评估了非癌症疾病过度诊断的证据:使用"公平裁判"框架进行了一项超流行病学研究
Sharon Sanders1, Alexandra Barratt2, Rachelle Buchbinder3
1Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland 4229, Australia.
Journal of clinical epidemiology
|November 12, 2023
概括
在非癌症疾病中过度诊断的证据往往很弱. 一项系统性审查强调了需要使用经过验证的框架进行强有力的研究,以准确估计和减少过度诊断.
科学领域:
- 医学诊断 医学诊断 医学诊断
- 基于证据的医学基于证据的医学.
- 卫生政策 卫生政策
背景情况:
- 过度诊断,即检测出不会引起症状或死亡的疾病,在非癌症疾病中越来越令人担忧.
- 评估过度诊断的真实程度需要有力的证据和适当的框架.
- 目前关于非癌症疾病过度诊断的证据在很大程度上未被评估.
研究的目的:
- 系统地评估非癌症疾病过度诊断的证据的强度.
- 评估各种非癌症疾病过度诊断的程度.
- 确定当前研究方法论对过度诊断的局限性.
主要方法:
- 在非癌症条件下对过度诊断的研究进行系统的文献搜索.
- 应用"公平裁判"框架来评估诊断证据的强度.
- 由两名研究人员进行的独立审查,以确定"公平裁判" (临床结果,测试或风险因素).
主要成果:
- 在审查的132项研究中,47%缺乏用于诊断判断的"公平裁判".
- 疾病特定的临床结果仅在21%的研究中被用作"公平的裁判";测试或风险因素更为常见.
- 确定的过度诊断率包括43-45%的腹部动脉瘤,54%的急性损伤和77%的橄水瘤.
结论:
- 目前在非癌症疾病中过度诊断的证据基础主要是弱的.
- "公平裁判"框架可以指导开发更强大的研究.
- 改进的研究设计对于准确的过度诊断估计和为基于证据的政策提供信息至关重要.
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