版權(quán)說(shuō)明:本文檔由用戶提供并上傳,收益歸屬內(nèi)容提供方,若內(nèi)容存在侵權(quán),請(qǐng)進(jìn)行舉報(bào)或認(rèn)領(lǐng)
文檔簡(jiǎn)介
1、Copyright H Photography 2006 iSPragmatic cohort studies and comparative effectivenessEric S Johnson, PhDKaiser PermanentesCenter for Effectiveness and Safety ResearchAHRQs Effective Healthcare Program:Scientific Resource Center June 18, 2010 UC Davis School of Medicine1Copyright Matt Knannlein 2005
2、iStockPThe risk of death associated with the use of conventional versus atypical antipsychoticsamong elderly patientsSebastian Schneeweiss, Soko Setoguchi, Alan Brookhart, Colin Dormuth, Philip S WangCanadian Medical Association Journal 2007;176:627-322Copyright Matt Knannlein 2005 iStockPBMJs PICO
3、format: Study questionDo conventional antipsychotic drugs pose risks equal to orgreater than those associated with newer, atypical drugsin an elderly population? 3Copyright Matt Knannlein 2005 iStockPBMJs PICO format: Design, intervention and controlWe conducted a retrospective cohort study of elder
4、ly patients with a diagnosis of dementia who started a conventional or an atypical antipsychotic drug. 4Copyright Matt Knannlein 2005 iStockPBMJs PICO format: Participants and settingWe followed 37,241 patients 65 years or older who started an antipsychotic drug between 1996 and 2004 and wereresiden
5、ts of British Columbia. 5Copyright Matt Knannlein 2005 iStockPBMJs PICO format: Outcomes and their timingWe compared the 180-day all-cause mortality rate for patientswho started conventional versus atypical antipsychotic drugs. 6Copyright Matt Knannlein 2005 iStockPBMJs PICO format: Results and role
6、 of chanceOf the 24,359 (control cohort) patients who started an atypical antipsychotic drug, 9.6% died by 180 days. In adjusted analyses, patients who started a conventional drug were 32% more likely to die (hazard ratio=1.32; 95% CI, 1.23 to 1.42)an excess of 3.5 deaths per 100 patients.7Copyright
7、 Matt Knannlein 2005 iStockPA pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designersKevin Thorpe, Merrick Zwarenstein, Andrew Oxman, and othersJ Clin Epidemiology 2009;62:464-75.“Pragmatic trials seek to answer the question: Does the intervention work under usual
8、conditions. ”8Copyright 2007 Robert Churchill iStockPThe pragmatic to explanatory trials continuum* Flexibility of comparisoninterventionPractitionerExpertise(experimental)Flexibility of theexperimentalinterventionEligibilitycriteriaPrimaryanalysisPractitioneradherenceParticipantcomplianceOutcomesFo
9、llow-upintensityPractitionerexpertise(comparison)E* J Clin Epidemiology 2009;62:464-759Copyright 2007 Robert Churchill iStockPA pragmatic cohort study: new users10Copyright Matt Knannlein 2005 iStockPEvaluating medication effects outside of clinical trials:New-user designsWayne RayAm J Epidemiol 200
10、3;158:915-20“Prevalent users can introduce two types of biases:Underascertainment of events that occur early in therapy Inability to control for predictors that may have been altered by the study drugs.”P(pán)revalent users also preclude meaningful propensity scores.11Copyright 2007 Robert Churchill iSto
11、ckPValid comparisons with usual care?12Copyright 2006 Ethan Myerson iStockPHow might we design a score to predict the usefulness of pragmatic cohort studies?How well does the cohort answer decision-makers questions?Inferiority or non-inferiority?How closely does the cohort resemble a pragmatic trial
12、? Design? Analysis?How easy is the cohort for systematicreviewers to GRADE and synthesize?An unintended outcome, a harm?. 13Copyright 2006 Ethan Myerson iStockP“A national CER programshould promote the professional ethos that places the interests ofpatients and the largercommunity above all othercon
13、siderations.”Harold Sox and Sheldon GreenfieldAnnals of Intern Med 2009;151:203-5Comparative effectivenessresearch: a report from theInstitute of Medicine 14Copyright Juan Monino 2006 iStockP“He wants to look at his plate,see a steak, and say,I like steak! ”“Give people what they want,then later you
14、 can give themwhat you want.” Pascal in Big Night (1996)15Copyright Matt Knannlein 2005 iStockPVariation in the risk of suicide attempts andcompleted suicides by antidepressant agentin adultsSebastian Schneeweiss, Amanda Patrick, Daniel Solomon, Jyotsna Mehta,Colin Dormuth, Matthew Miller, Jennifer
15、Lee, Philip S WangArchives of General Psychiatry 2010;67:497-50616Copyright Matt Knannlein 2005 iStockPDesign, intervention and control:Advanced strategies for propensity scores“After plotting and comparing the distribution of propensity scoreswe truncated our study population to the area of overlap
16、. Subjects with non-overlapping propensity scores mayhave absolute clinical indications or contraindications for aparticular treatment.”17Copyright Matt Knannlein 2005 iStockPDesign, intervention and control:Advanced strategies for propensity scores“We constructed a high-dimensional propensity score based on the top 500 identified variables in addition to the variablesidentified by usWe consider results from this analysis to be the most completely adjusted ”18
溫馨提示
- 1. 本站所有資源如無(wú)特殊說(shuō)明,都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請(qǐng)下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等,如果需要附件,請(qǐng)聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
- 3. 本站RAR壓縮包中若帶圖紙,網(wǎng)頁(yè)內(nèi)容里面會(huì)有圖紙預(yù)覽,若沒(méi)有圖紙預(yù)覽就沒(méi)有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 人人文庫(kù)網(wǎng)僅提供信息存儲(chǔ)空間,僅對(duì)用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理,對(duì)用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯,并不能對(duì)任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容,請(qǐng)與我們聯(lián)系,我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶因使用這些下載資源對(duì)自己和他人造成任何形式的傷害或損失。
最新文檔
- 2024年靈山縣一級(jí)造價(jià)工程師《土建計(jì)量》深度預(yù)測(cè)試題含解析
- 2024多媒體桌椅采購(gòu)合同范文
- 2024園林綠化工程施工合同書(shū)范本
- 2024國(guó)際貨運(yùn)貨代運(yùn)輸合同
- 2024委托研制合同范文
- 2024年新工藝生產(chǎn)的過(guò)氧化異丙苯(DCP)項(xiàng)目合作計(jì)劃書(shū)
- 2024夫妻離婚合同協(xié)議書(shū)范本
- 2024商鋪店面裝修合同范文
- 2024年錫焊專(zhuān)用設(shè)備合作協(xié)議書(shū)
- 2024年膨化硝銨炸藥項(xiàng)目建議書(shū)
- 2025年山東省春季高考語(yǔ)文模擬試卷試題(含答案詳解)
- 2024年江蘇省揚(yáng)州市中考英語(yǔ)試卷附答案
- 醫(yī)學(xué)檢驗(yàn)技術(shù)專(zhuān)業(yè)《有機(jī)化學(xué)》課程標(biāo)準(zhǔn)
- 小學(xué)語(yǔ)文課堂教學(xué)研究現(xiàn)狀
- DZ∕T 0221-2006 崩塌、滑坡、泥石流監(jiān)測(cè)規(guī)范(正式版)
- PCBA品質(zhì)控制計(jì)劃
- 蘇教版科學(xué)一年級(jí)上冊(cè)教學(xué)計(jì)劃及進(jìn)度表
- 小美滿合唱五線譜總譜
- 高考作文標(biāo)準(zhǔn)方格紙-A4-可直接打印
- 中藥學(xué)實(shí)訓(xùn)課教案及反思總結(jié)
- 電力系統(tǒng)經(jīng)濟(jì)學(xué)原理(第2版) 課件全套 第1-8章 引言、經(jīng)濟(jì)學(xué)基本概念-輸電投資
評(píng)論
0/150
提交評(píng)論