Ex IV-screening
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Obsa AbrahimEx IV-screening
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Obsa AbrahimScreening of diabetes
In a hypothetical study, 1000 patients attending a hospital general outpatient department
were tested for diabetes using the following two tests: fasting blood sugar (FBS) and
glucose tolerance test (GTT).There were 100 patients who had a positive GTT, and they
were classified as true cases of diabetes. There were also 140 patients with FBS at least
6 mmol/l (cut –off point to distinguish people with diabetes from those who do not have
diabetes). Among these 140 patients, only 98 were true cases of diabetes (i.e. only 98
had a positive GTT as well)
Question 1. What are the sensitivity, specificity and positive and negative predictive
values of the FBS in this study population?
Disease status
Positive Negative Total
Screening Positive
Test Negative
Total
Sensitivity
Specificity
PPV
NPV
Question 2. Calculate the positive predictive value and negative predictive value of
FBS in this surrey?
Disease status
Positive Negative Total
Screening Positive
Test Negative
Total
PPV NPV
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The FBS test and GTT were used in a hypothetical community survey to screen for
diabetes. Among 1000 people surveyed, 40 people had appositive GTT for diabetes
and were classified as true cases of diabetes. An FBS cut – off value of 6 mmol/l was
used to distinguish between people with and without diabetes and assume that at this
cut off point the FBS had sensitivity of 98% and specificity of 95% in diagnosing
diabetes.
Question 3. What are the positive predictive value and negative predictive value of
FBS in this survey?
Disease status
Positive Negative Total
Screening Positive
Test Negative
Total
PPV NPV
Question 4. Why is the positive predictive value different from that observed in
hypothetical hospital-based study?
Assume that if the cut off point of FBS is increased to 7.5 mmol/L the sensitivity
is 90%, and the specificity is 99% for the diagnosing diabetes.
Question 5
What are the positive predictive value and false negative error rate of FBS if the cut-
off point of 7.5 mmol/L is used to screen for diabetes in this community?
Disease status
Positive Negative Total
Screening Positive
Test Negative
Total
PPV NPV
Question 6. If you were asked to fix the cut off point of FBS, for a survey in your
community, what would you select 6 mmol/L or 7 mmol/L? Give your reason! 3
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