Basics of Biostatistics: A Manual for the Medical Practitioners Jatinder Bali, Anil Kant
INDEX
Page numbers followed by f refer to figure, and t refer to table
A
Abstract 455, 474
Age specific
death rate 362
fertility rate 360
Analytical research studies 71
Anecdotal information 463
Animal ethics 34
Antilogarithms 80
Arithmetic progression 79
Assessment, grading of 47
Attribute
association of 228
theory 225
terminology of 225
B
Baranowicze head injury experiment 15
Basic ethical principles 31
Bayes principle 445
Bayes theorem 139
Bell curve 164
Bibliography 474
Binomial distribution 147, 148, 148f, 150f
constants of 151
properties of 149
Bioethics 13, 14
main branches of 14
Biographical sketches 474
Biomedical research, broad fields of 62
Biostatistics 52
Bivariate frequency table 94t
Bradford Hill causality criteria 332
Budget 475
C
Calculating index numbers, method of 414
C-control chart 435, 435f
Central tendency, measure of 95
Central value 321
concept 95
Chi-square test 296
Civil registration system 358
Clostridium perfringens 16
Clostridium tetani 16
Cluster sampling 181
Cochran Q test 318
Cohort group 367
Cohort life table 368
Colligation, coefficient of 229
Complete life table 371
Conclusion 459
report and reporting of 69
Contingency, coefficient of 230
Continuous frequency distribution 90, 90t, 91t
Continuous random variable, expectation of 145
Control charts 430, 431
Convenience sampling 182
Correlation 191, 232
measures 192
Cover letter 476
Crude birth rate 360, 361
Curve
fitting method 385
types of 125f
Cyclical component 383, 396
D
Dachau and Auschwitz concentration camp hypothermia experiments 15
Dachau potable sea water experiment 16
Data
classification of 87
collection 67
consistency of 227
sources of 358
types of 321
Decision
criteria 442
making, principles of 444
methods 443
theory 440
tree analysis 449, 450f
under certainty 443
under uncertainty 444
Declaration, promotion of 30
Defects, proportion of 436
Determination, multiple coefficient of 219
Development, grading of 47
Discrete frequency distribution 90t
Discrete random variable, expectation of 144
Dispersion
coefficient of 120
measures of 114
Dynamic life table 368
E
Errors, propagation of 353
Estimates, theory of 238
Estimation 236, 238
methods of 239
Ethics, major divisions of 13
Etymology 14, 39, 49
Evidence-based practice, components of 39
Expectation method 228
Experimental approach 59
Exploratory research studies 71
Exponential distribution 176
curves 177f
Exponential trend 388
Exposure disease association 333
F
Face validity 343
False negative rate 348
F-distribution, constants and properties of 269
Fertility rates 360
Fisher's z-transformation 265
Fitting Poisson distribution 160
Fixed size sampling 185
Frequency distribution 87, 89, 105
Friedman test 314, 315
F-test 269271, 273
G
General fertility rate 360
Generation life table 368
Geometric distribution 147, 156
constants of 156
Geometric mean 107
demerits of 109
merits of 109
Geometric progression 79
Graphic method 400
Graphs 462
Greek alphabets 74
Gross reproduction rate 361
H
Helsinki, declaration of 22
Homoscedasticity 321
H-test 313
Human subjects and institutional review boards, protection of 473
Hypergeometric distribution 147, 157
Hypothesis 68, 241, 243
testing 71, 235, 236, 240
I
Index number 411, 414
construction 415
Infant mortality rate 362
Interpolation, methods of 400
J
Josef Mengele's experiments on twins 15
Judgment sampling 182
Justice 32
K
Kaplan-Meier curves 374, 378f
Karl Pearson's coefficient of correlation 193
Kelly's coefficient of distribution 124
Kendall's rank correlation 202
Kolmogorov-Smirnov test 307, 308
Kruskal-Wallis rank sum test 313
Kurtosis 125, 125f
measure of 126
L
Lagrange's method 404
Large sample tests 249
Least squares method 386, 386f, 388f
Lexis diagram 367
Life expectancy 365
Life table 357, 367, 370
calculations 370
construction 368
types of 368
uses of 374
Linear regression analysis 207
Literacy rates 364
Literature, types of 65
Logarithms 80
Logistic regression 212
Lognormal distribution 176
Log-rank test 378
Lorenz curve 119, 119f
graph of 119
M
Malaria experiments 16
Mann-Whitney U test 310
Marginal distribution 94
Maternal mortality rate 363
Maximax principle 445
Maximin principle 444
Mcnemar's test 317
Mean and range control chart 432, 434f
Mean deviation 116
Medical ethics 14
Minimax principle 445
Mode, demerits of 107
Modulus 76
Mortality rates 361, 367
Moving averages method 384
Multinomial distribution 147, 152
Multiple correlation 217
Multiple determination
adjusted coefficient of 220
coefficient of 219
Mustard gas experiments 16
N
National Sample Survey Organization 358
Natural increase rate 363
Negative binomial distribution 147, 153
constants of 154
Negative likelihood ratio 349
Negative predictive value 347
Neonatal death rate 362
Net migration rate 363
Net reproduction rate 361
Newton's backward difference interpolation 402
Newton's divided difference method 404
Newton's forward interpolation method 401
Nonclinical biomedical research 25
Nonparametric tests 301, 325
Nonprobability sampling methods 182
Nontherapeutic biomedical research 25
Normal curve 123, 164, 166, 166f, 168f
fitting of 172, 174f
properties of 165
Normal distribution 163
fitting of 164
properties of 164
Null hypothesis 240
Nuremberg code, ten points of 20
O
Odds ratio 334, 350
One and two-tailed tests 245
P
Paired T-test 261
Parabolic curve fitting method 401
Parabolic trends 387
Parametric tests 323
Partial and multiple correlation and regression 216, 218
P-control chart 436
Pearson's beta and gamma coefficients 126
Percentile deviation 116
Physicians, duties of 25, 26
Poisson distribution 147, 158
curves 159f
Population
attributable risk 335
vital index of 364
Positive likelihood ratio 348
Positive predictive value 347
Post-neonatal mortality rate 362
Preliminary studies 471
Price index number 414
construction 414
types 414
Probability based random sampling methods 180
Probability distribution 142
Probability method 228
Probability theory 131
terminology in 132
Proofing 462
Proportion method 229
P-value 267
Q
Qualitative approach 59
Quartile/decile/percentile, computation of 103, 104f
Quota sampling 182
R
Random component 383, 396
Ravensbrück sulfonamide experiments 15, 16
Raw data 88
R-chart 433
Recommendations, grading of 47
Rectangular distribution 174, 175f
References 459
Regression
analysis 205
components of 205
coefficient 209
types of 206
Reproductive rates 361
Research
design 69, 471
preparation of 66
types of 66, 70
ethics 31
methodology 57, 60
objectives of 57
plan 72
uses of 72
process 61, 65
question, formulation of 65
report writing 453
report, organization of 453
types of 58
Robert Allen (Laud) Humphreys' tearoom sex study 17
Root mean square deviation 117
Run test 302
S
Sample control chart 431f
Sample design 67
Sample registration system 358
Sample size 236
calculations 331
Sampling 437
advantages and disadvantages of 182
distribution 236
errors 185
methods, types of 180
theory 178, 186
Scatter diagram 193, 193f, 194f, 196f
Scientific method, basic postulates of 61
Sensitivity 346
Sex ratio 364
Simple aggregative method 414
Simple arithmetic mean 97
Simple averages method 391
Simple random sampling 180
Skewed curve for distribution 123f
Skewness 122
coefficient of 124, 125
measures of 123
Small sample tests 256
Spearman's and Kendall rank correlation, significance of 317
Spearman's rank correlation 199
significance test of 201
Specific fertility rate 360
Standard deviation 117, 166, 255
control chart 435
Standard error 186, 210, 237
Standard normal curve 166, 166f, 168f
Static life table 368
Statistical analysis, types of 52
Statistical quality control 429, 430
Statistical significance 212
Statistical tests, summary of 322
Sterilization experiments 16
Student's T distribution 257
curve 257f
Student's T test 248, 256, 258
Summary 459
Survival analysis 374
notations 376
Systematic sampling 180
T
Tchebysheff's theorem 118
Testing hypothesis 246
Theoretical analysis 456
Theoretical continuous probability distributions 163
Theoretical discrete
distributions, types of 147
probability distributions 142
Theoretical distribution 146
Theoretical survival function curve 376f
Time series
analysis 381
components 382
Title 454, 474
page 454
Total fertility rate 361, 366
Tree diagram 449
True negative test 346
Tuskegee syphilis study 18
U
Union, axiom of 136
Unit 731 17
Universal declaration 26
V
Validity, assessment of 344
Venn diagram 76, 78, 78f, 139f
Vibrio cholerae 328
Vital statistics 357
basics of 357
measures of 359
W
Wilcoxon signed rank test 304
Wilcoxon-Wilcox test 311
Working hypothesis, development of 66
Writing materials and methods section 456
Y
Yates' correction 299
Yules' coefficient of association 229
Z
Z test 248, 254, 255
×
Chapter Notes

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BASICS OF BIOSTATISTICS
BASICS OF BIOSTATISTICS A Manual for the Medical Practitioners
Jatinder Bali MBBS MS (Ophth) CDM PGDHHM STT (Pediatric Ophth); WHO Fellowship (VR&ROP) MBA (Operations Research and Management Information Systems) Member-Secretary Institutional Ethics Committee Hindu Rao Hospital and North Delhi Municipal Corporation (NDMC) Medical College, New Delhi Member-Secretary Scientific Research Committee Hindu Rao Hospital, New Delhi Formerly, Nodal Officer (Information Technology) and Assistant DNB Coordinator Hindu Rao Hospital, New Delhi, India Anil Kant BSc (Statistics), Kurukshetra University; MBA (International Business), Banaras Hindu University Head (Sales and Marketing), Max Speciality Films Ltd, New Delhi, India Formerly, Director, Wifag-Polytype India, Noida, Uttar Pradesh, India AVP, Sakata Inx India Ltd, Gurgaon, Haryana, India Foreword Barun K Nayak
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Basics of Biostatistics: A Manual for the Medical Practitioners
First Edition: 2017
9789386150714
Printed at
Dedicated to
Our teachers, parents and families
Padma Shri Prof (Dr) Surendra Singh Yadav
and
Dr Barun K Nayak
for his missionary efforts to guide a whole generation of researchers
Foreword
Research is very important in today's era of evidence-based medicine. I am of the opinion that if there is no evidence, then research should be carried out and the evidence should be created. Similarly, if there is evidence, then it should be found out from the available literature and applied wherever it seems fit. However, to do this, understanding the procedure is very necessary—both “conducting” and “applying”. Basics of Biostatistics: A Manual for the Medical Practitioners covers the different aspects of conducting an in-depth research.
This well-documented book starts by covering the two important aspects— bioethics and evidence-based medicine—in this evidence-based era. Most people in the medical profession are not well conversed with various aspects of research, which include planning, understanding of statistics, conducting a research and finally drawing the conclusion.
This book, authored by Jatinder Bali and Anil Kant, has been written in response to a ‘timely perceived requirement’ and deals with the various aspects of research in a lucid manner, wherein there will be something—right from the beginners to an accomplished researchers—to grasp.
I have seen that medical practitioners and clinicians feel vulnerable when confronted with statistics. This is a mindset and can be easily overcome after going through this book. I would particularly like to make a mention of the chapters which are dedicated to statistical concepts for medical administration, where indexing, statistical quality control, and decision theory have been elucidated.
There have been numerous instances when researches have never been taken up or left partially done because of lack of funds or sponsorship. At such times, it is heartbreaking not only for the person conducting the research but also for all of us, because we are keeping humankind away from another revelation, which may go a long way to help us in one way or the other. Taking this into account, the last section of this book also deals with report writing and grant applications, which is the backbone of research.
Needless to say, the authors have done a wonderful job. I am truly impressed with the topics and quality of contents and how they have, in a studious manner, gone about laying the flow of the topics making them easy-to-understand and relate to the practical use. I am of the opinion that the book should not be missed and should be kept handy for ready reference, as all the doctors need to contribute to the progress of medical science.
I am thankful to the authors for giving me the honor of writing the Foreword for this book because it is a subject which is very close to my heart and is a need of the hour.
Barun K Nayak
Honorary General Secretary
All India Ophthalmology Society
Head, Department of Ophthalmology
PD Hinduja National Hospital and Medical Research Center
Mumbai, Maharashtra, India
Editor, Journal of Clinical Ophthalmology and Research
Past Editor, Indian Journal of Ophthalmology
President, Maharashtra Ophthalmological Society
Past President, Bombay Ophthalmologists’ Association
Preface
This effort started off as replies to students’ queries when their research projects were being evaluated. Biomedical research driven by the large databases is already a reality. In fact, some of the biggest data centers in the world today host the complex information stores in their databases. However, research is not limited to these large datasets alone. It is conducted by a large proportion of practitioners and students of medicine also. Medical professionals often do not train in mathematics and statistics. Medical experts who conduct a large quantum of research often feel at ease using these datasets, when it comes to handling the data. Due to limited exposure to the various concepts and tools of statistics coupled with the fear of getting the procedure wrong, they often run the risk of improper application and incorrect inferences. These tools can be used in daily life as well as for researches.
Influenced by the lucid style of the workshops of Dr Barun K Nayak—one of the inspirations behind this effort—we made an effort to provide a reference manual in nonintimidating language in the field of basic statistical concepts related to medicine. It is written with the understanding that medical professionals are not mathematical experts. The prime purpose of the treatise is to remove the fear of statistics as an extra-terrestrial object and to foster the scientific way of thinking—being cynical and not agreeing until clearly proved. Pure mathematical approach has been limited to minimum possible with focus on the concepts. A complete overview of the statistical methods is provided in a concise and precise manner to build the strong foundation for understanding advanced tools and techniques. Concepts have been compared wherever possible so that the fine differences are captured and conveyed. The chapter Back to School to review elementary concepts such as fractions, logs, set theory, permutation and combination, etc. is added to recapitulate the concepts that were left behind in high school by many of us.
Basics of Biostatistics: A Manual for the Medical Practitioners is one of the few books on statistics written to provide the practical help to the medical professionals. The chapter Measurement and Error Analysis was incorporated because of the medical mindset of the authors whose focus is often research papers and clinical trials. Additional topics such as life table, Kaplan-Meier curves, interpolation, time series, etc. also have been included. Subjects such as statistical quality control, decision theory, index number, which find use in medical administration, also get a fair treatment. The authors felt that without these applied aspects, the treatise would be incomplete. Everyone will use some of the topics at some stages in his career and all topics will rarely be used by any set of practitioners. The appeal of this book lies in the fact that everyone—from the students to the hardened primary investigators—will find this book very useful. And the useful chapters will keep on changing with the level of expertise developed. We decided to go from the known to the unknown. So every time the readers come back to the book, they will find something new. It was an onerous task which took over a year in preparation. We hope it enriches the lives of our readers.
Special mention must be made of the efforts of Mr Hitesh Mendiratta, who stuck it out with me—decoding the conspicuously bad handwriting. We gave up a large number of assignments for this labor of love. It was an onerous task but the one which was enjoyed. Last but not least, our thanks to all those who are reading this book. Hope you find it educative.
Jatinder Bali
Anil Kant
Acknowledgments
I am thankful to Dr V Devgan, who is a great person and was an important source of inspiration for Basics of Biostatistics: A Manual for the Medical Practitioners by suggesting that I take it up in real earnest. Speaking of encouragement, special mention must be made of Dr Barun K Nayak, who mentored me in my learning years. He taught me the value of hard work and diligence. He is a fantastic teacher and I can only be grateful to have met him. Another special thank to Ms Shabry Bakshi, the author and the journalist, who was there with lots of words of help and each of those words turned out to be helpful. So finally, for me, one part of my quest is over.
Jatinder Bali
The place of a Guru is of highest order in our culture. I could very well realize this while undertaking this journey. In this respect, I thank Dr (Mrs) Anita Goyal, Kurukshetra University, Haryana, India, who taught and guided me through the maze of statistics. Life beyond classrooms teaches a lot and one can consider himself privileged if one gets professional gurus, who always motivate one to challenge and strive for the best. Thanks to Mr BS Kampani, Mr VK Seth and Mr K Alparslan for believing in me over the years. The padyatra i.e. the journey continues…
Anil Kant
First and foremost, we would like to thank our families Dr (Mrs) Renu, Ojasvini, Nandan, Mrs Meeta and Mahir as well as our parents, who put up with us through the writing of Basics of Biostatistics: A Manual for the Medical Practitioners. They have been anchors, who allowed us to weather many a storms in this odyssey. They knew this book meant a lot to us. They sacrificed many hours of happiness at the altar of the keyboard. We look forward to future family gatherings, where we will be able to discuss this book, which we hope, they all will read. Not really, but we hope, they find it useful if they ever chance upon this path in future.
Special thanks is also due to Mr KP Singh and the entire team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. We would like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing), Ms Samina Khan (Executive Assistant to Director–Publishing), Mr KK Raman (Production Manager), Mr Mohit Bhargava (Production Coordinator) and the other staff. They were prompt and professional in their responses. They have elucidated the value of time. They almost had the job finished even before the impossible deadline. They sure know how to hire good talent. They have been exceptional in the quality of artwork and back-end support for complicated projects. The future looks bright for Indian skill transfer publishing. We hope they keep it up like this only.
While on the subject of sticking it out with high-quality work, we must bring on board Mr Hitesh Mendiratta, a wizard with scientific data, if ever, there was one. He did medical terminology and complex mathematical equations with the same consummate ease. At times, he had picked out the mistakes in the printouts even before we read the drafts. He is one man we will have on our team for any prolonged writing campaign. He never tires. And, finally, thanks to all the students and principal investigators, who inspired us to undertake the project in the first place.