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
peopleyears1210423505new cases74

Practice exercise (made-up values, not clinical guidance). In a cohort, groups of people were followed for different lengths of time (see the table: number of people and years of follow-up for each). During follow-up, 74 new cases occurred. Find the incidence rate IR per 1000 person-years. Round to one decimal place.

210 × 4 years350 × 5 years74 new cases
IR = per 1000 person-years
2.Evidence-based practice statisticsHard
pre-test40%post-test?p′LR+

Practice exercise (made-up values, not clinical guidance). A patient has a pre-test probability of 40% for a disease. A test with sensitivity 78% and specificity 86% comes back positive. Find the post-test probability p′ of the disease as a percentage. Round to one decimal place.

pre-test 40%Se = 78%Sp = 86%positive
p′ = %
3.Descriptive statisticsMedium
2025303540455055

Find the sample standard deviation s of the data: 44, 22, 43, 53, 20, 58, 40.

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

Exam scores are normally distributed with mean 500 and standard deviation 75. Find the z-score z of a score of 593.8.

μ = 500σ = 75x = 593.8
z =
5.Confidence intervalsMedium
μ₁ − μ₂0LUx̄₁ − x̄₂E = ?90%

The battery life of two phone models is compared. Model 1: 100 phones, mean 93.5 h, known standard deviation 5 h. Model 2: 80 phones, mean 86 h, known standard deviation 9 h. Find the margin of error E of the 90% confidence interval for μ₁ − μ₂.

n₁ = 100x̄₁ = 93.5 hσ₁ = 5 hn₂ = 80x̄₂ = 86 hσ₂ = 9 h90%
E = h
6.Confidence intervalsHard
σ = 3, n = ?x̄ − Ex̄ + Ex̄E = 0.590%

The population standard deviation is 3. How large a sample n do you need so that a 90% confidence interval for the mean has a margin of error of at most 0.5?

σ = 3E = 0.590%
n =
7.Hypothesis tests & confidence intervalsMedium
t −1.9901.99

A sample of 81 students has a mean score of 71.56 and a sample standard deviation of 10. Find the test statistic t for H₀: μ = 75.

μ₀ = 75x̄ = 71.56s = 10n = 81
t =
8.Hypothesis tests & confidence intervalsHard
H₀H₁μ₀x̄cμ₀ + 2.5α = 0.05βσ = 13, power 80%, n = ?

A one-sided z test at α = 0.05 must detect a shift of the mean of 2.5 units with a power of 80%. The standard deviation is 13. Find the minimum sample size n.

α = 0.05power = 80%δ = 2.5σ = 13zα = 1.645zβ = 0.842
n =

3Solutions

1.Evidence-based practice statistics

Answer: IR = 28.6 per 1000 person-years

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.

Person-years

PY = 210·4 + 350·5 = 2590

Incidence rate

IR = 74/2590·1000 = 28.6 per 1000 person-years

Answer

IR = 28.6 per 1000 person-years
2.Evidence-based practice statistics

Answer: p′ = 78.8 %

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+ = 0.78/(1 − 0.86) = 5.571

Pre-test odds

0.4/(1 − 0.4) = 0.6667

Post-test odds

0.6667·5.571 = 3.714

Post-test probability

p′ = 3.714/(1 + 3.714) = 0.7879 ≈ 78.8%

Answer

p′ = 78.8%
3.Descriptive statistics

Answer: s = 14.39

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 = 280/7 = 40

Squared deviations

Σ(x − x̄)² = 4² + (−18)² + 3² + 13² + (−20)² + 18² + 0² = 1242

Standard deviation

s = √(1242/6) = 14.39

Answer

s = 14.39
4.Descriptive statistics

Answer: z = 1.25

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 = (593.8 − 500)/75 = 1.25

Answer

z = 1.25
5.Confidence intervals

Answer: E = 1.848 h

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.

Point estimate

x̄₁ − x̄₂ = 93.5 − 86 = 7.5

Standard error

SE = √(5²/100 + 9²/80) = 1.124

Margin of error

E = 1.645·1.124 = 1.848

Answer

E = 1.848 h

The interval does not contain 0, so the means differ significantly.

6.Confidence intervals

Answer: n = 98

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.

Solve for n

n = (1.645·3/0.5)² = 97.42

Round up

A sample size is a whole number, and rounding down would make the margin too large.

n = 98

Answer

n = 98
7.Hypothesis tests & confidence intervals

Answer: t = −3.096

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 = 10/√81 = 10/9 = 1.111

Test statistic

t = (71.56 − 75)/1.111 = −3.096

Answer

t = −3.096
t0.025; df = 80 = 1.99

|t| > 1.99, so H₀ is rejected at the 5% level (two-sided).

8.Hypothesis tests & confidence intervals

Answer: n = 168

Sample size for a test: to detect a true shift δ with power 1 − β in a one-sided z test at level α, the standard error must satisfy δ = (z_α + z_β)·σ/√n, so n = ((z_α + z_β)·σ/δ)², rounded up.

Solve for n

n = ((1.645 + 0.842)·13/2.5)² = 167.2

Round up

n = 168

Answer

n = 168

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