Data, Validitas

& Reliabilitas
data



Fakultas Kedokteran Unram
Bobby M. Syahrizal
13 November 2007
Health measurement
Health as the outcome/effect of exposure to a
risk factor or a planned intervention (etiological,
prognostic research)
What makes a good outcome measure?
Health as the absence or presence of disease to
be assessed from certain indicators present with
people who have complaints (diagnostic
research)
Quality/value of diagnostic test?
Health as the probable presence or absence of
disease, to be assessed by means of a certain
test applied to (apparently) healthy individuals
(early diagnosis, screening)
What are useful screening test?
Jenis Data/Skala Pengukuran
Data kualitatif or categorical data
Data which can be grouped based on certain
category
Nominal:
Binary or two category only exist, e.g. sex, yes/no
Unordered or ranked category, e.g. blood group (A,
B, A/B & O), type of cancer, race
Ordinal
Ordered or ranked qualitative category, e.g. high,
moderate & low
.lanjutan jenis data
Data kuantitatif
Can be either measured (continuous) or
counted (discrete)
Discrete only absolute value
e.g. frekuensi kunjungan ke puskesmas,
jumlah anak, frekuensi pemeriksaan ante
natal
Continuous can take any value within a
given range
e.g. kadar kolesterol, age, height, weight,
blood pressure
.lanjutan jenis data
Consisted of
Ratio with true zero point that reflects the
absence of the measured characteristic
e.g. blood pressure, body weight, time, age,
kelvin
temperature
Interval without absolute zero value

Exercise 1
Specify each of the following variable
whether nominal, ordinal, ratio or interval
Household income ($)
Infant birthweight (grams)
Systolic blood pressure (below normal, within
normal range, above normal)
Diastolic blood pressure (mm Hg)
Parity (number of viable offspring produced by
a woman)
Drug dose (mg)
Cancer staging (e.g. Dukes classification
scheme)
Exercise 2
Twenty-five male vlunteers, ages 18
to 24 years, participated in a study
to compare the effects of small doses
of melatonin and a placebo to induce
sleep at bedtime. Subjects who took
melatonin fell asleep in 5 or 6
minutes; volunteers who received
the placebo took 15 minutes or more
to fall asleep.
Validity
Validity
Validity = accuracy the relative
abstinence of systematic (non-random)
errors
The extent to which a device (e.g. a test)
measures what it purports to measure, or
a clinical observation accurately describes
a phenomenon
For diagnostic or screening test, validity
has 2 components: sensitivity & specificity
Sensitivity & specicity
What will happen if the same
diagnostic tool applied in two
different populations?
What will happen if two different
diagnostic tools applied in the same
population?
250 250
250 250
100 400
100 400
180 400
20 400
100 80
100 720
Prevalence = 50%
Sensitivity = 50%
Specificity = 50%
Prevalence = 20%
Sensitivity = 50%
Specificity = 50%
Prevalence = 20%
Sensitivity = 90%
Specificity = 50%
Prevalence = 20%
Sensitivity = 50%
Specificity = 90%
Exercise 3
A physical examination was used to screen
for breast cancer in 2,500 women with
biopsy-proven adenocarcinoma o the
breast and in 5,000 age- and race-
matched control women. The results of
the physical examination were positive
(i.e., a mass was palpated) in 1,800 cases
and in 800 control women, all of whom
shoed no evidence of cancer at biopsy.
Determine the sensitivity, specificity,
positive and negative predictive value of
the physical examination was?
Exercise 4
A physician visited his general internist for a regular
annual medical examination, which included a stool
examination for occult blood. One of the three stool
specimens examined in the test was positive. The
internist told his physician-patient that the result was
of no significance because he regularly encountered
many false-positive test results in his busy practice.
The test was repeated, and all three stool specimens
were now negative. Nevertheless, sensing his
patients lingering concerns, the internist referred his
physician-patient to a gastroenterologist. The
gastroenterologist said, In my experience the
positive stool finding is serous. Such a finding is
almost always associated with gastrointestinal
pathological disorders. The subsequent negative test
mean nothing, because you could have a tumor that
only bleeds intermittently.
Whose judgment was correct in this occasion?
Reliability
Precision, reproducibility,
repeatability
Relative absence of random error
Regardless of the sensitivity and
specificity of a test, if the test results
cannot be reproduced, the value and
usefulness of the test are minimal
Sources of variability
Biological variation
Within individuals
Between individuals
Errors in measurement tool
Same instrument
Different instruments
Rater/observer error
Same rater/observer
Different rater/observer
Biological variation
Blood
pressure
(mm Hg)
Female
aged 27
yr
Female
aged 62
yr
Male aged
33 yr
Basal 110/70 132/82 152/109
Lowest
hour
86/47 102/61 123/78
Highest
hour
126/79 172/94 153/107
Casual 108/64 155/93 157/109
Exercise 5 at home
How can we measured validity when
there is no gold standard instrument
as a comparison?
How can we assess inter-observer
variation?
Iridology: does it look well?
Within the domain of alternative medicine iridology is
applied as a procedure to diagnose (the predisposition
to) certain disorders. The whole procedure (looking
into a persons eye) rest on the assumption that many
organs of the human body are connected with the iris
of the eye and are projected into it through nervous
paths. Disorders of these organs are said to be
expressed by typical changes in particular structures
of the iris.
Several iridologists are practicing also in the
Netherlands. The are making good business. One of
the reasons for their popularity is the attractive layout
of the diagnostic procedure they rely on. Internal
organs are approached by means of a non-invasive
technique and the patient doesnt suffer any physical
pain, at worst only in his wallet.
Iridology: Ideal or ideology?
Iridologists: can they look their clients straight into
their eyes?