meta－分析的統(tǒng)計(jì)學(xué)基礎(chǔ)-展示頁(yè)
2024-10-15 15:39本頁(yè)面
【正文】 Rs assess study quality: – 240 SRs from journals: 48% assessed quality (Moher 1999) – 480 SRs in DARE: 52% assessed quality (Petticrew 1999) – 50 SRs on asthma: 28% reported validity assessment criteria (Jadad 2022) ? Berkeley, 2022 on quality of SRs on HIV, published during 2022 –Quality assessment done in 56% of reviews – Testing for heterogeneity done in 56% of reviews –Not all SRs with significant heterogeneity explored reasons for it – Many reviews did not state the rationale for choice of models used for bining data – Only 12% of reviews evaluated publication bias 近年 Meta分析文獻(xiàn)中存在的 主要問(wèn)題 （ 2022年到 2022年 5月） ㈠ 提供 Meta分析流程圖 ㈡文獻(xiàn)搜索范圍 ㈢發(fā)表偏倚的說(shuō)明 ㈣異質(zhì)性檢驗(yàn)執(zhí)行情況 ㈤敏感度分析 Meta分析流程圖 ? 僅有 2篇文獻(xiàn)有進(jìn)行流程圖的描述，這種情況的發(fā)生可能與國(guó)內(nèi)期刊并不要求等因素有關(guān)。 McAlister 1999) – Cochrane reviews, on average, may be more rigorous and better reported than journal reviews (Mulrow 1987。 ? All systematic reviews are not metaanalyses! Systematic reviews/metaanalyses indexed in PubMed – 10 years 050010001500202225001992 1993 1994 1995 1996 1997 1998 1999 2022 2022How to read a systematic review? 研究顯示 – Not all SRs are truly systematic (Petticrew 1999。 ? 可以將針對(duì)同一問(wèn)題的，多個(gè)獨(dú)立的研究結(jié)果進(jìn)行定量分析。 循證醫(yī)學(xué)與傳統(tǒng)醫(yī)療實(shí)踐的四個(gè)重要區(qū)別 (1992 JAMA) ? 系統(tǒng)收集的證據(jù)優(yōu)于非系統(tǒng)的臨床觀察 ? 以病人終點(diǎn)結(jié)局為判效指標(biāo)的試驗(yàn)優(yōu)于僅根據(jù)生理學(xué)原理制定指標(biāo)的試驗(yàn) ? 解釋醫(yī)學(xué)文獻(xiàn)對(duì)醫(yī)生是一項(xiàng)重要技能 ,有必要正規(guī)學(xué)習(xí)一些證據(jù)的相關(guān)通則 ,以達(dá)到熟練解釋的程度 ? 醫(yī)生對(duì)病人的個(gè)體化評(píng)價(jià)優(yōu)于專家意見(jiàn)。 系統(tǒng)性綜述 ? Systematic reviews（ 系統(tǒng)評(píng)價(jià) ） ? 是循證醫(yī)學(xué)重要的手段。 ?四級(jí)：無(wú)對(duì)照的系列病例觀察 。 ?二級(jí)：?jiǎn)蝹€(gè)樣本量足夠大的 RCT。 ?醫(yī)療決策僅靠證據(jù)遠(yuǎn)遠(yuǎn)不夠 ,還須考慮病人的價(jià)值取向和意愿。 但這絕非否認(rèn)從古至今傳統(tǒng)決策中亦在部分使用上述方法。 用 X線進(jìn)行乳腺癌篩查 Mammography for breast cancer is an established screening method ? Is screening with mammography justifiable? ? Gotzsche amp。Meta－分析的統(tǒng)計(jì)學(xué)基礎(chǔ) 王洪源 北京大學(xué)公共衛(wèi)生學(xué)院 流行病學(xué)與衛(wèi)生統(tǒng)計(jì)學(xué)系 一、 概 述 什么是循證醫(yī)學(xué) ?Evidencebased medicine (EBM) ?循證醫(yī)學(xué) 是在對(duì)個(gè)體病人制定臨床決策時(shí)應(yīng)基于當(dāng)前最佳的科學(xué)研究成果。 ?循證醫(yī)學(xué) 是最佳的證據(jù)、臨床經(jīng)驗(yàn)和病人價(jià)值的有機(jī)結(jié)合。 Olsen [Nordic Cochrane Centre] conducted a systematic review in 2022 and updated it in 2022. ? They identified 8 large RCTs on this topic, with over 182,000 women randomized ? The authors found that no trial data were of high quality – Two were of medium quality, and the rest were poor quality or flawed. ? When the results of the two medium quality trials were bined, the risk ratio was (95% CI , ) ? They concluded that “screening for breast cancer with mammography is unjustified” The US Preventive Services Task Force reviewed the same set of trials Recently, a 2022 Cochrane Collaboration review of the same trials concluded that six of the eight trials were flawed or of poor quality and that the pooled results from the remaining two better trials did not support a benefit from mammography. ? The metaanalysis pe
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