Here are the calculations for the predictive values of a positive HIV test with 95% sensitivity and 98% specificity in populations with different prevalence rates:
1) Prevalence of HIV in blood donors = 2%
Total tested = 1000
With HIV = 1000 * 0.02 = 20
Without HIV = 1000 - 20 = 980
Sensitivity = 95%
Specificity = 98%
True Positives (a) = Sensitivity * With HIV = 0.95 * 20 = 19
False Positives (b) = (1 - Specificity) * Without HIV = 0.02 * 980 = 20
False Negatives (c) = (1 - Sensitivity) * With HIV = 0
Epidemiological Approaches for Evaluation of diagnostic tests.pptxBhoj Raj Singh
Diagnosis of a disease or a problem is the first step towards solution/ treatment. Clinical Diagnosis or Provisional Diagnosis is the first step in diagnosis and is done after a physical examination of the patient by a clinician. Clinical diagnosis may or may not be true and to reach Final diagnosis Laboratory Investigations using gross and microscopic pathological observations and determining the disease indicators are required. The diagnostic tests may be Non-dichotomous Diagnostic Tests (when continuous values are given by the test in a range starting from sub-normal to above-normal range) and Dichotomous Diagnostic Tests (when results are given either plus or minus, disease or no-disease). To make non- Dichotomous diagnostic test a Dichotomous one you need to establish the cut-off values based on reference values or Gold Standard test readings or with the use of Receiver operator characteristic (ROC) curves, Precision-Recall Curves, Likelihood Ratios, etc., and finally establishing statistical agreement (using Kappa values, Level of Agreement, χ2 Statistics) between the true diagnosis and laboratory diagnosis. Thereafter, the Accuracy, Precision, Bias, Sensitivity, Specificity, Positive Predictive value, and Negative Predictive value, of a diagnostic test are established for use in clinical practice. Diagnostic tests are also used to determine Prevalence (True prevalence, apparent prevalence) and Incidence of the disease to estimate the disease burden so that control measures can be implemented. There are several Phases in the development and use of a diagnostic assay starting from conceptualization of the diagnostic test, development and evaluation to determine flaws in diagnostic test use and Interpretation influencers. This presentation mainly deals with the epidemiological evaluation procedures for diagnostic tests.
Screening is an essential concept in the field of Medicine, specially in Preventive Medicine. This presentation covers the essentials to understand Screening of Diseases.
Epidemiological method to determine utility of a diagnostic testBhoj Raj Singh
The usefulness of diagnostic tests, that is their ability to detect a person with disease or exclude a person without disease, is usually described by terms such as sensitivity, specificity, positive predictive value and negative predictive value (NPV). Many clinicians are frequently unclear about the practical application of these terms (1). The traditional method for teaching these concepts is based on the 2 × 2 table (Table 1). A 2 × 2 table shows results after both a diagnostic test and a definitive test (gold standard) have been performed on a pre-determined population consisting of people with the disease and those without the disease. The definitions of sensitivity, specificity, positive predictive value and NPV as expressed by letters are provided in Table 1. While 2 × 2 tables allow the calculations of sensitivity, specificity and predictive values, many clinicians find it too abstract and it is difficult to apply what it tries to teach into clinical practice as patients do not present as ‘having disease’ and ‘not having disease’. The use of the 2 × 2 table to teach these concepts also frequently creates the erroneous impression that the positive and NPVs calculated from such tables could be generalized to other populations without regard being paid to different disease prevalence. New ways of teaching these concepts have therefore been suggested.
VALIDITY AND RELIABLITY OF A SCREENING TEST seminar 2.pptxShaliniPattanayak
A presentation shedding some insight into the tricky concepts of validity and reliability of any screening test, used in day-to-day lives, using easy and understandable language.
Diagnostic, screening tests, differences and applications and their characteristics, four pillars of screening tests, sensitivity, specificity, predictive values and accuracy
Epidemiological Approaches for Evaluation of diagnostic tests.pptxBhoj Raj Singh
Diagnosis of a disease or a problem is the first step towards solution/ treatment. Clinical Diagnosis or Provisional Diagnosis is the first step in diagnosis and is done after a physical examination of the patient by a clinician. Clinical diagnosis may or may not be true and to reach Final diagnosis Laboratory Investigations using gross and microscopic pathological observations and determining the disease indicators are required. The diagnostic tests may be Non-dichotomous Diagnostic Tests (when continuous values are given by the test in a range starting from sub-normal to above-normal range) and Dichotomous Diagnostic Tests (when results are given either plus or minus, disease or no-disease). To make non- Dichotomous diagnostic test a Dichotomous one you need to establish the cut-off values based on reference values or Gold Standard test readings or with the use of Receiver operator characteristic (ROC) curves, Precision-Recall Curves, Likelihood Ratios, etc., and finally establishing statistical agreement (using Kappa values, Level of Agreement, χ2 Statistics) between the true diagnosis and laboratory diagnosis. Thereafter, the Accuracy, Precision, Bias, Sensitivity, Specificity, Positive Predictive value, and Negative Predictive value, of a diagnostic test are established for use in clinical practice. Diagnostic tests are also used to determine Prevalence (True prevalence, apparent prevalence) and Incidence of the disease to estimate the disease burden so that control measures can be implemented. There are several Phases in the development and use of a diagnostic assay starting from conceptualization of the diagnostic test, development and evaluation to determine flaws in diagnostic test use and Interpretation influencers. This presentation mainly deals with the epidemiological evaluation procedures for diagnostic tests.
Screening is an essential concept in the field of Medicine, specially in Preventive Medicine. This presentation covers the essentials to understand Screening of Diseases.
Epidemiological method to determine utility of a diagnostic testBhoj Raj Singh
The usefulness of diagnostic tests, that is their ability to detect a person with disease or exclude a person without disease, is usually described by terms such as sensitivity, specificity, positive predictive value and negative predictive value (NPV). Many clinicians are frequently unclear about the practical application of these terms (1). The traditional method for teaching these concepts is based on the 2 × 2 table (Table 1). A 2 × 2 table shows results after both a diagnostic test and a definitive test (gold standard) have been performed on a pre-determined population consisting of people with the disease and those without the disease. The definitions of sensitivity, specificity, positive predictive value and NPV as expressed by letters are provided in Table 1. While 2 × 2 tables allow the calculations of sensitivity, specificity and predictive values, many clinicians find it too abstract and it is difficult to apply what it tries to teach into clinical practice as patients do not present as ‘having disease’ and ‘not having disease’. The use of the 2 × 2 table to teach these concepts also frequently creates the erroneous impression that the positive and NPVs calculated from such tables could be generalized to other populations without regard being paid to different disease prevalence. New ways of teaching these concepts have therefore been suggested.
VALIDITY AND RELIABLITY OF A SCREENING TEST seminar 2.pptxShaliniPattanayak
A presentation shedding some insight into the tricky concepts of validity and reliability of any screening test, used in day-to-day lives, using easy and understandable language.
Diagnostic, screening tests, differences and applications and their characteristics, four pillars of screening tests, sensitivity, specificity, predictive values and accuracy
Screening of Diseases_Community Medicine
Slides may be referred by both undergraduate and postgraduate students and anyone affiliated to Public health.
Any comments or doubts may be addressed to vineeta1992@gmail.com
Application of a test or a procedure to large number of population who have no symptoms of a particular disease for the purpose of determining their likelihood of having the disease.
Validity and reliability expressesions means as to how measurements and diagnostic approaches can more efficiently and maintaning the accuracy with many repeated tests. In validity we basically speak of specificity and sensitivity of tests, which can be affected by prevalence.
Diagnostic Testing & Likelihood Ratios: how we should be ordering tests!nfpineda
https://vimeo.com/152035436
How do you decide if you are going to treat a patient with strep throat, or send a test to rule in or rule out the disease or just send him home on NSAIDs? What if instead of strep throat you are suspecting a pulmonary embolism, what do yo do?
One of the key things before thinking in ordering a specific test, is assigning that particular disease PRETEST probability, and then knowing what your therapeutic and diagnostic threshold are for that specific disease. It is the only way of knowing if the test you ordered is good enough to rule in or rule out that disease!
Screening of Diseases_Community Medicine
Slides may be referred by both undergraduate and postgraduate students and anyone affiliated to Public health.
Any comments or doubts may be addressed to vineeta1992@gmail.com
Application of a test or a procedure to large number of population who have no symptoms of a particular disease for the purpose of determining their likelihood of having the disease.
Validity and reliability expressesions means as to how measurements and diagnostic approaches can more efficiently and maintaning the accuracy with many repeated tests. In validity we basically speak of specificity and sensitivity of tests, which can be affected by prevalence.
Diagnostic Testing & Likelihood Ratios: how we should be ordering tests!nfpineda
https://vimeo.com/152035436
How do you decide if you are going to treat a patient with strep throat, or send a test to rule in or rule out the disease or just send him home on NSAIDs? What if instead of strep throat you are suspecting a pulmonary embolism, what do yo do?
One of the key things before thinking in ordering a specific test, is assigning that particular disease PRETEST probability, and then knowing what your therapeutic and diagnostic threshold are for that specific disease. It is the only way of knowing if the test you ordered is good enough to rule in or rule out that disease!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Diagnostic and Screening tests
Diagnostic and screening tests are used to obtain
information that guide health personnel’s decision
to initiate or continue a therapeutic intervention.
Tests performed in persons with a symptom or a
sign of an illness are usually termed as diagnostic
tests.
Tests that are done in individuals with no such
symptoms or sign are called screening.
3. Diagnostic and screening tests
Standardized interviews,
Physical examinations,
Laboratory tests,
More sophisticated measurements such as
radiography, electro-cardiograph, slit-lamp
examination.
4. There are different types of screening,
each with specific aims;
1. Mass screening: It involves the screening of a whole
population.
2. Multiple or multi-phase screening: It involves the use
of a variety of screening tests on the same occasion.
3. Case finding or opportunistic screening; It is
restricted to patients who consult a health
practitioner for some other purposes.
5. Rationale of applying tests requires
judgment of:
Person tested
Costs of illness (monetary and physical)
Costs of the tests.
Cost of accuracy
6. Criteria for instituting a screening program
1. Disease Serious
High prevalence of preclinical stage
Natural history understood
Long period between first diagnosis and
overt disease
2. diagnostic test Sensitive and specific
Simple and cheap
Safe and acceptable
Reliable
3. Diagnosis and
treatment
Facilities are adequate
Effective, acceptable and safe treatment /
rehabilitative methods available
7. VALIDITY OF A DIAGNOSTIC
TEST
A central issue in evaluating a test is its
validity, or the ability to differentiate
accurately between those who have the
disease and those who do not have.
The validity of the test refers to the extent to
which the test is capable of correctly
diagnosing the presence or absence of the
disease concerned.
8. Cont…
There are two important aspects of validity:
These two aspects,
1) Correctly diagnosing as having a disease is
referred as the sensitivity.
2) Correctly diagnosing of not having a disease
are referred as the specificity of the test.
9. For example,
A test is said to have a sensitivity of 90% if it
gives a positive result in 90% of persons who
actually have the disease.
On the other hand, a test is said to have a
specificity of 90% if it gives a negative result
in 90% of persons who actually do not have
the disease.
Cont…
13. Cont…
Sensitivity and specificity are proportions
comparing test results to the “True” disease
situation, “Gold standard”.
However, tests are actually used the other way
around when they are needed to predict which
individuals have the disease, hence the importance
of the positive and negative predictive values.
The predictive value of a test which depends upon
the prevalence of a disease, as well as a test’s
sensitivity and specificity is the most important
measure determining its usefulness in a field.
14. Predictive value and its relationship
with prevalence
Predictive Value Positive (PVP) – The probability
that a person with a positive result in a screening
or diagnostic test is in fact a true positive.
Predictive Value Negative (PVN) – The
probability that a person with a negative result in a
screening or diagnostic test is in fact a true
negative.
Prevalence – The total number of persons with
actual disease in the population.
19. Example
Considering a diagnostic test has a
sensitivity of 95 % and specificity of 80 %
and calculate the Positive and negative
predicative value when the prevalence of the
disease is:
1) 20 %?
2) 1%?
20. PV(+) = . P x Sn .
(P x Sn) + ((1 - P) x (1 - Sp))
= . 0.2 x 0.95 .
(0.2 x 0.95) + ((1 – 0.2) x (1 – 0.8))
= 0.54 or 54 %
This means that of all the positives found by the
screening test only 54 % are true positives.
1a. Prevalence 20 %
21. PV(-) = . (1 – P) x Sp .
((1 – P) x Sp) + (P x (1 - Sn))
= . (1 – 0.2) x 0.80 .
((1 - 0.2) x 0.80) + ( 0.2 x (1 – 0.95))
= 0.98 or 98 %
This means that of all the negatives found by the
screening test 98 % are true negatives.
1b. Prevalence 20 %
22. PV(+) = . P x Sn .
(P x Sn) + ((1 - P) x (1 - Sp))
= . 0.01 x 0.95 .
(0.01 x 0.95) + ((1 – 0.01) x (1 – 0.8))
= 0.045 or 4.5 %
This means that of all the positives found by the
screening test only 4.5 % are true positives.
2a. Prevalence 1 %
23. 2b. Prevalence 1 %
PV(-) = . (1 – P) x Sp .
((1 – P) x Sp) + (P x (1 - Sn))
= . (1 – 0.01) x 0.80 .
((1 - 0.01) x 0.80) + ( 0.01 x (1 – 0.95))
= 0.999 or 99.9 %
This means that of all the negatives found by the
screening test almost all are true negatives.
24. Relationship between Prevalence and
predictive values
Predictive value Positive
(when the sensitivity and
specificity constant) is
directly related to the
prevalence of a disease in a
community.
Predictive value Negative
(when the sensitivity and
specificity constant) is
inversely related to the
prevalence of a disease in a
community.
P
r
e
v
a
l
PV (+)
PV (-)
P
r
e
v
a
l
25. Home test.
For the following calculations, show the data first in the form
of a 2X2 table, starting with the marginal totals for those with
and without disease, based on the given prevalence rate.
Assuming a sensitivity of 95% and a specificity of 98% for the
EIA test for HIV-1 infection, what would be the predictive
value of the positive test for:
1. A population of 1000 blood donors with an estimated
prevalence rate of HIV-1 infection of 2%.
2. A population of 1000 female sex workers with an estimated
prevalence rate of HIV-1 infection of 28%.
3. From the above answers, what can you conclude about the
relationship between the PVP and the prevalence rate, with
sensitivity and specificity held constant?