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[随机临床试验的优势与不足:根据个性化医疗不断演变的变化]

[STRENGTHS AND WEAKNESSES OF RANDOMISED CLINICAL TRIALS: EVOLVING CHANGES ACCORDING TO PERSONALIZED MEDICINE].

作者信息

Ernest Ph, Jandrain B, Scheen A J

出版信息

Rev Med Liege. 2015 May-Jun;70(5-6):232-6.

Abstract

Randomised Controlled Trials (RCTs) represent the cornerstone of Evidence-Based Medicine (EBM). Based upon the rules of Good Clinical Practice (GCP), they offer many strengths but also present some weaknesses. The rigorous methodology used allows avoid bias related to confounding factors (through a control group), selection bias (through randomisation) and interpretation bias (through double blinding). However, patients recruited in clinical trials and study experimental conditions markedly differ from the situation in real life. Furthermore, clinical trials recruit a mix of good and poor responders, so that the average therapeutic response is most often mitigated. Clinical trials must evolve according to the new concepts of personalized medicine to become even more performing. In a near future, they must progress from a statistical analysis on large cohorts of patients to a more individualized analysis guided by patient phenotype and genotype characteristics.

摘要

随机对照试验(RCTs)是循证医学(EBM)的基石。基于良好临床实践(GCP)的规则,它们有诸多优点,但也存在一些不足。所采用的严格方法能够避免与混杂因素相关的偏倚(通过对照组)、选择偏倚(通过随机化)以及解释偏倚(通过双盲)。然而,临床试验中招募的患者和研究的实验条件与现实生活中的情况显著不同。此外,临床试验招募了反应良好和反应不佳的患者,因此平均治疗反应通常会减弱。临床试验必须根据个性化医疗的新概念不断发展,以变得更具效能。在不久的将来,它们必须从对大量患者队列的统计分析转向由患者表型和基因型特征指导的更个体化分析。

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