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SpIn SnOut

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From clinical point of view, it is very important to understand the concept of sensitivity and specificity of

a test.
Sensitivity: The % of the time that it is what it says it is!
Suppose 10 subjects were screened for a test. In reality all 10 did have the disease but the test came
back positive only for 8 people. This test failed to catch 2 people who had the disease. Test showed false
negative tests for those two persons. This test is only 80 % sensitive.
Sensitivity is calculated by the following formula: True positives/True positives+False negative
An ideal test will have a high sensitivity meaning it will catch all people with a disease. If a test has a low
sensitivity, it wouldn't be reliable because as a clinician based on a false negative, you will tell your
patient that he/she does not have the disease while in reality he/she is diseased. Its like letting loose a
real criminal.
A sensitivity of 100% means that the test recognizes all actual positives - for example, all sick people are
recognized as being ill. Thus, negative results in a high sensitivity test are used to rule out the disease.
A test with a high sensitivity has a low type II error rate (giving a false negative).

Thus…
SnOUT: If a highly Sensitive test says it’s OUT…ITS OUT! (if the test comes back negative, they don’t
have it!)

Specificity: The % of the time that it isn’t what it says it isn’t!


Suppose 10 persons were tested for a disease and all 10 people came positive for that disease. In reality,
only 8 people had the disease. The two people who came back positive do not have the disease in
reality. They have some other condition that gives a false positive.
If a test has a low specificity, it is not reliable because it will give false positive results.
The formula for specificity is: True negative/true negative+False positive

A specificity of 100% means that the test recognizes all actual negatives - for example, all healthy people
will be recognized as healthy. Because 100% specificity means no positives are erroneously tagged, a
positive result in a high specificity test is used to confirm the disease. The maximum can trivially be
achieved by a test that claims everybody healthy regardless of the true condition. Therefore, the
specificity alone does not tell us how well the test recognizes positive cases. We also need to know the
sensitivity of the test.
A test with a high specificity has a low type I error rate (giving a false positive).
An example of a test that is not very specific is VDRL and RPR (syphilis diagnostic tests). These tests show
positive results for SLE (systemic lupus erythematosus).

Thus…
SpIN: use a Specific test to rule in a hypothesis. ( If you get a positive test, you can count on it being a
true positive.)

PS: On Journal article comparisons of two means: If the probability level is 0.5 or less (p<0.05), there is
a statistically significant difference between the two means.

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