循证医学-系统评价和meta分析-黄鹏(研).ppt

系统评价和Meta分析Systematic Review and Meta-analysis南昌大学公共卫生学院黄鹏
黄鹏,男,籍贯江西临川。南昌大学公共卫生学院流行病学教研室副教授、医学博士。
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个人简介
问题的提出
对上述结果,
是不是难以判断并选择?
用X线进行乳腺癌筛查Mammography for breast cancer is an established screening method
Is screening with mammography justifiable?
Gotzsche & Olsen [Nordic Cochrane Centre] conducted a systematic review in 2000 and updated it in 2001.
They identified 8 large RCTs on this topic, with over 182,000 women randomized
The authors found that no trial data were of high quality
Two were of medium quality, and the rest were poor quality or flawed.
When the results of the two medium quality trials bined, the risk ratio was (95% CI , )
They concluded that
“screening for breast cancer with
mammography is unjustified”
The US Preventive Services Task Force reviewed the same set of trials
Recently, a 2001 Cochrane Collaboration review of the same trials concluded that
six of the eight trials were "flawed" or of "poor quality" and that the pooled results from the remaining two better trials did not support a benefit from mammography.
The meta-analysis performed for the USPSTF on the most current published data found that the pooled effect size of bined trials was sizable and statistically significant:
the summary relative risk (RR) of breast cancer death among women randomized to screening in seven trials that included women older than 50 was (95 percent CI, -).
The USPSTF mends screening mammography, with or without clinical breast examination, every 1-2 years for women aged 40 and older.
被动吸烟的危害
A topic of great debate and controversy for many years
First few epidemiologic studies were published in 1918