Accumulating research: a systematic account of how cumulative meta-analyses would have provided knowledge, improved health, reduced harm and saved resources.
Accumulating research: a systematic account of how cumulative meta-analyses would have provided knowledge, improved health, reduced harm and saved resources.
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DOI：
10.1371/journal.pone.0102670
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Chalmers I
中科院分区：
文献类型：
--
作者：
Clarke M;Brice A;Chalmers I
“累积荟萃分析”描述了一种统计学程序，每当系列中的另一项试验的结果可用时，就根据类似试验的结果回顾性地计算汇总估计值。20世纪90年代初，对心肌梗死治疗的累积荟萃分析与医学教科书中的建议进行了比较，结果表明，在积累了对治疗效果的可靠估计之后，研究仍在继续，医学教科书忽略了来自试验的强有力的现有证据。累积荟萃分析随后被用来评估如果新的研究通过对相关现有证据的系统性审查以及如何减少废物而获得信息，则可能会知道什么。我们使用系统方法来识别和总结1992年至2012年发表的临床干预措施效果研究的累积荟萃分析结果。检索PubMed、MEDLINE、EMBASE、科克伦方法学数据库和科学引文索引。共确定了50份合格报告，包括1，500多项累积荟萃分析。各种主题都用具体的例子加以说明。研究表明，随着试验的进行，荟萃分析中最初的阳性结果变为无效或阴性;早期的无效或阴性结果被推翻;如果在新的试验之前进行荟萃分析，就会看到稳定的结果（有益、有害和中性）;额外的试验太少，无法解决剩余的不确定性。这一大型、独特的累积荟萃分析集强调了对现有证据的审查如何帮助研究人员、从业人员、患者和资助者在数十年的研究中对新试验做出更明智的决定和选择。这将导致在实践中更早地采用有效的干预措施，减少试验参与者对不太有效的治疗的暴露，并减少不合理研究造成的浪费。
“Cumulative meta-analysis” describes a statistical procedure to calculate, retrospectively, summary estimates from the results of similar trials every time the results of a further trial in the series had become available. In the early 1990s, comparisons of cumulative meta-analyses of treatments for myocardial infarction with advice promulgated through medical textbooks showed that research had continued long after robust estimates of treatment effects had accumulated, and that medical textbooks had overlooked strong, existing evidence from trials. Cumulative meta-analyses have subsequently been used to assess what could have been known had new studies been informed by systematic reviews of relevant existing evidence and how waste might have been reduced. We used a systematic approach to identify and summarise the findings of cumulative meta-analyses of studies of the effects of clinical interventions, published from 1992 to 2012. Searches were done of PubMed, MEDLINE, EMBASE, the Cochrane Methodology Register and Science Citation Index. A total of 50 eligible reports were identified, including more than 1,500 cumulative meta-analyses. A variety of themes are illustrated with specific examples. The studies showed that initially positive results became null or negative in meta-analyses as more trials were done; that early null or negative results were over-turned; that stable results (beneficial, harmful and neutral) would have been seen had a meta-analysis been done before the new trial; and that additional trials had been much too small to resolve the remaining uncertainties. This large, unique collection of cumulative meta-analyses highlights how a review of the existing evidence might have helped researchers, practitioners, patients and funders make more informed decisions and choices about new trials over decades of research. This would have led to earlier uptake of effective interventions in practice, less exposure of trial participants to less effective treatments, and reduced waste resulting from unjustified research.
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影响因子：
17.3
作者：
Clarke, Mike;Halsey, Jim
通讯作者：
Halsey, Jim
影响因子：
120.7
作者：
ANTMAN, EM;LAU, J;CHALMERS, TC
通讯作者：
CHALMERS, TC
影响因子：
3.7
作者：
Booth, Alison;Clarke, Mike;Stewart, Lesley
通讯作者：
Stewart, Lesley
影响因子：
--
作者：
Adams, Clive E;Polzmacher, Stefanie;Wolff, Annabelle
通讯作者：
Wolff, Annabelle
影响因子：
7.6
作者：
Brok, J.;Gluud, L. -L.;Gluud, C.
通讯作者：
Gluud, C.