【专题】观察性研究的Meta分析研究

蓝鱼o_0

Meta 分析作为一种用于鉴定、评价、综合分析相关研究的系统性的方法，已越来越广泛地用于随机对照试验（randomized controlled trials,RCTs)。但事实上，很多情况下随机对照的设计并都是可行的，很多数据是从观察性的研究（observational study)中得来的。观察性研究缺乏对干预因素的随机分配，仅从某种研究特征改变及这种研究特征的改变引起的观察结果变化来得出结论。观察性研究固然有其优点，但不足之处是显而易见的，因此如何对其进行Meta分析就成为一个问题？
分享一篇JAMA的文章。这篇文章不算很新，但是很有指导意义！
JAMA，2000,283（15）2008

文章认为对于观察性研究Meta分析应包括以下条目：
Table. A Proposed Reporting Checklist for Authors, Editors, and Reviewers of Meta-analyses of Observational Studies
Reporting of background should include
Problem definition
Hypothesis statement
Description of study outcome
Type of exposure or intervention used
Type of study designs used
Study population
Reporting of search strategy should include
Qualifications of searchers (eg, librarians and investigators)
Search strategy, including time period included in the synthesis and keywords
Effort to include all available studies, including contact with authors
Databases and registries searched
Search software used, name and version, including special features used (eg, explosion)
Use of hand searching (eg, reference lists of obtained articles)
List of citations located and those excluded, including justification
Method of addressing articles published in languages other than English
Method of handling abstracts and unpublished studies
Description of any contact with authors
Reporting of methods should include
Description of relevance or appropriateness of studies assembled for assessing the hypothesis to be tested
Rationale for the selection and coding of data (eg, sound clinical principles or convenience)
Documentation of how data were classified and coded (eg, multiple raters, blinding, and interrater reliability)
Assessment of confounding (eg, comparability of cases and controls in studies where appropriate)
Assessment of study quality, including blinding of quality assessors; stratification or regression on possible predictors of study results
Assessment of heterogeneity
Description of statistical methods (eg, complete description of fixed or random effects models,
justification of whether the chosen models account for predictors of study results,
dose-response models, or cumulative meta-analysis) in sufficient detail to be replicated
Provision of appropriate tables and graphics
Reporting of results should include
Graphic summarizing individual study estimates and overall estimate
Table giving descriptive information for each study included
Results of sensitivity testing (eg, subgroup analysis)
Indication of statistical uncertainty of findings
Reporting of discussion should include
Quantitative assessment of bias (eg, publication bias)
Justification for exclusion (eg, exclusion of non–English-language citations)
Assessment of quality of included studies
Reporting of conclusions should include
Consideration of alternative explanations for observed results
Generalization of the conclusions (ie, appropriate for the data presented and within the domain
of the literature review)
Guidelines for future research
Disclosure of funding source

蓝鱼o_0

Observational Studies的质量评价
关于JADAD的讨论，这个标准只能用来评价RCT，而无法评价观察性研究。一定要注意这点。
关于Observational Studies质量评价的方法，有2007年发表一篇文献进行专门讨论（Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. 2007，Sanderson S）。该文献提到，截至2007年，共有86中方法用以评价Observational Studies的质量。部分方法的适用范围很窄，如只能用以评价cohort study，部分研究的适用范围相对较宽泛，可以用来评价不同设计的研究。
同样遗憾的是，即使有这么多种文献质量评价方法，却没有一个通用、广泛认同的标准。因此，在文章结尾，作者并没有给出推荐的tool，而是建议：Our broad recommendations are that tools should (i) include a small number of key domains; (ii) be as specific as possible (with due consideration of the particular study design and topic area); (iii) be a simple checklist rather than a scale and (iv) show evidence of careful development, and of their validity and reliability.

放飞梦想

谢谢楼主，你总是给大家带来新的信息。

南京南京

非常好，简明扼要，我简单利用翻译软件大概翻译了一下，方便大家阅读，本人水平有限，仅供大家参考：

Table. A Proposed Reporting Checklist for Authors, Editors, and Reviewers of Meta-analyses of Observational Studies
一份作者、编辑和观察性研究的Meta分析的评论的建议报告清单

Reporting of background should include
背景报告应包括
Problem definition
问题定义
Hypothesis statement
假设声明
Description of study outcome
研究结果说明
Type of exposure or intervention used
暴露或干预用于的类型
Type of study designs used
研究中使用的设计类型
Study population
研究人群
Reporting of search strategy should include
搜索策略报告应包括
Qualifications of searchers (eg, librarians and investigators)
搜索者的资格（例如，图书馆馆员和调查员）
Search strategy, including time period included in the synthesis and keywords
检索策略，包括一段时间内，包含在合成词和关键字中
Effort to include all available studies, including contact with authors
通过包括所有可用的研究（包括与作者联系）的努力
Databases and registries searched
搜索的数据库和登记
Search software used, name and version, including special features used (eg, explosion)
使用搜索软件名称和版本，包括特殊功能（如爆炸）
Use of hand searching (eg, reference lists of obtained articles)
使用手工检索（例如，获得文章的参考文献目录）
List of citations located and those excluded, including justification
引文出处与排除（包括原由）清单
Method of addressing articles published in languages other than English
英语以外的语言发表文章的解决方法
Method of handling abstracts and unpublished studies
处理摘要和未发表的研究方法
Description of any contact with authors
与作者联系说明

Reporting of methods should include
方法报告应包括
Description of relevance or appropriateness of studies assembled for assessing the hypothesis to be tested
评估假设进行测试组装说明相关性或适宜性研究
Rationale for the selection and coding of data (eg, sound clinical principles or convenience)
理由选择和数据编码（例如，健全的临床原则或便利）
Documentation of how data were classified and coded (eg, multiple raters, blinding, and interrater reliability)
如何将数据进行分类和编码（例如，多个评价者，设盲，和评判间信度）
Assessment of confounding (eg, comparability of cases and controls in studies where appropriate)
混杂的评估（例如，病例组和对照组在适当情况下的可比性混杂评估研究）
Assessment of study quality, including blinding of quality assessors; stratification or regression on possible predictors of study results
研究结果可能预测研究质量的评估，包括质量评审设盲、分层或回归
Assessment of heterogeneity
异质性的评估
Description of statistical methods (eg, complete description of fixed or random effects models, justification of whether the chosen models account for predictors of study results,
dose-response models, or cumulative meta-analysis) in sufficient detail to be replicated
统计方法的描述（例如，固定或随机效应模型的完整描述，是否选择模型预测的研究结果帐户的理由，剂量 - 反应模型，或累积荟萃分析）在足够的细节能被复制
Provision of appropriate tables and graphics
提供适当的表格和图形

Reporting of results should include
结果报告应包括
Graphic summarizing individual study estimates and overall estimate
图形总结个人的一项研究估计和总体估计
Table giving descriptive information for each study included
表格为每个研究展示描述性信息
Results of sensitivity testing (eg, subgroup analysis)
敏感性测试结果（如亚组分析）
Indication of statistical uncertainty of findings
统计结果的不确定性的指示

Reporting of discussion should include
讨论的报告应包括
Quantitative assessment of bias (eg, publication bias)
量化考核的偏倚（如发表偏倚）
Justification for exclusion (eg, exclusion of non–English-language citations)
排除的理由（例如，排除非英语语言的参考文献）
Assessment of quality of included studies
纳入研究的质量评估

Reporting of conclusions should include
结论的报告应包括
Consideration of alternative explanations for observed results
审议替代解释观察到的结果
Generalization of the conclusions (ie, appropriate for the data presented and within the domain of the literature review)
广义的结论（即适的数据和域范围内的文献综述）
Guidelines for future research
未来的研究指引
Disclosure of funding source
资金来源的披露

ilovelondon

如何合并观察性研究和RCT？

细菌耐药

非常好的学习资料，谢谢蓝鱼版主。

沉默雪儿

已下载学习，谢谢老师的分享。