Medicamentsen-ligne vous propose les traitements dont vous avez besoin afin de prendre soin de votre santé sexuelle. Avec plus de 6 ans d'expérience et plus de 80.000 clients francophones, nous étions la première clinique fournissant du acheter levitra original en France à vente en ligne et le premier vendeur en ligne de Levitra dans le monde. Pourquoi prendre des risques si vous pouvez être sûr avec Medicamentsen-ligne - Le service auquel vous pouvez faire confiance.

Galton.uchicago.edu

Meta-Analysis
(or Overview)
Clinical Scenario
Mrs BW 64 y.o.
Hysterectomy
Dx of osteoporosis (Spinal BMD < 2SD below
Dx of osteoporosis (Spinal BMD < 2SD below
? aminobisphosphonate (etidronate,
? aminobisphosphonate (etidronate,
alendronate)
Pt concern: cost
Osteoporosis
Affects 30-40% of postmenopausal women
1.5M fractures annually
Vertebral fractures most common
Nonvertebral fractures (esp. hip) major causes
Nonvertebral fractures (esp. hip) major causes
of morbidity, mortality, cost
Risk of hip fracture (50yo white woman): 1/6
Risk of wrist fracture (50yo white woman): 1/6
Postmenopausal
Postmenopausal
osteoporosis
Imbalance of bone formation and resorption
Progressive decline in bone mass, + risk of
Progressive decline in bone mass, + risk of
fracture
Aminobisphosphonates: potent, specific
Aminobisphosphonates: potent, specific
inhibitor of osteoclast-mediated bone
inhibitor of osteoclast-mediated bone
resorption
Eg: etidronate, alendronate
Alendronate
+ Bone mineral density
—But is new bone weaker?
—But is new bone weaker?
Mineralization unaffected at therapeutic does
—But is there a clinical effect?
—But is there a clinical effect?
- Vertebral fracture incidence
—But most morbidity from hip, wrist
—But most morbidity from hip, wrist
Does it reduce nonvertebral fractures?
Meta-Analysis is
A formal method for research synthesis
A quantitative and potentially more objective
A quantitative and potentially
more objective
alternative to the expert review paper.
Aspirin and MI
How strong is the effect of aspirin in reducing
How strong is the effect of aspirin in reducing
post-MI mortality?
Answer: about 10% reduction
How do we know?
Many studies “inconclusive”
Finding small effects
Small effects can be important
A 10% reduction is hard to find
(reducing 20% mortality to 18%)

—Without a long, huge (thus expensive) study
How large a study?
Need to have 95% CI narrower than roughly
Need to have 95% CI narrower than roughly
0.20 ± 0.02
This gives 50-50 chance of detection

Thus, need se(difference) < 0.01
SE(difference of two proportions) =

0.8 x 0.2 x
Setting this equal to 0.01 and solving for n we
Setting this equal to 0.01 and solving for n we
have n 800 in each group
Combine evidence
Combine evidence
from many studies
Assess whether there really is any effect
Estimate the size of the effect
Reasons for doing
Reasons for doing
meta-analysis
Increase power by increasing sample size
Increase power by increasing sample size
(pooling)
Resolve conflicting reports (consensus)
Improve estimates of effect size
Answer new questions
Meta-analysis
Combines features of multicenter trials and
Combines features of multicenter trials and
retrospective studies
Multicenter trials similarities—we are
Multicenter trials similarities—we are
combining studies with
Common questions
Common questions
Similar study designs
Similar study designs
Simultaneous controls within each study unit
Simultaneous controls within each study unit
Similarities to retrospective studies
Investigators choose which studies to include and exclude
Investigators choose which studies to include and exclude
Susceptible to selection biases
Susceptible to selection biases
Susceptible to ascertainment biases (Are “negative”
Susceptible to ascertainment biases (Are “negative”
studies as likely to be published?)
studies as likely to be published?)
Alendronate
Alendronate
meta-analysis
Karpf, et al, JAMA (April 9, 1997)
Five studies
RCT
Placebo controlled
>2 yr duration
Meta-analysis Issues
Were criteria for including and excluding
Were criteria for including and excluding
studies clearly defined in advance?
Were criteria for evaluating the results from
Were criteria for evaluating the results from
studies clearly defined in advance?
Does the overview use patient-level data?
➔ • How objective was the review?
➔ • Does the overview assess heterogeneity?
How objective was the
How objective was the
Review by more than one reader
Procedures for resolving disagreements
Procedures for resolving disagreements
between readers
Blinded review
Use of prepared data-extraction forms
Does the overview
Does the overview
assess heterogeneity?
Variation in the validity of the studies being
Variation in the validity of the studies being
Homogeneity of the studies regarding study
Homogeneity of the studies regarding study
Homogeneity of the studies with respect to the
Homogeneity of the studies with respect to the
size of measured effects?
Possible factors accounting for heterogeneity?
Reader's Guide:
All articles

Are the results valid?
What were the results?
Will the results help me in caring for my
Will the results help me in caring for my
patients?
Are the results valid?
Did the review address a focused clinical
Did the review address a focused clinical
question?
Were the criteria used to select articles for
Were the criteria used to select articles for
inclusion appropriate?
Secondary guides
Is it unlikely that important, relevant studies were missed?
Is it unlikely that important, relevant studies were missed?
Was the validity of the included studies appraised?
Was the validity of the included studies appraised?
Were assessments of studies reproducible?
Were assessments of studies reproducible?
Were the results similar from study to study?
Were the results similar from study to study?
What are the results?
What are the overall results of the review?
How precise were the results?
Will the results help me in
Will the results help me in
caring for my patients?
Can the results be applied in my patient care?
Were all clinically important outcomes
Were all clinically important outcomes
considered?
Are the benefits worth the harms and costs?

Source: http://galton.uchicago.edu/~thisted/courses/315/lectures/2297.pdf

Post partum depression.pub

and indirectly may help depression. Biofeed-before taking any new prescription or nonpre-back, like relaxation therapies, should be done only in addition to psychotherapy and medi- Exercise as appropriate for you physical condi- Massage Therapy: Massage therapy may help tion in the days right after giving birth. lower stress, but it does not cure depression. Participate in

s378402789.initial-website.co.uk

Summary of Presentations from the Bristol Myers Squibb/AstraZeneca Alliance Symposium, European Association for the Study of Diabetes (EASD) 49th Annual Congress, Barcelona, Spain, 23rd September 2013. Michael Nauck,1 Dídac Mauricio,2 Anthony Barnett3Tina Vilsbøll,4 Samy Hadjadj,5 Peter Rossing,6 Edoardo Mannucci,7 Harald 1. Head, Diabeteszentrium Bad Lauterberg, Harz, Germany2. Chi

Copyright © 2010-2014 Pharmacy Pills Pdf