tailieunhanh - Báo cáo y học: "Measuring effectiveness of drugs in observational databanks: promises and perils"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Measuring effectiveness of drugs in observational databanks: promises and perils. | Available online http content 6 2 41 Commentary Measuring effectiveness of drugs in observational databanks promises and perils Eswar Krishnan and James F Fries Division of Immunology Department of Medicine Stanford University Palo Alto CA USA Corresponding author Eswar Krishnan e-mail eswar_krishnan@ Received 11 Dec 2003 Accepted 20 Jan 2004 Published 5 Feb 2004 Arthritis Res Ther 2004 6 41-44 DOI ar1151 2004 BioMed Central Ltd Print ISSN 1478-6354 Online ISSN 1478-6362 Abstract Observational databanks have inherent strengths and shortcomings. As in randomized controlled trials poor design of these databanks can either exaggerate or reduce estimates of drug effectiveness and can limit generalizability. This commentary highlights selected aspects of study design data collection and statistical analysis that can help overcome many of these inadequacies. An international metaRegister and a formal mechanism for standardizing and sharing drug data could help improve the utility of databanks. Medical journals have a vital role in enforcing a quality checklist that improves reporting. Keywords bias cohort study confounding data banks randomized controlled trial rheumatoid arthritis. Introduction The decision to terminate the Women s Health Initiative WHI study a randomized controlled trial RCT of hormone replacement therapy and the public anxiety caused by the subsequent media publicity have put the hierarchy of evidence in epidemiology in the spotlight. Clinical medicine including rheumatology has also sometimes witnessed similar contradictions between the results of RCTs and observational studies. For example RCTs indicated an efficacy for auranofin greatly exceeding that observed in observational studies or in clinical practice 1-3 . A meta-analysis of RCTs in 1990 4 concluded that the efficacy of injectable gold salts penicillamine and sulfasalazine did not differ from that of methotrexate in patients with rheumatoid .