Abstract：
:Statistical tests of heterogeneity and bias, in particular publication bias, are very popular in meta-analyses. These tests use statistical approaches whose limitations are often not recognized. Moreover, it is often implied with inappropriate confidence that these tests can provide reliable answers to questions that in essence are not of statistical nature. Statistical heterogeneity is only a correlate of clinical and pragmatic heterogeneity and the correlation may sometimes be weak. Similarly, statistical signals may hint to bias, but seen in isolation they cannot fully prove or disprove bias in general, let alone specific causes of bias, such as publication bias in particular. Both false-positive and false-negative signals of heterogeneity and bias can be common and their prevalence may be anticipated based on some rational considerations. Here I discuss the major common challenges and flaws that emerge in using and interpreting statistical tests of heterogeneity and bias in meta-analyses. I discuss misinterpretations that can occur at the level of statistical inference, clinical/pragmatic inference and specific cause attribution. Suggestions are made on how to avoid these flaws, use these tests properly and learn from them.
journal_name
J Eval Clin Practjournal_title
Journal of evaluation in clinical practiceauthors
Ioannidis JPdoi
10.1111/j.1365-2753.2008.00986.xsubject
Has Abstractpub_date
2008-10-01 00:00:00pages
951-7issue
5eissn
1356-1294issn
1365-2753pii
JEP986journal_volume
14pub_type
杂志文章,评审abstract：RATIONALE, AIMS AND OBJECTIVES:Clinical guidelines are tools that systematize scientific evidence and help to achieve proper care. Several difficulties are reported regarding the effective use, such as the shortcomings in the level of knowledge and attitudes by the professionals, the service structure and the preferenc...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2011.01681.x
更新日期：2011-08-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:It has been proposed that delivery should be accomplished within 30 minutes after diagnosis of fetal distress. The objective of this study was to determine the decision-to-delivery interval (DDI) in emergency caesarean delivery for non-reassuring fetal heart rate (FHR). METHODS:A total o...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.12613
更新日期：2016-12-01 00:00:00
abstract：OBJECTIVES:To determine IMR trends and regional variations among 47 prefectures in Japan and to identify associated population-based factors. METHODS:We conducted an ecological study of infant mortality rate (IMR) by analyzing publicly available data from the Ministry of Health, Labour and Welfare of Japan. Outcome me...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2012.01862.x
更新日期：2013-10-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:The standard of preventive care for poorly controlled seasonal allergic rhinitis (AR) is subcutaneous immunotherapy (SCIT) with allergen extracts, administered in a physician's office. As an alternative to SCIT, sublingual immunotherapy (SLIT) is now an option for patients with seasonal A...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章,评审
doi：10.1111/jep.12112
更新日期：2014-06-01 00:00:00
abstract：OBJECTIVE:To review the literature on the perceived benefits and disadvantages associated with significant event analysis (SEA) and identify reported barriers and facilitating factors. METHOD:A comprehensive search of electronic databases and peer reviewed journals was conducted during June 2006. Studies which explore...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章,评审
doi：10.1111/j.1365-2753.2007.00908.x
更新日期：2008-08-01 00:00:00
abstract：RATIONALE, AIMS, AND OBJECTIVES:The main purpose of this paper is to measure the efficiency and ranking of medical diagnostic laboratories by applying a network data envelopment analysis (NDEA). METHODS:In this study, each medical diagnostic laboratory is considered as a decision-making unit (DMU), and an NDEA model i...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.13337
更新日期：2020-10-01 00:00:00
abstract：BACKGROUND:Research indicates that multifaceted practice development (PD) interventions are more effective than single strategies. However, models of education in health care need to consider cost-effectiveness. OBJECTIVES:This paper presents a research-based, PD theory called the Individual Practice Development Theor...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2010.01618.x
更新日期：2012-06-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:Adverse events (AEs) among hospitalized patients occur frequently and result in significant sequelae. Federal policy is incentivizing health information technology (HIT) use, although research demonstrating safety benefits from HIT is mixed. Our objective was to evaluate the potential eff...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.12139
更新日期：2014-08-01 00:00:00
abstract：UNLABELLED:Medical tradition considers a physical examination (PE) an essential part of the clinical encounter. In real medical practice, however, a full PE may not be necessary when the diagnosis is clear after anamnesis and general impression. We assessed the value of PEs in 500 diagnoses of upper respiratory infecti...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2008.00980.x
更新日期：2009-02-01 00:00:00
abstract：:Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themse...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2006.00617.x
更新日期：2006-08-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:We aim to determine the prevalence of reconciliation errors (REs) at admission to surgery departments, report their potential clinical impact and analyse possible risk factors. METHODS:Prospective observational study was conducted for 8 months in a regional public hospital in Spain. The ...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.12403
更新日期：2016-02-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:The incidence of falls and fall-related injuries in older age is predicted to increase concomitantly with global population ageing, representing a serious challenge to health care systems. In spite of the availability of policy and practice guidelines for the prevention of falls and fall-...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2009.01307.x
更新日期：2010-12-01 00:00:00
abstract：:A small percentage of emergency department (ED) visitors account for a disproportionate portion of ED visits. Little is known about their relationships with their primary care providers (PCPs). This study compares frequent and infrequent ED visitors' primary care utilization and perceptions of primary care access, con...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.12672
更新日期：2017-06-01 00:00:00
abstract：:Clinical guidelines are essential in promoting the implementation of evidence-based practice within the NHS. But there are two broad schools of thought about their development and implementation: the first argues that guidelines should be entirely evidence-based and tolerates a degree of complexity which may make the ...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.1998.tb00088.x
更新日期：1998-11-01 00:00:00
abstract：RATIONALE, AIMS, AND OBJECTIVES:Measures of safety climate are increasingly used to guide safety improvement initiatives. However, cost and respondent burden may limit the use of safety climate surveys. The purpose of this study was to develop a 15- to 20-item safety climate survey based on the Patient Safety Climate i...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.12731
更新日期：2017-08-01 00:00:00
abstract：RATIONALE, AIMS, AND OBJECTIVES:The patient-centred medical home (PCMH) is an innovative approach to health care reform. Despite a well-established process for recognizing PCMH practices, fidelity to, and/or adaptation of, the PCMH model can limit health care and population health improvements. This study explored the ...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.13136
更新日期：2019-12-01 00:00:00
abstract：:Evidence-based medicine (EBM) calls for medical practitioners to "integrate" our best available evidence into clinical practice. A significant amount of the literature on EBM takes this integration to be unproblematic, focusing on questions like how to interpret evidence and engage with patient values, rather than cri...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.13109
更新日期：2019-12-01 00:00:00
abstract：OBJECTIVE:To assess the association of the quality of allocation concealment with heterogeneity in age, the P value of the primary outcome and statistical significance of the primary outcome. STUDY DESIGN AND SETTING:We extracted data from articles published in four major medical journals in 2017 and 2018 that reporte...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章,评审
doi：10.1111/jep.13313
更新日期：2020-08-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:Single-group interrupted time series analysis (ITSA) is a popular evaluation methodology in which a single unit of observation is studied; the outcome variable is serially ordered as a time series, and the intervention is expected to "interrupt" the level and/or trend of the time series, ...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.12638
更新日期：2017-04-01 00:00:00
abstract：OBJECTIVES:To describe the practices of physicians on the diagnosis and treatment of antituberculosis drug-induced hepatotoxicity (ATH), and to evaluate the concordance between these practices and the American Thoracic Society (ATS) 2006 guidelines. METHODS:Information was reviewed on 670 new cases of tuberculosis pat...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2011.01706.x
更新日期：2012-12-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:Existing literature suggests that doctors' poor adherence with guidelines is one of the major contributing factors to suboptimal control of hypertension. This study aims to evaluate doctors' adherence with Malaysian clinical practice guideline (CPG 2008) in a tertiary care hospital, and f...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2012.01852.x
更新日期：2013-10-01 00:00:00
abstract：OBJECTIVES:The purpose of this study is to examine Electronic Health Record (EHR) adoption among Florida doctors who treat the elderly. This analysis contributes to the EHR adoption literature by determining if doctors who disproportionately treat the elderly differ from their counterparts with respect to the utilizati...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2009.01277.x
更新日期：2010-12-01 00:00:00
abstract：AIMS AND OBJECTIVES:Musculoskeletal system has been found to be involved in genesis and perpetuation of chronic pelvic pain (CPP) and has strong evidences that up to 80% of women with CPP present dysfunction of the musculoskeletal system. In this study, we report a series of women with CPP caused by tenderness of pelvi...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2009.01202.x
更新日期：2010-10-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:A clinical practice guideline for chronic obstructive pulmonary disease (COPD) was implemented in all Veterans Health Administration (VHA) hospitals in the US. The aim of the current analyses is to describe current adherence rates and the organizational factors related to provider adheren...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2005.00541.x
更新日期：2005-08-01 00:00:00
abstract：OBJECTIVES:The aim of this study was to examine the impact of the use of an inter-professional care team on patient length of stay and payer charges in a geriatric transitional care unit. METHODS:An analysis of de-identified administrative records for transitional care patients for the 12-month period (2003-2004) care...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2008.01114.x
更新日期：2010-02-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:Hospital discharge notes can be used to identify rates of revisions in hip and knee arthroplasty surgeries if such administrative codes are accurate. In order to trust the data taken from the hospital discharge abstracts it is important to assess their reliability. The purpose of this stu...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章,多中心研究
doi：10.1111/j.1365-2753.2010.01622.x
更新日期：2012-06-01 00:00:00
abstract：:Results of renal transplantation have improved steadily over the years. This article reviews the current status of patient and graft survival and discusses major causes of mortality and renal allograft failure. Review of recent literature demonstrates that the traditional enemies of transplantation, acute rejection an...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章,评审
doi：10.1111/j.1365-2753.2003.00408.x
更新日期：2004-02-01 00:00:00
abstract：RATIONALE, AIMS AND OBJECTIVES:The focus on the diagnosis is a pivotal aspect of medical practice since antiquity. Diagnostic taxonomy helped to categorize ailments to improve medical care, and in its social sense resulted in validation of the sick role for some, but marginalization or stigmatization for others. In the...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.12113
更新日期：2016-02-01 00:00:00
abstract：:One knowledge translation method, of putting evidence into practice, is the use of clinical practice guidelines (CPG). The purpose of this brief report is to describe an 8-step process of "how to" contextualize a training programme to increase CPG-uptake for a targeted audience in a clearly defined setting. This proce...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.13476
更新日期：2020-09-14 00:00:00
abstract：:Medical malpractice claims can be analysed to gain insights aimed at improving quality of care. However, using medical malpractice claims in medical research raises epistemological and methodological concerns related to certain features of the litigation process. Medical research should therefore approach medical malp...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.13178
更新日期：2019-10-01 00:00:00
