医学干预的非常大的治疗效果的经验评估
Tiago V Pereira1, Ralph I Horwitz, John P A Ioannidis
1Health Technology Assessment Unit, Institute of Education and Sciences, German Hospital Oswaldo Cruz, Sao Paulo, Brazil.
JAMA
|October 25, 2012
概括
在医学上,大多数大的治疗效果都来自小型研究,并随着额外的试验而减少. 经过充分验证的大规模效应是罕见的,通常涉及非致命的结果.
科学领域:
- 医学研究 医学研究
- 临床试验分析临床试验分析
- 基于证据的医学是基于证据的医学.
背景情况:
- 大多数医疗干预都会产生适度的效果.
- 偶尔,临床试验报告实质性的好处或危害.
研究的目的:
- 确定医学中非常大的治疗效果的频率和特征.
- 分析这些影响如何随着后续研究而改变.
主要方法:
- 从系统性审查的科克兰数据库 (2010) 分析了85,002个森林地块.
- 基于统计学上显著的非常大的效应 (odds比率≥5) 在第一个或随后的出版物中对试验进行分类.
- 深入评估来自每个类别的250个随机抽样主题.
主要成果:
- 9.7%的第一次试验和6.1%的后续试验显示出显著的非常大的效应.
- 在实验室定义的疗效结果中,非常大的效应比死亡率更常见.
- 在元分析中,效应大小通常显著下降;90-98%变小.
结论:
- 非常大的治疗效果往往来自小型研究,并且往往随着更多的研究而减少.
- 确认的大规模影响是罕见的,主要与非致命的结果有关.
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