Network geometry shows evidence sequestration for medical vs. surgical practices: treatments for basal cell carcinoma.
Network geometry shows evidence sequestration for medical vs. surgical practices: treatments for basal cell carcinoma.
复制标题
网络几何显示了医疗与外科手术的证据隔离：基底细胞癌的治疗。
DOI：
10.1016/j.jclinepi.2013.10.015
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发表时间：
2014
影响因子：
7.2
通讯作者：
J. Ioannidis
中科院分区：
文献类型：
--
作者：
David Kim;Jean Y. Tang;J. Ioannidis
目标 基底细胞癌 (BCC) 是最常见的癌症，每年有 200 万次治疗，但几乎没有基于证据的治疗指南。 BCC 的干预措施分为三类（手术、破坏性和局部），本研究旨在确定在随机对照试验 (RCT) 中比较不同类型的 BCC 治疗方法时是否存在偏好或回避。研究设计和设置 PubMed、Cochrane 临床试验中央注册中心和 ClinicalTrials.Gov 用于识别合格的已发表和注册的正在进行的 RCT。结果 55 项试验（42 项已发表，13 项已注册）试验）已确定。只有一项未发表的注册试验比较了局部干预与手术干预，只有一项试验比较了局部干预与破坏性干预。相反，55 项试验中有 44 项比较了同一治疗类别的干预措施，55 项试验中有 9 项比较了手术干预与破坏性干预。在大多数试验中，不必根据 BCC 病变的类型（非侵袭性浅表或结节性与侵袭性、浸润性、形态性 BCC，P= 0.155）或其位置（面部与非面部，P= 0.137）来选择同类比较器。实践（医疗与外科）。以前对同质性的评估涉及不同的干预措施，其中所有干预措施都是医疗（药物）并在相同的医疗保健环境中进行。我们记录的内科和外科干预措施之间的非沟通性证据突出了证据和相应医疗保健实践不必要的封存问题。
ObjectivesBasal cell carcinoma (BCC) is the most common cancer with 2 million treatments per year with little evidence-based guidelines for treatment. There are three classes of interventions (surgical, destructive, and topical) for BCC, and this study aimed to determine whether there are preferences or avoidances in comparisons of different types of treatments for BCC in randomized controlled trials (RCTs).Study Design and SettingPubMed, Cochrane Central Registry of Clinical Trials, and ClinicalTrials.Gov were used to identify eligible published and registered ongoing RCTs.ResultsFifty-five trials (42 published and 13 registered trials) were identified. Only one unpublished registered trial compared a topical vs. a surgical intervention, and only one trial compared a topical vs. a destructive intervention. Conversely, 44 of the 55 trials compared interventions within the same treatment class and 9 of 55 trials compared surgical vs. destructive interventions. In most trials, selection of same-class comparators was not necessitated by the type of BCC lesions (nonaggressive superficial or nodular vs. aggressive, infiltrative, morpheic BCCs,P= 0.155) or their location (face vs. nonfacial,P= 0.137).ConclusionThis is the first time that an evaluation of network geometry is applied to address issues of comparisons between different families of interventions that belong to different specialties and practices (medical vs. surgical). Previous evaluations of homophily have addressed different families of interventions, in which all interventions are medical (drugs) and performed in the same health-care settings. The noncommunicating bodies of evidence between medical and surgical interventions that we document highlight a problem of unnecessary sequestration of the evidence and the corresponding health-care practices.
DOI：
10.1056/nejmoa1113538
发表时间：
2012-06-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Tang JY;Mackay-Wiggan JM;Aszterbaum M;Yauch RL;Lindgren J;Chang K;Coppola C;Chanana AM;Marji J;Bickers DR;Epstein EH Jr
通讯作者：
Epstein EH Jr