循证医学系统评价和meta分析黄鹏(研).ppt

;问题的提出; 对上述结果， 是不是难以判断并选择？;用X线进行乳腺癌筛查Mammography for breast cancer is an established screening method;The authors found that no trial data were of high quality Two were of medium quality, and the rest were poor quality or flawed. When the results of the two medium quality trials were combined, the risk ratio was 1.00 (95% CI 0.96, 1.05) They concluded that “screening for breast cancer with mammography is unjustified” ;The US Preventive Services Task Force reviewed the same set of trials;The meta-analysis performed for the USPSTF on the most current published data found that the pooled effect size of the combined trials was sizable and statistically significant: the summary relative risk (RR) of breast cancer death among women randomized to screening in seven trials that included women older than 50 was 0.77 (95 percent CI, 0.67-0.89).;The USPSTF recommends screening mammography, with or without clinical breast examination, every 1-2 years for women aged 40 and older. ;被动吸烟的危害;Hackshaw et al. conducted a very comprehensive systematic review in 1997 ;Their meta-analysis revealed that the overall risk of lung cancer among lifelong non-smoking women was 1.24 times higher when their husbands smoked, as compared to those women whose husbands did not smoke. ;让我们来看看 系统评价的真实面目;系统评价的定义;Systematic review (SR);Meta-分析的概念;系统评价的要点;系统评价的主要特征;系统评价与Meta分析的关系;Meta analysis的原理和基本思想;基本原理;基本原理;基本原理（理想状态）;实际情况; Meta analysis的目的及适用性 ;Meta analysis的局限性;Meta-analysis is typically a two-stage process（两阶段过程）;系统评价的方法和步骤; 明确研究目的 提出检验假设 注意特殊的亚组 确定和选择研究的方法和标准 提取和分析资料的方法和标准; 原则 多途径、多渠道、最大限度 途径 利用多途径广泛收集资料 多种电子资源数据库 参考文献的追溯 注意 未正式发表“灰色文献”（grey literature）——这些文献中可能包含阴性研究结果 会议专题论文 未发表的学位论文 ;检索大量的文献 根据入选和排除标准进行仔细的筛选 挑出合格的研究进行系统综述??Meta分析;排除;绘制筛选文献流程图 ; ; 随机对照试验(RCT)的方法学质量考察: 受试者分组是否真正随机 随机方案是否隐藏 是否详细说明入选标准 组间基线是否可比 研究过程中是否使用了盲法 对失访、退出及不良反应病例是否进行了详细录，是否报告失访原因 是否采用意向分析法（intention-to-treat,ITT）分析结果 患者的依从性（compliance）如何;记分为1～