test.