An illustrated guide to the methods of meta-analysis
An illustrated guide to the methods of meta-analysis
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DOI：
10.1046/j.1365-2753.2001.00281.x
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发表时间：
2001-05-01
影响因子：
2.4
通讯作者：
Jones, DR
中科院分区：
文献类型：
--
作者：
Sutton, AJ;Abrams, KR;Jones, DR
荟萃分析现在被认为是评估医疗保健的必要工具。几乎在医学的每个领域都进行了这样的分析，以评估广泛的卫生保健干预措施和政策。本文有三个主要目的：（1）描述荟萃分析的基本原理，以旨在降低再入院率的干预措施的荟萃分析为例;（2）考虑对荟萃分析内部有效性的威胁，以及可以采取的措施，以尽量减少其影响;以及（3）对更专业和发展中的数据综合方法进行概述，旨在概述荟萃分析未来可能采取的方向。用于综合研究的方法，采取“加权平均值”的效果大小已被细化到一个很高的程度，而用于处理威胁的荟萃分析的有效性，如出版物的偏见，并在主要研究的质量变化的方法，是在一个不太先进的阶段。然而，许多人认为这种标准的“加权平均”方法荟萃分析不是“最先进的”，至少在某些情况下，使用更复杂的方法，通常解释不同研究的估计值的变化，并综合更广泛的证据基础，将是有利的。目前，试图做到这一点的方法主要仍处于试验阶段，不幸的是，听起来自然和有吸引力的想法往往难以在实践中实施。显然，要经常使用它们还需要一段时间，但已经采取了重要步骤。
Meta-analysis is now accepted as a necessary tool for the evaluation of health care. Such analyses have been carried out in virtually every area of medicine to evaluate a wide spectrum of health care interventions and policies. This paper has three broad aims: (1) to describe the basic principles of meta-analysis, using a meta-analysis of interventions intended to reduce hospital re-admission rates for illustration; (2) to consider threats to the internal validity of meta-analysis, and the measures which can be taken to minimize their impact; and (3) to present an overview of more specialist and developing methods for synthesizing data, with the intention of outlining the directions meta-analysis may take in the future. The methods used to synthesize studies, which take 'weighted averages' of effect sizes have been refined to a high degree, while the methods for dealing with threats to the validity of meta-analyses such as publication bias, and variations in quality of the primary studies, are at a less advanced stage. However, many consider this standard 'weighted average' approach to meta-analysis not to be 'state of the art' in at least some situations, where the use of more sophisticated methods, generally to explain variation in estimates from different studies and synthesize a broader base of evidence, would be advantageous. Currently, approaches which attempt to do this are mainly still in the experimental stage and, unfortunately, ideas which sound natural and appealing are often difficult to implement in practice. Clearly, it will be some time before they are used routinely, but significant steps have been made.