Abstract：
BACKGROUND AND OBJECTIVES:Meta-analyses sometimes summarize results in the presence of substantial unexplained between-study heterogeneity. As GRADE criteria highlight, unexplained heterogeneity reduces certainty in the evidence, resulting in limited confidence in average effect estimates. The aim of this paper is to provide a new clinically useful approach to estimating an intervention effect in light of unexplained heterogeneity. METHODS:We used a random-effects model to estimate the distribution of an intervention-effect across various groups of patients given data derived from meta-analysis. The model provides a distribution of the probabilities of various possible effects in a new group of patients. We examined how our method influenced the conclusions of two meta-analyses. RESULTS:In one example, our method illustrated that evidence from a meta-analysis did not support authors' highly publicized conclusion that hypericum is as effective as other antidepressants. In the second example, our method provided insight into a subgroup analysis of the effect of ribavirin in hepatitis C, demonstrating clear important benefit in one subgroup but not in others. CONCLUSION:Analysing the distribution of an intervention-effect in random-effects models may enable clinicians to improve their understanding of the probability of particular-intervention effects in a new population.
journal_name
J Clin Epidemioljournal_title
Journal of clinical epidemiologyauthors
Saad A,Yekutieli D,Lev-Ran S,Gross R,Guyatt Gdoi
10.1016/j.jclinepi.2018.11.023subject
Has Abstractpub_date
2019-03-01 00:00:00pages
101-106eissn
0895-4356issn
1878-5921pii
S0895-4356(18)30597-3journal_volume
107pub_type
杂志文章abstract：OBJECTIVES:Emergency department triage systems can be considered prediction rules with an ordinal outcome, where different directions of misclassification have different clinical consequences. We evaluated strategies to compare the performance of triage systems and aimed to propose a set of performance measures that sh...
journal_title：Journal of clinical epidemiology
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更新日期：2018-02-01 00:00:00
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journal_title：Journal of clinical epidemiology
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journal_title：Journal of clinical epidemiology
pub_type： 杂志文章
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更新日期：2006-01-01 00:00:00
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journal_title：Journal of clinical epidemiology
pub_type： 历史文章,杂志文章
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journal_title：Journal of clinical epidemiology
pub_type： 杂志文章,评审
doi：10.1016/j.jclinepi.2005.10.003
更新日期：2006-04-01 00:00:00
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journal_title：Journal of clinical epidemiology
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journal_title：Journal of clinical epidemiology
pub_type： 临床试验,杂志文章,随机对照试验
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更新日期：2003-11-01 00:00:00
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journal_title：Journal of clinical epidemiology
pub_type： 杂志文章,评审
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更新日期：2017-12-01 00:00:00
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journal_title：Journal of clinical epidemiology
pub_type： 杂志文章,评审
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更新日期：2007-08-01 00:00:00
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pub_type： 杂志文章,meta分析
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更新日期：2007-03-01 00:00:00
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pub_type： 杂志文章
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更新日期：2001-11-01 00:00:00
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doi：10.1016/j.jclinepi.2011.06.007
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journal_title：Journal of clinical epidemiology
pub_type： 杂志文章
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更新日期：2003-07-01 00:00:00
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journal_title：Journal of clinical epidemiology
pub_type： 杂志文章
doi：10.1016/j.jclinepi.2012.06.023
更新日期：2013-02-01 00:00:00
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更新日期：2006-02-01 00:00:00
