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MED1BSF – Topic 4

Dr Agnes
Agnes.lim@psb-academy.edu.sg

La Trobe University CRICOS Provider Code Number 00115M

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Week 4 Runsheet
S/N Activities
1 Intended Learning Outcomes
2 Summary
3 Pre-workshop WS
4 Workshop WS
5 Journal articles
6 Online Quiz
ILOs
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Intended Learning Outcomes

1. Recognize the importance of patient data collection, specifically
blood tests, as a diagnostic tool.

2. Discuss the importance of relating a patient’s data to reference

ranges (or reference intervals) for diagnostic purposes.

3. Be able to describe the different ways the central tendency and

variability of a dataset can be represented.

4. Explain how reference ranges (or reference intervals) for individual

diagnostics are determined and how the mode of distribution
influences reference ranges (or reference intervals).
Summary
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Qualitative Data from Medical Tests

Data can be:

• Qualitative

• Categorical

• Binary
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Numerical Data from Medical Tests

Numerical

• Discrete (Count)

• Continuous
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Defining a Reference Range

used as a benchmark

1. We can’t measure the whole population – need a

sample. selected from the defined population

2. Demographically, it should match the population whose

tests will be compared to this reference range.*
define your reference population

3. The sampling method should yield a random sample of

individuals representing the reference population.

4. Perform the tests. It is important to treat these exactly

as the patients will be treated.

5. Analyse the results.

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Obtain the following data – organised lowest to highest

2.85 3.19 3.50 3.69 3.90 4.14 4.32 4.50 4.80 5.20
2.85 3.20 3.54 3.70 3.96 4.16 4.44 4.56 4.80 5.30
2.98 3.30 3.54 3.70 4.05 4.20 4.47 4.68 4.90 5.43
3.04 3.39 3.57 3.75 4.08 4.20 4.47 4.70 5.00
3.10 3.42 3.60 3.78 4.10 4.30 4.47 4.71 5.10
3.10 3.48 3.60 3.83 4.14 4.30 4.50 4.78 5.10

The simplest way to look at variation is to look at the minimum

and maximum values - range

The range:
Does not give any idea how the data is arranged in between.
Tends to get larger with sample size.
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The Interquartile Range

2.85 3.19 3.50 3.69 3.90 4.14 4.32 4.50 4.80 5.20
2.85 3.20 3.54 3.70 3.96 4.16 4.44 4.56 4.80 5.30
2.98 3.30 3.54 3.70 4.05 4.20 4.47 4.68 4.90 5.43
3.04 3.39 3.57 3.75 4.08 4.20 4.47 4.70 5.00
3.10 3.42 3.60 3.78 4.10 4.30 4.47 4.71 5.10
3.10 3.48 3.60 3.83 4.14 4.30 4.50 4.78 5.10
The interquartile range (IQR) is a measure of variability, based on
dividing a data set into quartiles. Quartiles divide a rank-ordered data
set into four equal parts.

IQR = upper quartile (Q3) – lower quartile (Q1)

Indicates the spread of the middle 50% middle half" of your data lies
Less sensitive than range to sample size and outliers
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The Median

2.85 3.19 3.50 3.69 3.90 4.14 4.32 4.50 4.80 5.20
2.85 3.20 3.54 3.70 3.96 4.16 4.44 4.56 4.80 5.30
2.98 3.30 3.54 3.70 4.05 4.20 4.47 4.68 4.90 5.43
3.04 3.39 3.57 3.75 4.08 4.20 4.47 4.70 5.00
3.10 3.42 3.60 3.78 4.10 4.30 4.47 4.71 5.10
3.10 3.48 3.60 3.83 4.14 4.30 4.50 4.78 5.10

IQR
Median
The median is one measure of the average value. If the
data are arranged in order it is the middle observation.

The mode is another measure of the average

value. It is the value which occurs most often.
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Measures of Dispersion
Simple statistics to make predictions about the population
from the sample

R
±SD R= Range
SD = Standard Deviation
±SE
SE = Standard Error
SE = (SD/√𝒏)
95% CI
CI = Confidence Interval
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Inferential error bars • Range (R) and standard deviation (SD)
describe the spread of the data

• R tends to get larger as sample size

increases, but SD stays about the same.

• The true (or population) mean can be

estimated from the sample mean using
the inferential error bars, standard
error (SE) or 95% confidence intervals
(CI).

• If n is ten or more, there is a ~95%

chance the 'true' mean is within the
interval mean ± 2xSE.

• There is a 95% chance the true mean is

within the 95% CI bars.

• Note how the interval predicting the

'true' mean becomes smaller as the
sample size increases.
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Estimating the 95% Reference Range

If sample size is large enough (>30) and if data is normally

distributed, then:

95% of “normal” individuals will fall within the mean ± 2 x SD

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What is the Reference Range for Forced Expiratory

Volume (litres) in one second (FEV1)?

18
16
14
12
Frequency

10
8
6
4
2
0

We have 57 observations, mean 4.06 and standard deviation

0.67 litres. The reference interval is thus 2.7 to 5.4 litres.
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Non-normal Distributions
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More Non-normal Distributions

If the distribution is normal, a parametric method may be used. A

minimum of 30 result values are required to calculate a reference
range by this method. The reference range is defined as the mean
plus or minus two standard deviations: Reference Range = X + 2SD

If the distribution is non-Gaussian, a non-parametric method must be

used.
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Summary
• Chance of finding “true mean” in the 95% CI interval
– n >10
– apply mean ± 2 x SE

• Finding the reference range

– n >30
– normally distributed
– apply mean ± 2 x SD
Pre-workshop
Worksheet
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Determining your resting heart rate

Data on LMS
Workshop
Worksheet
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Part A – Discussion
1. Do you think the measure for heart rate (beats per minute) is a
discrete or continuous variable?
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Part A
2. What factors might affect a person’s resting heart rate? Write
down a list.
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Part A
3. Do you expect the class data to be normally distributed? Why or
why not?
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Part B - Examining the class data

1. Working in your groups, retrieve the sample data from the LMS.

2. What is the sample size? (That is, (n) the number of independent
measurements made in the class.)

3. What is the sample mean heart rate?

4. What is the range of the data? (The lowest and highest values of the
sample)
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Part B Heart Rate Range (inclusive) Number of Students

28-32
5. Tally the number of students who have 33-37
38-42
a resting heart rate within the ranges in 43-47
the table below. 48-52
53-57
58-62
63-67
68-72
73-77
78-82
83-87
88-92
93-97
98-102
103-107
108-112
113-117
118-122
123-127
128-132
133-137
138-142
143-147
148-152
153-158
Total
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Part B
6. What is the median and mode of the Heart Rate data?
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Part B
7. Create a graph of the frequency distribution. Plot the frequency (number
of students) for each interval. For example, the interval 63-67 is
represented by 65 on the x-axis.
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Part B
8. Describe the shape of the frequency distribution. Is it symmetrical
(normal distribution), is it skewed to one side or are there two peaks
(bimodal distribution)?
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Part C – Making assumptions about the general

population
So far you have only just really described your data but could we use this data
to make some inferences about the general population? Inferential statistics
can used to make inferences from our data about the general population. The
use of confidence intervals is a major concept of inferential statistics that can
help in making inferences about population from samples. We can use this
with normally distributed data.
The 95% confidence interval is a range of values that you can be 95% certain
contains the true mean of the population. Remember this is not the same as a
range that contains 95% of the values. A way to visualize this range is to use
a graph of the frequency distribution. The 95% confidence interval is the
range of values which bracket 95% of the area under the curve, leaving 2.5%
of the area at each end.
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Part C – Making assumptions about the general

population
For the sake of the exercise, we will assume that the data is normally
distributed.

You can check the calculations by entering the data into any statistics
calculator (e.g., Excel) or using an online calculator
http://www.calculator.net/standard-deviation-calculator.html.

From the class resting heart rate data could we make a prediction about the
mean resting heart rate for the general population? Just from your graph
estimate the 95% confidence interval.
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Part C
2. Compare your estimate to the calculated value.
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Part C
3. If we had a larger sample size what do you expect to happen to the 95%
confidence interval?
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Part C
4. Discuss the following statement; “A 95% confidence interval for resting
heart rate obtained from a sample of 100 people has a better chance of
containing the population mean than a 95% confidence interval obtained
from a sample of 50 people.”
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Part C
5. What do you think would happen to the range of our data if we increased
the sample size?
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Part C
6. Many people get confused between the terms standard deviation and
standard error.

– Standard deviation (SD) is a measure of the spread of the data. To work

it out, first work out the mean. Then for each number: subtract the mean
and square the result. Then work out the mean of those squared
differences. Take the square root of that and this is the SD.

– Standard error (SE) or sometimes called standard error of the mean

(SEM) or sample is calculated by dividing the SD by the square root of n
(sample size). This is a measure of the accuracy of the sample mean to
the population mean.

i. What do you think happens to the SD as sample size increases?

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Part C
ii. What do you think happens to the SE as sample size increases?
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Part C
iii. If we wanted to compare the effect of a new experimental drug on resting
heart rate versus a placebo on a random sample of individuals which
statistic would be more important to use?
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Part C
7. Could we use the class resting heart data to make any inferences about
the general population? Why or why not?
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Part C
8. Imagine we merged our data with another class which happened to be
made up of 50 students who all happened to be elite long distance
runners. Draw what you think our frequency distribution graph would look
like?
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Part C
9. You set up a new assay to determine the concentration of a particular
serum analyte. You take measurements from a completely random
sample of the general population. The results come back from your initial
measurements and you decide to analyse them by plotting them on
frequency distribution graph. The results you obtain look like this:

Discuss what would you do next?

Journal
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Dengue Fever
1. Read article on Dengue Fever before next week’s
workshop

2. Follow the “How to read Science Article” to get started

3. Complete the STARD checklist

Post
Workshop
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Post-workshop
1. Online Quiz 4
– Due on 7 to 18 Jun, 23:59
 Thank you
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