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临床试验与统计分析:皮肤科医生在一份报告中应关注什么?

Clinical trials and statistical analyses: what should dermatologists look for in a report?

作者信息

Alosh Mohamed, Fritsch Kathleen, Soukup Mat, Wilkin Jonathan

机构信息

Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, CDER, FDA, Silver Spring, Maryland, USA.

出版信息

Dermatol Ther. 2009 May-Jun;22(3):199-203. doi: 10.1111/j.1529-8019.2009.01232.x.

Abstract

Clinicians need to evaluate the quality of individual clinical studies and synthesize the information from multiple clinical studies to provide insights in selecting appropriate therapies for patients. Understanding the key statistical principles that underlie a clinical trial and how they may be implemented can help clinicians properly interpret the efficacy and safety findings of clinical trials. Several factors should be considered when evaluating clinical studies reported in the literature, as important differences might exist among reported studies, thereby impacting the reliability of their findings. Studies vary in terms of study design, conduct, analysis, and presentation of findings. The key features to consider when evaluating clinical trials are inferential intent (exploratory versus confirmatory), choice of control group, randomization, extent of blinding, prespecification of analyses, appropriate handling of missing data, and multiple end points. Making comparisons across studies is extremely difficult and rarely statistically justified. However, this article will point out issues to keep in mind when evaluating multiple studies, such as variations in design and study populations.

摘要

临床医生需要评估单个临床研究的质量,并综合多个临床研究的信息,以便为患者选择合适的治疗方法提供见解。了解临床试验背后的关键统计原则以及如何应用这些原则,有助于临床医生正确解读临床试验的疗效和安全性结果。在评估文献中报道的临床研究时,应考虑几个因素,因为所报道的研究之间可能存在重要差异,从而影响其结果的可靠性。研究在研究设计、实施、分析和结果呈现方面各不相同。评估临床试验时要考虑的关键特征包括推断意图(探索性与确证性)、对照组的选择、随机化、盲法程度、分析的预先设定、缺失数据的适当处理以及多个终点。对不同研究进行比较极其困难,而且在统计学上很少有依据。然而,本文将指出在评估多个研究时需要牢记的问题,例如设计和研究人群的差异。

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