DISEASE NO DISEASE

TEST + True positives False Positive / Type I

error PPV
You have mono and you
have a positive mono spot You don’t have mono true positive
test but test says you do true positive + false positive

aka p value “a measure of true positives”

TEST - False negatives / Type II True negatives

error NPV
You don’t have mono
You have mono but test says and the test confirms that true negative
you don’t true negative + false negative

Beta / Power “a measure of true negatives”

N.B. In all these equations,

sensitivity: specificity: the numerator always
contains one term and always
only concerned with those only concerned with contains “true”
that are ILL HEALTHY people

true positive true negative

true positive + false negative true negative + false pos

Another way to Remember Type I vs Type II:

If you have a type I error only you (1 person) are affected (you are upset b/c the test tells
you that you have mono, when in fact you don’t—false positive).

If you have a type II error, two people are affected, because you unknowingly infect
your loved one (the test told you didn’t have mono, but indeed you do and are
infectious—false negative).

Depending on the test:

Minimize false negatives (highly sensitive) such as to catch everyone who may have the
disease (HIV testing).
Minimize false positives (highly specific) such as to confirm a diagnosis (Biopsy)
 DISEASE NO DISEASE
TEST POSITIVE a b
TEST NEGATIVE c d

SPECIFICITY (⇑ Specificity = ⇓ False Positives) –NO Disease COLUMN

d / (d + b)
True negatives / Total for No Disease

SENSITIVITY (⇑ Sensitivity = ⇓ False Negatives) –Disease COLUMN

a / (a + c)
True positives / Total who have Disease

POSITIVE PREDICTIVE VALUE –Test Positive ROW

a / (a + b)
Of all who test positive, those who are actually positive

NEGATIVE PREDICTIVE VALUE –Test Negative ROW

d / (c + d)
Of all who test negative, those who are actually negative

ODDS RATIO:
OK ONLY when a and c (incidence of disease) are SMALL; otherwise do a relative risk
(a/b) OR (ad)
(c/d) (bc)

RELATIVE RISK:
a/(a+b)
c/(c+d)

In order to ⇓ power: ⇓ study size, ⇑ variance, ⇓ degree of association hypothesized

Reject Null = Go to study hypothesis
For below: Disease = Turning blue

CASE REPORT:
Descriptive: 12 case reports of med students who after doing 20 Qbank questions / day
turned blue

CROSS SECTION:
Point in time: A study that measures the amount of questions med students do the day
before the boards, to see if there is a correlation to turning blue

CASE CONTROL:
Retrospective: A study that looks at a group of med students who turned blue and
matches them to a group of med students who did not turn blue and then compares their
previous Qbank use.

COHORT:
Prospective: At age 21, 1000 med students were enrolled in a study in which they are
followed to see if they turn blue and they fill out a questionare on how many Qbank
questions they do per day.

RANDOMIZED TRIAL:
At age 21, 1000 med students are randomized to two groups: one which is told to do 20
Qbank questions / day and one in which they do 20 placebo questions / day (don’t ask me
what a placebo question is; hopefully you can follow the jist) and the incidence of turning
blue is measured.

the end.