False alarms and pseudo-epidemics: the limitations of observational epidemiology.

Abstract:

:Most reported associations in observational clinical research are false, and the minority of associations that are true are often exaggerated. This credibility problem has many causes, including the failure of authors, reviewers, and editors to recognize the inherent limitations of these studies. This issue is especially problematic for weak associations, variably defined as relative risks (RRs) or odds ratios (ORs) less than 4. Such associations, commonly reported in the medical literature, are more likely to be attributable to bias than to causal association. All observational research has bias (which can include selection, information, and confounding bias). Hence, detection of small associations falls below the discriminatory ability of observational studies. In general, unless RRs in cohort studies exceed 2 to 3 or ORs in case-control studies exceed 3 or 4, associations in observational research findings should not be considered credible. However, these guidelines are not foolproof: strong (yet spurious) associations can result when large amounts of bias are present. Only in a properly performed randomized controlled trial, free of bias, should small associations merit attention. Better training and more circumspection on the part of investigators, tougher editorial standards on the part of journals, and hefty skepticism on the part of referees and readers are necessary to avoid the dangers of false alarms, pseudo-epidemics, and their unfortunate consequences.

journal_name

Obstet Gynecol

authors

Grimes DA,Schulz KF

doi

10.1097/AOG.0b013e31826af61a

subject

Has Abstract

pub_date

2012-10-01 00:00:00

pages

920-7

issue

4

eissn

0029-7844

issn

1873-233X

pii

00006250-201210000-00025

journal_volume

120

pub_type

杂志文章
  • Comparison between urinary 17-ketosteroids and serum androgens in hirsute patients.

    abstract::In order to ascertain the usefulness of urinary 17-ketosteroids (17-KS) in the evaluation of hirsutism, 28 paired determinations of 17-KS and serum androgens were performed in 26 hirsute women before (control) and after (post Dex) 7 days of dexamethasone (Dex) administration. Upper normal control and post Dex urinary ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Maroulis GB,Manlimos FS,Abraham GE

    更新日期:1977-04-01 00:00:00

  • Effect of Fasting on Total Bile Acid Levels in Pregnancy.

    abstract:OBJECTIVE:To evaluate differences between fasting and nonfasting bile acid levels in asymptomatic and symptomatic pregnant women. METHODS:This is a report of two prospective cohort studies describing bile acid levels in the fasting and nonfasting state in pregnancy. The first cohort included asymptomatic women with si...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0000000000004160

    authors: Smith DD,Kiefer MK,Lee AJ,Davis SB,Summerfield TL,Landon MB,Rood KM

    更新日期:2020-12-01 00:00:00

  • Biophysical profile scoring in the management of the diabetic pregnancy.

    abstract::Biophysical profile scoring was the principal technique of antepartum fetal surveillance in 238 well-controlled diabetic pregnancies. Fifty insulin-dependent diabetics had twice-weekly testing, and 188 gestational diabetics had weekly testing. Intervention was not pursued unless there were maternal or fetal complicati...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/00006250-198812000-00005

    authors: Johnson JM,Lange IR,Harman CR,Torchia MG,Manning FA

    更新日期:1988-12-01 00:00:00

  • Preeclampsia: is induction of labor more successful?

    abstract:OBJECTIVE:To test the hypothesis that preeclamptic women are more readily inducible than are nonpreeclamptic women, regardless of cervical condition. METHODS:One hundred eighty-three preeclamptic women and 461 nonpreeclamptic women requiring labor induction were studied prospectively. Patients were categorized by Bish...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章

    doi:10.1016/S0029-7844(97)00043-4

    authors: Xenakis EM,Piper JM,Field N,Conway D,Langer O

    更新日期:1997-04-01 00:00:00

  • Piperacillin versus clindamycin plus gentamicin for pelvic infections.

    abstract::Piperacillin, a new semisynthetic penicillin, has broad spectrum activity against most clinically important aerobic and anaerobic bacteria. In the present study, piperacillin was compared with a combination of clindamycin and gentamicin for the treatment of 83 women with pelvic infection (42 with endometritis, 29 with...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Gilstrap LC 3rd,Maier RC,Gibbs RS,Connor KD,St Clair PJ

    更新日期:1984-12-01 00:00:00

  • Contraceptive effectiveness of a polyurethane condom and a latex condom: a randomized controlled trial.

    abstract:OBJECTIVE:To compare the contraceptive effectivenesses of a polyurethane condom and a standard latex condom. Secondary outcomes of interest were safety, functionality, discontinuation, and acceptability. METHODS:We randomized 901 couples to use either the polyurethane condom or a standard latex condom as their only fo...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1016/s0029-7844(02)02732-1

    authors: Steiner MJ,Dominik R,Rountree RW,Nanda K,Dorflinger LJ

    更新日期:2003-03-01 00:00:00

  • Prevention of neonatal group B streptococcal disease: intrapartum detection and chemoprophylaxis of heavily colonized parturients.

    abstract::Parturients with heavy vaginal colonization of group B streptococci were selected randomly to receive either penicillin or no antibiotic. A simple and fast latex agglutination test, applied in 8977 consecutive parturients, detected 412 women with heavy colonization with group B streptococcus, 199 of whom were eligible...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Tuppurainen N,Hallman M

    更新日期:1989-04-01 00:00:00

  • Anaphylactic Shock After Intravenous Fluorescein Administration for Intraoperative Cystoscopy.

    abstract:BACKGROUND:Rates of administration of intravenous sodium fluorescein during cystoscopy have increased since indigotindisulfonate sodium was removed from the market in 2014. Although sodium fluorescein has been extensively evaluated and found to be safe, side effects including anaphylaxis have been observed, with an inc...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0000000000002519

    authors: Lee T,Sanderson D,Doyle P,Buchsbaum G

    更新日期:2018-04-01 00:00:00

  • Second-trimester ultrasound markers for detection of trisomy 21: which markers are best?

    abstract:OBJECTIVE:To investigate which second-trimester ultrasound markers for aneuploidy are the most diagnostically efficient in detecting fetal trisomy 21. METHODS:All second-trimester genetic sonograms performed since November 1, 1992 for women at increased risk for fetal trisomy 21 were analyzed retrospectively. Statisti...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/s0029-7844(97)00152-x

    authors: Vintzileos AM,Campbell WA,Guzman ER,Smulian JC,McLean DA,Ananth CV

    更新日期:1997-06-01 00:00:00

  • Ovarian carcinoma: a multivariate analysis of prognostic factors.

    abstract::Five hundred and fifty six women with invasive epithelial ovarian carcinoma were assessed for postoperative treatment between 1966 and 1976. The records of this group were reviewed retrospectively. Sixteen characteristics of the patient and tumor were analyzed for prognostic significance by univariate and multivariate...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Swenerton KD,Hislop TG,Spinelli J,LeRiche JC,Yang N,Boyes DA

    更新日期:1985-02-01 00:00:00

  • Intrauterine anesthesia for gynecologic procedures: a systematic review.

    abstract:OBJECTIVE:To assess the effectiveness of intrauterine local anesthesia in reducing pain associated with outpatient gynecologic procedures. DATA SOURCES:We searched online databases PubMed or MEDLINE, Embase, Google Scholar, and Clinicaltrials.gov and hand-searched reference lists from reviews evaluating pain-control m...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审

    doi:10.1097/AOG.0b013e3182639ab5

    authors: Mercier RJ,Zerden ML

    更新日期:2012-09-01 00:00:00

  • Cervical carcinoma rates among young females in the United States.

    abstract:OBJECTIVE:All national organizations now recommend that women be screened for cervical cancer beginning at age 21 years, regardless of age of sexual initiation; however, studies have shown that providers continue to screen much earlier than recommended. Two federal cancer surveillance systems were used to quantify the ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/aog.0b013e31826e4609

    authors: Benard VB,Watson M,Castle PE,Saraiya M

    更新日期:2012-11-01 00:00:00

  • Pregnancy outcomes in women with and without gestational diabetes mellitus according to the International Association of the Diabetes and Pregnancy Study Groups criteria.

    abstract:OBJECTIVE:To estimate the incidence of gestational diabetes mellitus (GDM) according to The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and the pregnancy complications in women fulfilling these criteria but who are not considered diabetic according to the Canadian Diabetes Ass...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0b013e31826994ec

    authors: Bodmer-Roy S,Morin L,Cousineau J,Rey E

    更新日期:2012-10-01 00:00:00

  • Is endometriosis an autoimmune disease?

    abstract::Among 59 laparoscopically staged endometriosis patients, 28.8% tested positive for antinuclear antibody. Of 44 patients, 45.5% were lupus anticoagulant positive (greater than 1.3) and 20.5% were within a borderline range (1.2-1.3). Antinuclear antibody positivity was inversely related to stage of disease (P = .009); l...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Gleicher N,el-Roeiy A,Confino E,Friberg J

    更新日期:1987-07-01 00:00:00

  • Determination of gestational age by serum concentrations of human chorionic gonadotropin.

    abstract::To examine the accuracy and predictability of human chorionic gonadotropin concentrations in determining gestational age, serum concentrations of human chorionic gonadotropin (beta-subunit) were measured during the first 157 days after last menses. Using the regression curve generated, human chorionic gonadotropin con...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Lagrew DC,Wilson EA,Jawad MJ

    更新日期:1983-07-01 00:00:00

  • Successful delivery after age 50: a report of two cases as a result of oocyte donation.

    abstract:BACKGROUND:Because of donor oocyte programs, women who previously were considered too old to successfully achieve conception and delivery can now bear children. To our knowledge, there have been no previous reports of pregnancy outcome in women over age 50 who conceived using donor oocytes. This study presents the preg...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Check JH,Nowroozi K,Barnea ER,Shaw KJ,Sauer MV

    更新日期:1993-05-01 00:00:00

  • Maternal and umbilical serum concentrations of granulocyte colony-stimulating factor and its messenger RNA during clinical chorioamnionitis.

    abstract:OBJECTIVE:To determine whether women with chorioamnionitis developed elevated serum granulocyte colony-stimulating factor (G-CSF) concentrations and, if so, whether the G-CSF crossed to the fetus. METHODS:We quantified G-CSF before, during, and after delivery and in the cord blood of 12 women with clinical chorioamnio...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/0029-7844(95)00189-x

    authors: Li Y,Ohls RK,Rosa C,Shah M,Richards DS,Christensen RD

    更新日期:1995-09-01 00:00:00

  • ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists, number 57, November 2004. Gynecologic herpes simplex virus infections.

    abstract::Both herpes simplex virus (HSV) type I and HSV type 2 can cause genital herpes. Because the infection is chronic, genital herpes has become the most common sexually transmitted disease among women. The prevalence of the HSV-2 antibody among women in the United States is 26%, although genital herpes has been diagnosed ...

    journal_title:Obstetrics and gynecology

    pub_type: 指南,杂志文章,实务指引

    doi:

    authors: ACOG Committee on Practice Bulletins--Gynecology.

    更新日期:2004-11-01 00:00:00

  • Direct laparoscopic entry using a sharp and dull trocar technique.

    abstract::For direct laparoscopic entry using a sharp and dull trocar technique, the sharp trocar is inserted with a twisting motion under constant pressure, then replaced with a dull trocar when a slight loss of resistance is felt. A slow, gradual entry into the peritoneal cavity is accomplished by twisting the dull trocar und...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/0029-7844(96)00215-3

    authors: Hasaniya NW,Kosasa TS,Shieh T,Nakayama RT

    更新日期:1996-10-01 00:00:00

  • ACOG Practice Bulletin No. 189 Summary: Nausea And Vomiting Of Pregnancy.

    abstract::Nausea and vomiting of pregnancy is a common condition that affects the health of a pregnant woman and her fetus. It can diminish a woman's quality of life and also significantly contributes to health care costs and time lost from work (1, 2). Because morning sickness is common in early pregnancy, the presence of naus...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审

    doi:10.1097/AOG.0000000000002450

    authors:

    更新日期:2018-01-01 00:00:00

  • Increasing maternal body mass index and characteristics of the second stage of labor.

    abstract:OBJECTIVE:To evaluate the length of the second stage of labor in relation to increasing maternal prepregnancy body mass index (BMI) among nulliparous parturient women, and to determine whether route of delivery differs among obese, overweight, and normal-weight women reaching the second stage of labor. METHODS:We perf...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,多中心研究

    doi:10.1097/AOG.0b013e318236fbd1

    authors: Robinson BK,Mapp DC,Bloom SL,Rouse DJ,Spong CY,Varner MW,Ramin SM,Sorokin Y,Sciscione A,Mercer BM,Thorp JM Jr,Malone FD,Harper M,Ehrenberg H

    更新日期:2011-12-01 00:00:00

  • Instagram Users' Experiences of Miscarriage.

    abstract:OBJECTIVE:To explore the shared experiences of miscarriage using a qualitative analysis of social media posts on Instagram. METHODS:We performed this qualitative study by collecting text, photos, hashtags, and emoji from 200 Instagram posts on five arbitrarily selected days in 2019. Key eligibility criteria included p...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0000000000003621

    authors: Mercier RJ,Senter K,Webster R,Henderson Riley A

    更新日期:2020-01-01 00:00:00

  • Newly diagnosed adult-onset Still disease in pregnancy.

    abstract:BACKGROUND:Adult-onset Still disease is a rare febrile disorder that can present for the first time during pregnancy. It is a diagnosis of exclusion with nonspecific laboratory results. Good maternal and fetal outcomes can be expected after initial diagnosis and treatment. CASE:A 21-year-old (gravida 2, para 1) at 20 ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/s0029-7844(03)00065-6

    authors: Pan VL,Haruyama AZ,Guberman C,Kitridou RC,Wing DA

    更新日期:2003-05-01 00:00:00

  • Biparietal diameter/femur length ratio, cephalic index, and femur length measurements: not reliable screening techniques for Down syndrome.

    abstract::Previous published reports have shown that fetuses affected with Down syndrome have normal biparietal diameter (BPD), high BPD-to-femur length ratio, and shorter femur length and occipitofrontal diameter. A retrospective comparison of the BPD, occipitofrontal diameter, cephalic index, femur length, and BPD/femur lengt...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Shah YG,Eckl CJ,Stinson SK,Woods JR Jr

    更新日期:1990-02-01 00:00:00

  • Pulmonary edema following ritodrine-saline infusion in premature labor.

    abstract::Twenty-three patients with premature uterine contractions occurring between the 27th and 35th weeks of pregnancy were treated in a prospective and randomized study with intravenous ritodrine in a 0.1 wt/vol% solution of isotonic saline (N = 12) or isotonic glucose (N = 11). The aim of the study was to record the effec...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Philipsen T,Eriksen PS,Lynggård F

    更新日期:1981-09-01 00:00:00

  • Neonatal Morbidity and Maternal Complication Rates in Women With a Delivery Body Mass Index of 60 or Higher.

    abstract:OBJECTIVE:To investigate neonatal morbidity and maternal complication rates with delivery body mass index (BMI) 60 or greater. METHODS:This retrospective, multicenter cohort study included singleton pregnancies between 23 and 42 weeks of gestation from January 2005 to April 2016. Women with BMI 60 or greater were comp...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,多中心研究

    doi:10.1097/AOG.0000000000002316

    authors: Kim T,Burn SC,Bangdiwala A,Pace S,Rauk P

    更新日期:2017-11-01 00:00:00

  • Active pharmacologic management of the third stage of labor. A comparison of oxytocin and ergometrine.

    abstract::Postpartum hemorrhage is a common and serious complication of the third stage of labor resulting in anemia and increased morbidity in the puerperium. Administration of uterotonic drugs and suitable mechanical assistance in delivery of the placenta may significantly reduce this hazard. Ergometrine and oxytocin have bee...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Sorbe B

    更新日期:1978-12-01 00:00:00

  • Cost of transferring one through five embryos per in vitro fertilization cycle from various payor perspectives.

    abstract:OBJECTIVE:We sought to examine the costs of transferring one through five embryos per in vitro fertilization cycle from each of three perspectives: society, the infertile couple, and the insurer. METHODS:Data from the 2003 Assisted Reproductive Technology Report was used to create Markov decision analytic models strat...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/01.AOG.0000230534.54078.b3

    authors: Little SE,Ratcliffe J,Caughey AB

    更新日期:2006-09-01 00:00:00

  • Inidcations for prenatal diagnosis in relatives of patients with neural tube defects.

    abstract::We have reviewed the family histories of children with neural tube defects to determine which relatives are at sufficient risk to be offered amniocentesis for prenatal diagnosis. The recurrence risks for sibs was 6%; therefore, women with one affected child should be made aware of the availability of this test for mon...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Lippman-Hand A,Fraser FC,Biddle CJ

    更新日期:1978-01-01 00:00:00

  • Forty weeks and beyond: pregnancy outcomes by week of gestation.

    abstract:OBJECTIVE:To assess pregnancy outcomes at 40, 41, and 42 weeks' gestation when labor induction is done routinely at 42 but not 41 weeks. METHODS:We reviewed all singleton pregnancies delivered at 40 or more weeks' gestation between 1988 and 1998 at Parkland Memorial Hospital, Dallas, Texas. We excluded women with hype...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/s0029-7844(00)00862-0

    authors: Alexander JM,McIntire DD,Leveno KJ

    更新日期:2000-08-01 00:00:00