如何解讀診斷性臨床試驗(yàn)(參考版)
2024-07-29 20:59本頁(yè)面
【正文】 when the prevalence of population is %, then PPV=*(*+*)=% hence: a positive test result means the probability of real HIV(+) is %. PPV (1 ) (1 )S e PS e P S p P?? ? ? ? ?復(fù)旦大學(xué)公共衛(wèi)生學(xué)院 Result Reliability index ? kappa statistic: ? If Kappa = 1, then there is perfect agreement. ? If Kappa = 0, then there is no agreement. The higher the value of Kappa, the stronger the agreement For diagnostic tests: ? k ≥0. 75 good； ? 0. 4 k 0. 75 general； ? k ≤0. 4 bad 復(fù)旦大學(xué)公共衛(wèi)生學(xué)院 Tradeoffs between sensitivity and specificity Put weights to Se and Sp ?Same weights， then maximum Se+Sp use the ROC curve :the top left corner ? Different weights， then maximum α Se+Sp ?Considerations： ? further examinations ? consequences of misdiagnosis or missed diagnosis ? next examination ? prevalence ? necessity of treatment 復(fù)旦大學(xué)公共衛(wèi)生學(xué)院 Comparisons and statistic tests ?Area under the ROC curve Area should ? test H0:the area= , ? if H0 ,then the diagnostic test have no clinical value ?Different diagnostic tests the larger the area,the better the test 復(fù)旦大學(xué)公共衛(wèi)生學(xué)院 Considerations ?Costbenefit/effect analysis, CBA/ CEA ?Increasing the efficiency of tests ? parallel test: increasing Se ? serial test: increasing Sp ?No gold standard ?Prevalence ?Ethics： Informed consent ,Beneficence amp。s index,YI： YI=Se+Sp1 ?Likelihood ratio ,LR ? LR+： the probability of positive test result in people with the disease divided by the probability of positive test result in people without disease. ? LR： the probability of negative test result in people with the disease divided by the probability of negative test result in people without disease. Reliability ?measurement data ： STD， CV ?categorical data： agreement analysis kappa statistic an index which pares the agreement against that which might be expected by chance. The chancecorrected proportional agreement, 復(fù)旦大學(xué)公共衛(wèi)生學(xué)院 Cutoff points ?cutoff point： to distinguish normal from abnormal 。 ?觀察者的變異： 包括觀察者間和觀察 者內(nèi)的變異 控制 ： 嚴(yán)格培訓(xùn)觀察者，統(tǒng)一判斷標(biāo)準(zhǔn) ?被觀察者的個(gè)體生物學(xué)變異 控制 ： 嚴(yán)格規(guī)定統(tǒng)一的測(cè)量時(shí)間、條件等 評(píng)價(jià)小結(jié) 感謝您的關(guān)注！ How to interpret diagnostic tests Professor: Yu jinming School of Public Health Fudan U
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