Systematic Reviews and Meta-Analyses：系统综述和Meta分析.ppt

Systematic Reviews and Meta-Analyses And the Cochrane Library Problems with Todays Medical Literature Most studies are too small Inconclusive, often conflicting results Traditional reviews are unstructured subjective Biased conclusions WHO CAN KEEP UP? Over 345,000 trials published to date Over 20,000 new trials published annually For General Physiciansto keep current: Read 19 new articles per day which appear in medical journals 19 x 2 hrs (Critical Appraisal) = 38 hrs per day Davidoff F et al. (1995) EBM; A new journal to help doctors identify the information they need. BMJ 310:1085-86. 1996 G. WELCH, S. GABBEReview of Statistics Usage in the Amer J Obstet Gynecol 175;1138-41 All clinical papers: Jan - June 1994 (Vol. 170, No. 1 to 6) 31.7% (46/145) had inappropriate statistics 27 of 46 papers had serious flaws Problems with Standard Reviews Lack of scientific purpose (question) Undocumented methods of literature search Unstated criteria for selecting studies No methodological assessment of selected studies Inadequate assessment of inter-study differences in results No attempt at quantitative synthesis (pooling) to take advantage of increased power The Cochrane Collaboration - origins Archie Cochrane “It is surely a great criticism of our profession that we have not organized a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials.” Pregnancy and childbirth work - 1980s Aims and objectives of the CC “The Cochrane Collaboration is an international organization that aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions” Founded 1993 CC built on 10 Principles collaboration building on the enthusiasm of individuals avoiding duplication minimizing bias keeping up to date striving for relevance promoting access ensuring quality continuity enabling wide