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
Jaypee Brothers Medical Publishers (P) Ltd.
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd.
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
E-mail: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd.
83, Victoria Street, London, SW1H 0HW (UK)
Phone: +44-20 3170 8910
Fax: +44(0) 20 3008 6180
e-mail: info@jpmedpub.com
Jaypee-Highlights Medical Publishers Inc.
City of Knowledge, Building 235, 2nd Floor
Clayton, Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
E-mail: cservice@jphmedical.com
Jaypee Medical Inc.
325, Chestnut Street
Suite 412, Philadelphia, PA 19106, USA
Phone: +1 267-519-9789
E-mail: support@jpmedus.com
Jaypee Brothers Medical Publishers (P) Ltd.
17/1-B, Babar Road, Block-B
Shaymali, Mohammadpur
Dhaka-1207, Bangladesh
Mobile: +08801912003485
E-mail: jaypeedhaka@gmail.com
Jaypee Brothers Medical Publishers (P) Ltd.
Bhotahity, Kathmandu, Nepal
Phone: +977-9741283608
E-mail: kathmandu@jaypeebrothers.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2017, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Basics of Biostatistics: A Manual for the Medical Practitioners
First Edition: 2017
9789386150714
Printed at
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.