Evidence-Based Practice: cram pack

Formula sheets, the key method steps for every topic and 8 practice problems, with full solutions at the back.

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1Formulas and methods

Evidence-based practice statistics

Sensitivity and specificity
Se = a/(a + c), Sp = d/(b + d)
Predictive values
PPV = a/(a + b), NPV = d/(c + d)
Accuracy
(a + d)/n
Likelihood ratios
LR+ = Se/(1 − Sp), LR− = (1 − Se)/Sp
PPV at prevalence p
Se·p / (Se·p + (1 − Sp)(1 − p))
Odds
odds = p/(1 − p); p = odds/(1 + odds); post-test odds = pre-test odds × LR
Risk measures
RR = EER/CER, ARR = CER − EER, RRR = ARR/CER
Number needed to treat
NNT = 1/ARR, rounded up; NNH = 1/(EER − CER)
Odds ratio
OR = ad/(bc)
Incidence rate
new cases / person-time

Method

  1. Draw the 2 × 2 table and label a, b, c and d before you calculate.
  2. Read sensitivity and specificity down the columns, predictive values along the rows.
  3. For another prevalence, imagine 10 000 people and fill the table with Se, Sp and the prevalence.
  4. For a likelihood ratio, convert the probability to odds, multiply, and convert back.
  5. For a trial, find EER and CER first; then RR = EER/CER, ARR = CER − EER and NNT = 1/ARR rounded up.

Descriptive statistics

Mean
x̄ = Σx/n
Sample standard deviation
s = √(Σ(x − x̄)²/(n − 1))
Median
middle value of the sorted data
z-score
z = (x − μ)/σ
Normal distribution
68% within ±1σ, 95% within ±2σ

Confidence intervals

σ known
x̄ ± z·σ/√n
σ unknown
x̄ ± t·s/√n, df = n − 1
Critical z
90%: 1.645, 95%: 1.96, 99%: 2.576
Sample size
n = (z·σ/E)², rounded up

Method

  1. Decide between z (population σ known) and t (only the sample s, with n − 1 degrees of freedom).
  2. Find the critical value for the confidence level.
  3. Margin of error: E = critical value × standard deviation/√n.
  4. Interval: x̄ ± E.

Hypothesis tests & confidence intervals

z-test for a mean
z = (x̄ − μ0)/(σ/√n)
t-test for a mean
t = (x̄ − μ0)/(s/√n), df = n − 1
Two-sided at 5%
reject H0 if |z| > 1.96
Confidence interval
x̄ ± z·σ/√n

Method

  1. State H₀ and H₁ and decide whether the test is one- or two-sided.
  2. Calculate the test statistic: (x̄ − μ₀)/(σ/√n), or with s and t.
  3. Compare with the critical value, or find the p-value.
  4. Reject H₀ if the statistic is beyond the critical value (p below α), and state the conclusion in words.

2Practice problems

1.Evidence-based practice statisticsMedium
eventno eventtotaltreatment73577650abcontrol67413480cd

Practice exercise (made-up values, not clinical guidance). In a randomised trial, 650 patients received a new treatment and 480 received the control treatment. The table shows how many in each group had the outcome (an unwanted event such as a stroke). Find the absolute risk reduction ARR as a percentage. Round to one decimal place.

treatment: 73/650control: 67/480
ARR = %
2.Evidence-based practice statisticsHard
pre-test5%post-test?p′LR+

Practice exercise (made-up values, not clinical guidance). A patient has a pre-test probability of 5% for a disease. A test with sensitivity 92% and specificity 92% comes back positive. Find the post-test probability p′ of the disease as a percentage. Round to one decimal place.

pre-test 5%Se = 92%Sp = 92%positive
p′ = %
3.Descriptive statisticsMedium
101520253035404550

Find the sample standard deviation s of the data: 22, 54, 45, 12, 10, 25, 20.

n = 7
s =
4.Descriptive statisticsHard
z −2−1012

Exam scores are normally distributed with mean 100 and standard deviation 12. Find the z-score z of a score of 124.

μ = 100σ = 12x = 124
z =
5.Confidence intervalsMedium
x̄E₁ = 11.590%, n = 64x̄E₂ = ?90%, n = 16

A 90% confidence interval for a mean, based on 64 observations and a known σ, has a margin of error of 11.5. What is the margin of error E₂ if the same study uses 16 observations instead?

90%n₁ = 64E₁ = 11.5n₂ = 16
E₂ =
6.Confidence intervalsHard
μ₁ − μ₂, t(12) = 1.7820LUx̄₁ − x̄₂E = ?90%

Two fertilisers are tested. Plot group 1: 6 plots, mean yield 44.5 kg, standard deviation 8.5 kg. Plot group 2: 8 plots, mean 40 kg, standard deviation 4 kg. Assume equal variances (pooled t, df = n₁ + n₂ − 2). Find the margin of error E of the 90% confidence interval for μ₁ − μ₂.

n₁ = 6x̄₁ = 44.5s₁ = 8.5n₂ = 8x̄₂ = 40s₂ = 490%t(12) = 1.782
E = kg
7.Hypothesis tests & confidence intervalsMedium
t −2.01102.011

A sample of 49 students has a mean score of 123.3 and a sample standard deviation of 8. Find the test statistic t for H₀: μ = 120.

μ₀ = 120x̄ = 123.3s = 8n = 49
t =
8.Hypothesis tests & confidence intervalsHard
μ₀x̄c

A one-sided z test of H₀: μ = 500 against H₁: μ < 500 is done at α = 0.01 with a sample of 100; the standard deviation is known to be 20. In reality the mean is 492. Find the probability of a Type II error β in percent.

μ₀ = 500μ = 492σ = 20n = 100α = 0.01
β = %

3Solutions

1.Evidence-based practice statistics

Answer: ARR = 2.7 %

Likelihood ratios and risk measures: LR+ = sensitivity/(1 − specificity), LR− = (1 − sensitivity)/specificity. In a trial, EER and CER are the event rates with and without treatment: RR = EER/CER, ARR = CER − EER, RRR = ARR/CER and NNT = 1/ARR, rounded up. In a case-control study only the odds ratio OR = ad/(bc) can be used. An incidence rate = new cases/person-time.

Event rates

EER = 73/650 = 0.1123
CER = 67/480 = 0.1396

Absolute risk reduction

ARR = 0.1396 − 0.1123 = 0.02728 ≈ 2.7%

Answer

ARR = 2.7%
2.Evidence-based practice statistics

Answer: p′ = 37.7 %

Predictive values depend on prevalence: PPV = Se·p/(Se·p + (1 − Sp)(1 − p)) and NPV = Sp(1 − p)/(Sp(1 − p) + (1 − Se)p). With likelihood ratios: pre-test odds = p/(1 − p), post-test odds = pre-test odds × LR, probability = odds/(1 + odds). For a population of N, true positives = N·p·Se and false positives = N·(1 − p)·(1 − Sp). NNT = 1/(CER × RRR), rounded up.

Likelihood ratio

LR+ = 0.92/(1 − 0.92) = 11.5

Pre-test odds

0.05/(1 − 0.05) = 0.05263

Post-test odds

0.05263·11.5 = 0.6053

Post-test probability

p′ = 0.6053/(1 + 0.6053) = 0.377 ≈ 37.7%

Answer

p′ = 37.7%
3.Descriptive statistics

Answer: s = 16.56

Descriptive statistics: the mean is the sum divided by n; the median is the middle value of the sorted data (the average of the two middle values when n is even). The sample standard deviation is s = √(Σ(x − x̄)²/(n − 1)). A z-score z = (x − μ)/σ says how many standard deviations a value lies from the mean.

Mean

x̄ = 188/7 = 26.86

Squared deviations

Σ(x − x̄)² = (−4.857)² + 27.14² + 18.14² + (−14.86)² + (−16.86)² + (−1.857)² + (−6.857)² = 1645

Standard deviation

s = √(1645/6) = 16.56

Answer

s = 16.56
4.Descriptive statistics

Answer: z = 2

Descriptive statistics: the mean is the sum divided by n; the median is the middle value of the sorted data (the average of the two middle values when n is even). The sample standard deviation is s = √(Σ(x − x̄)²/(n − 1)). A z-score z = (x − μ)/σ says how many standard deviations a value lies from the mean.

Standardise

z = (124 − 100)/12 = 2

Answer

z = 2
5.Confidence intervals

Answer: E₂ = 23

Confidence interval for a mean: x̄ ± margin of error. With a known population σ the margin is z·σ/√n; with only the sample standard deviation s, use t with n − 1 degrees of freedom: t·s/√n. Critical values: z = 1.645 (90%), 1.96 (95%), 2.576 (99%). To get a margin E or smaller, you need n ≥ (z·σ/E)², rounded up.

Ratio of margins

E₂/E₁ = (1.645/1.645)·√(64/16) = 2

New margin

E₂ = 11.5·2 = 23

Answer

E₂ = 23
6.Confidence intervals

Answer: E = 6.044 kg

Interval for a difference: estimate ± critical value × standard error. For two independent means with known σ: SE = √(σ₁²/n₁ + σ₂²/n₂) and z. With equal unknown variances: pooled s_p and t with n₁ + n₂ − 2 degrees of freedom. For paired data, work with the differences: d̄ ± t·s_d/√n.

Pooled standard deviation

sp² = (5·8.5² + 7·4²)/12 = 39.44
sp = 6.28

Margin of error

E = 1.782·6.28·√(1/6 + 1/8) = 6.044

Answer

E = 6.044 kg
7.Hypothesis tests & confidence intervals

Answer: t = 2.887

Testing a mean: the test statistic measures how many standard errors the sample mean lies from the value claimed in H₀: z = (x̄ − μ₀)/(σ/√n) when σ is known, t = (x̄ − μ₀)/(s/√n) when it is estimated from the sample. A confidence interval is x̄ ± (critical value)·(standard error).

Standard error

SE = 8/√49 = 8/7 = 1.143

Test statistic

t = (123.3 − 120)/1.143 = 2.887

Answer

t = 2.887
t0.025; df = 48 = 2.011

|t| > 2.011, so H₀ is rejected at the 5% level (two-sided).

8.Hypothesis tests & confidence intervals

Answer: β = 4.707 %

Power of a test: power = 1 − β is the probability of rejecting H₀ when it is false. Find the cutoff x̄c from μ₀ and z_α, then compute the probability of landing beyond x̄c using the true mean: z = (x̄c − μ)/(σ/√n).

Critical sample mean

SE = 20/√100 = 2
x̄c = 500 − 2.326·2 = 495.3

z under the true mean

z = (495.3 − 492)/2 = 1.674

Type II error

power = P(Z < 1.674) = 95.29%
β = 100% − 95.29% = 4.707%

Answer

β = 4.707%

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