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Did you add the same study twice in the meta-analysis?
No full textComment to Hoskins et al (2015) Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis.Br J Psychiatry 206(2):93-100
Forensic database study suggests selective serotonin reuptake inhibitors do not increase the risk of suicide in people taking antidepressants
No full textLevels of evidence: can quality of systematic reviews be quantified?
No full textnon disponibileIntroduction
One of the key theoretical principles of meta-analyses is that all data must be
treated equally with precision. In recent years, however, the quality of the
reporting of data in primary studies, often used as a proxy measure for
methodological quality, has been shown to affect estimates of intervention
efficacy reported in meta-analyses (Schulz et al., 1995; Moher et al., 1999;
Tierney & Stewart, 2005; Gluud, 2006), although data are still controversial
Emerson et al., 1990; Kjaergard et al., 2001; Balk et al., 2002; Juni et al., 2001).
Meta-analysts need to take quality into consideration to reduce heterogeneity
and to provide unbiased treatment estimates (Moher et al., 1999). In order to
investigate whether different methods of quality assessment provide different
estimates of intervention efficacy, Moher and colleagues randomly selected 11
meta-analyses (127 RCTs, mostly placebo-controlled) dealing with different
medical areas (digestive diseases, circulatory diseases, mental health, neurology
and pregnancy and childbirth) (Moher et al., 1999). A statistically significant
exaggeration of treatment efficacy was found when results of lower-quality
trials were pooled whether the trial quality assessments were made by a scale
approach or by an individual component approach. However, generalisability
of findings can be limited by whether or not there is an active comparator
(heterogeneity of intervention, population and outcome) and furthermore
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sensitivity analyses can miss to find possible confounding variables, apparently
not related to trial quality.
In the field of meta-analyses of data extracted from antidepressant (AD) RCTs,
quality remains a hot issue. It is unclear whether in this specific field a
relationship exists between quality measures and treatment estimates and,
additionally, it is unclear whether different quality measures provide different
estimates of treatment efficacy. Furthermore, to reliably inform clinical practice
there is the need for grading the evidence coming from systematic reviews (and
meta-analyses) in the field of AD treatment for major depression. To answer
these questions, we therefore investigated the following issues in a step-wise
approach:
(1) whether RCT quality, assessed by either validated rating scales or
individual components, influenced treatment estimates in a
homogeneous sample of AD RCTs. An ongoing Cochrane review
concerned with fluoxetine included published clinical trials comparing
fluoxetine to other ADs, offered an opportunity for this analysis (Cipriani
et al., 2006).
(2) whether it is possible to find a validated way of grading the quality of
systematic reviews (and meta-analyses) in order to have an explicit
hierarchy of robustness and reliability of findings. An ongoing multiple
treatment meta-analysis (MTM) was used to test this hypothesis
Time to abandon Evidence Based Medicine?
No full textThe article focuses on the evidence based approach in psychiatr
Dataset for primary outcomes (Cipriani et al, Lancet 2016)
Full text linkFull dataset for the primary outcomes of the network meta-analysis about pharmacological treatments for major depressive disorder in children and adolescents (Cipriani et al., Lancet 2016
Lessons learned from Restoring Study 329: Transparent reporting, open databases and network meta-analyses as the way forward
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What is a clinical trial protocol?
No full textTrial protocols are documents that describe the objectives, design, methodology, statistical considerations and aspects related to the organization of clinical trials. Trial protocols provide the background and rationale for conducting a study, highlighting specific research questions that are addressed, and taking into consideration ethical issues. Trial protocols must meet a standard that adheres to the principles of Good Clinical Practice, and are used to obtain ethics approval by local Ethics Committees or Institutional Review Boards
Commentary on: Analysis and reporting of factorial trials: a systematic review (McAlister et al., JAMA)
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