meta-analysis 統合分析 蔡崇弘. ebm ( evidence based medicine) ask acquire appraising apply...
TRANSCRIPT
![Page 1: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/1.jpg)
meta-analysis 統合分析 蔡崇弘
![Page 2: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/2.jpg)
EBM ( evidence based medicine)AskAcquireAppraisingApplyAudit
![Page 3: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/3.jpg)
FIRE
Formulate an answerable question Information search Review of information and clinical
appraisal Employ the result in clinical practice
![Page 4: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/4.jpg)
question
Intervention Frequency or rate Diagnostic accuracy Risk or etiology Prediction and prognosis
![Page 5: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/5.jpg)
Finding relevant studies
Existing systematic reviews Published primary studies Breaking down study question into
components Synonyms Snowballing Handsearching Methodological terms Methodological filters
![Page 6: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/6.jpg)
Finding relevant studies
Different databases Unpublished primary studies search relevant databases writing to experts
![Page 7: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/7.jpg)
Appraising and selecting studies VIP Jadad score
![Page 8: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/8.jpg)
review
Narrative reviews Systematic review
![Page 9: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/9.jpg)
paper
One question, one paper One question, more papers More papers to get one conclusion. Different paper, different effect 7 ( 4 effect 3 non-effect) Conclusion!
![Page 10: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/10.jpg)
Vote counting
P value ( P>0.05, P<0.05) Is it good for you?
![Page 11: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/11.jpg)
Meta-analysis
Systematic review and meta-analysis
Meta-analysis is used in many fields of research
Meta-analysis as part of the research process
![Page 12: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/12.jpg)
Four stages of research synthesis Problem collection Data collection Data evaluation Data analysis and interpretation
![Page 13: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/13.jpg)
Simpson’s paradox 法學院:報名人數 錄取人數 錄取率 商學院:報名人數 錄取人數 錄取率 男生 : 53 8 15.1% 男生 : 251 201 80.1% 女生 : 152 51 33.6% 女生 : 101 92 91.1% 總和 : 205 59 28.8% 總和 : 352 293 83.3%
總報名人數 總錄取人數 總錄取率 男生: 304 209 68.8% 女生: 253 143 56.5%
![Page 14: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/14.jpg)
What does a meta-analysis entail?
Which comparisons should be made? Which study results should be used in
each comparison? What is the best summary of effect for
each comparison? Are the results of studies similar within
each comparison? How reliable are those summaries?
![Page 15: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/15.jpg)
Types of data and effect measures
Dichototomous outcomes OR, RD, NNT. Continuous outcomes mean difference, standardised mean difference, Ordinal outcomes Counts and rates Time-to-event outcomes Log scales
![Page 16: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/16.jpg)
How a meta-analysis work
Individual studies Effect size Precision Study weights P-values The summary effect Heterogeneity of effect sizes
![Page 17: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/17.jpg)
software
Comprehensive meta-analysis Reman Stata macro with stata SAS R
![Page 18: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/18.jpg)
Why perform a meta-analysis
Statistical significance Clinical importance of the effect Consistency of effects
![Page 19: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/19.jpg)
Doing arithmetic with words The words are based on p-values the
words are the wrong words.
![Page 20: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/20.jpg)
Effect size and precision
Treatment effects and effect sizes How to choose an effect size Parameters and estimates Outline of effects size computations
![Page 21: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/21.jpg)
Factors that affect precision
Variance, standard error, and confidence intervals
Factors that affect precision Sample size Study design Concluding remarks
![Page 22: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/22.jpg)
Fixed-effect model
A single true value Weighs are 1/d2 (d2 variance of
studies )
![Page 23: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/23.jpg)
Random-effect model
True value varies Weighs are 1/(d2 + Tau2 ) Tau= study- to study variation
![Page 24: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/24.jpg)
If between study variance is small then fixed and random effects models are similar.
If the between study variance is large, the weighs for each study become almost equal.
Minimal between study variation- the choice doesn’t matter.
Considerable between study variation then an explanation should be sought.
![Page 25: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/25.jpg)
Identifying and quantifying heterogeneity Isolating the varivation in true effects Computing Q The expected value of Q based on
within-study error The excess variation Ratio of observed to expected variation Testing the assumption of homogeneity
in effects Concluding remarks about Q and p-
value
![Page 26: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/26.jpg)
Estimating Concluding remarks about T Tau Concluding remark about T The I statising Comparing the measures of
heterogeneity Confidence interval for
![Page 27: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/27.jpg)
Prediction intervals
Prediction intervals in primary studies Prediction intervals in meta-analysis Confidence intervals and prediction
intervals Comparing the confidence interval with
the prediction interval
![Page 28: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/28.jpg)
Subgroup analysis
Fixed-effect model within subgroups Computing the summary effects Computation for A studies Computation for B studies Computations for all ten studies Comparing the effect
![Page 29: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/29.jpg)
Meta-regression
Fixed-effect model Assessing the impact of the slope The Z-test and Q-test Quantify the magnitude of the
relationship Fixed or random effects for
unexplained heterogeneity The proportion of variance explained
![Page 30: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/30.jpg)
Publication bias
The problem of missing studies Studies with significant results are
more likely to be published Published studies are more likely to be
included in a meta-analysis Other sources of bias Methods for addressing bias.
![Page 31: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/31.jpg)
Generally of the basic inverse-variance method Other effect sizes Simple descriptive statistics Physical contents Two-group studies with other types of
data Three-group studies Regression coefficients
![Page 32: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/32.jpg)
Further methods for dichotomous data Mantel-Haenszel method Peto odds ratio method Dersimonnian and Laird random
effects method
![Page 33: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/33.jpg)
When does it make sense to perform a meta-analysis? Are the studies similar enough to combine? Can I combine studies with different
designs? Randomized trials versus observational
studies Studies that used independent groups,
paired groups, clustered groups Can I combine studies that report results in
different ways? How many studies are enough to carry out a
meta-analysis?
![Page 34: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/34.jpg)
Reporting the results of a meta-analysis Are the effects consistent? The computational model Forest plots Sensitivity analysis
![Page 35: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/35.jpg)
Cumulative meta-analysis
Why perform a cumulative meta-analysis?
Cumulative meta-analysis as an educational tool
To identify patterns in the data c Display, not analysis Using a cumulative analysis
prospectively
![Page 36: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/36.jpg)
Criticisms of meta-analysis One number cannot summarize a
research field The file drawer problem invalidates
meta-analysis Mixing apples and oranges Garbage in, garbage out Important studies are ignored Meta-analysis can disagree with
randomized trials Meta-analyses are performed poorly
![Page 37: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/37.jpg)
![Page 38: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/38.jpg)
![Page 39: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/39.jpg)
![Page 40: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/40.jpg)
![Page 41: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/41.jpg)
![Page 42: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/42.jpg)
![Page 43: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/43.jpg)
![Page 44: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/44.jpg)
![Page 45: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/45.jpg)
![Page 46: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/46.jpg)
![Page 47: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/47.jpg)
![Page 48: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/48.jpg)
![Page 49: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/49.jpg)
![Page 50: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/50.jpg)
![Page 51: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/51.jpg)
![Page 52: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/52.jpg)
![Page 53: Meta-analysis 統合分析 蔡崇弘. EBM ( evidence based medicine) Ask Acquire Appraising Apply Audit](https://reader036.vdocuments.net/reader036/viewer/2022081421/56649ee95503460f94bfa8d4/html5/thumbnails/53.jpg)