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
casescontrolsexposed12222abnot exposed198108cd

Practice exercise (made-up values, not clinical guidance). A case-control study compares 320 patients with a disease (cases) and 130 people without it (controls). The table shows how many in each group were exposed to a risk factor. Find the odds ratio OR for the exposure. Round to two decimal places.

a = 122b = 22c = 198d = 108
OR =
2.Evidence-based practice statisticsHard
p (%)PPV (%)15%PPV = ?100

Practice exercise (made-up values, not clinical guidance). A screening test has a sensitivity of 84% and a specificity of 93%. It is used in a population where the prevalence is 15%. Find the positive predictive value PPV as a percentage. Round to one decimal place.

Se = 84%Sp = 93%p = 15%
PPV = %
3.Descriptive statisticsMedium
20253035404550

Find the sample standard deviation s of the data: 23, 30, 23, 16, 52, 16.

n = 6
s =
4.Descriptive statisticsHard
z −2−1012

A quantity is normally distributed with mean 70 and standard deviation 20. What proportion P of values is below 46?

μ = 70σ = 20x = 46
P =
5.Confidence intervalsMedium
n = 6, sd​ = 3.40L = ?Ud̄ = 6.2E95%

The blood pressure of 6 patients is measured before and after a treatment. The differences d = before − after (mmHg) have mean 6.2 and standard deviation 3.4. Find the lower limit of the 95% confidence interval for the mean difference.

n = 6d̄ = 6.2sd = 3.495%t(5) = 2.571
lower limit = mmHg
6.Confidence intervalsHard
σ = 31, n = ?x̄ − Ex̄ + Ex̄E = 1.599%

The population standard deviation is 31. How large a sample n do you need so that a 99% confidence interval for the mean has a margin of error of at most 1.5?

σ = 31E = 1.599%
n =
7.Hypothesis tests & confidence intervalsMedium
−2.1792.179t = ?df = 12

Two teaching methods are compared. Group 1: 6 students, mean score 42, standard deviation 9. Group 2: 8 students, mean score 45.7, standard deviation 3. Assume equal population variances and use the pooled two-sample t test. Find the test statistic t for H₀: μ₁ = μ₂, taking the difference as x̄₁ − x̄₂ (group 1 minus group 2).

n₁ = 6x̄₁ = 42s₁ = 9n₂ = 8x̄₂ = 45.7s₂ = 3
t =
8.Hypothesis tests & confidence intervalsHard
μ₀x̄c

A one-sided z test of H₀: μ = 80 against H₁: μ > 80 is done at α = 0.01 with a sample of 100; the standard deviation is known to be 10. In reality the mean is 81.7. Find the probability of a Type II error β in percent.

μ₀ = 80μ = 81.7σ = 10n = 100α = 0.01
β = %

3Solutions

1.Evidence-based practice statistics

Answer: OR = 3.02

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.

Odds of exposure

cases: 122/198 = 0.6162
controls: 22/108 = 0.2037

Odds ratio

OR = (122·108)/(22·198) = 3.025 ≈ 3.02

Answer

OR = 3.02

OR above 1: exposure is more common among the cases.

2.Evidence-based practice statistics

Answer: PPV = 67.9 %

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.

True and false positives (per person)

Se·p = 0.84·0.15 = 0.126
(1 − Sp)·(1 − p) = 0.07·0.85 = 0.0595

Positive predictive value

PPV = 0.126/(0.126 + 0.0595) = 0.6792 ≈ 67.9%

Answer

PPV = 67.9%

The lower the prevalence, the lower the PPV of the same test.

3.Descriptive statistics

Answer: s = 13.47

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 = 160/6 = 26.67

Squared deviations

Σ(x − x̄)² = (−3.667)² + 3.333² + (−3.667)² + (−10.67)² + 25.33² + (−10.67)² = 907.3

Standard deviation

s = √(907.3/5) = 13.47

Answer

s = 13.47
4.Descriptive statistics

Answer: P = 0.1151

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 = −1.2

Standard normal table

Φ(−1.2) = 0.1151
P = 0.1151

Answer

P = 0.1151
5.Confidence intervals

Answer: lower limit = 2.631 mmHg

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.

Critical value

df = 5, t = 2.571

Margin of error

E = 2.571·3.4/√6 = 3.569

Interval

6.2 ± 3.569 → [2.631, 9.769]

Answer

lower limit = 2.631 mmHg
6.Confidence intervals

Answer: n = 2835

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 = (2.576·31/1.5)² = 2834

Round up

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

n = 2835

Answer

n = 2835
7.Hypothesis tests & confidence intervals

Answer: t = −1.097

Hypothesis test: the test statistic = (estimate − value under H₀)/(standard error under H₀). The p-value is the probability, assuming H₀ is true, of a statistic at least as extreme as the one observed: the area in one tail for a one-sided H₁, twice the tail area for a two-sided H₁. Reject H₀ when p ≤ α.

Pooled variance

sp² = (5·9² + 7·3²)/12 = 39
sp = 6.245

Standard error

SE = 6.245·√(1/6 + 1/8) = 3.373

Test statistic

t = (42 − 45.7)/3.373 = −1.097

Answer

t = −1.097

With df = 12, the two-sided 5% critical value is 2.179; |t| is smaller, so H₀ is not rejected.

8.Hypothesis tests & confidence intervals

Answer: β = 73.43 %

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 = 10/√100 = 1
x̄c = 80 + 2.326·1 = 82.33

z under the true mean

z = (82.33 − 81.7)/1 = 0.626

Type II error

power = P(Z > 0.626) = 26.57%
β = 100% − 26.57% = 73.43%

Answer

β = 73.43%

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