Download or read book Developing a Protocol for Observational Comparative Effectiveness Research A User s Guide written by Agency for Health Care Research and Quality (U.S.) and published by Government Printing Office. This book was released on 2013-02-21 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)

Download or read book Statistical Methods to Study Heterogeneity of Treatment Effects written by Lin H. Taft and published by . This book was released on 2016 with total page 168 pages. Available in PDF, EPUB and Kindle. Book excerpt: Randomized studies are designed to estimate the average treatment effect (ATE) of an intervention. Individuals may derive quantitatively, or even qualitatively, different effects from the ATE, which is called the heterogeneity of treatment effect. It is important to detect the existence of heterogeneity in the treatment responses, and identify the different sub-populations. Two corresponding statistical methods will be discussed in this talk: a hypothesis testing procedure and a mixture-model based approach. The hypothesis testing procedure was constructed to test for the existence of a treatment effect in sub-populations. The test is nonparametric, and can be applied to all types of outcome measures. A key innovation of this test is to build stochastic search into the test statistic to detect signals that may not be linearly related to the multiple covariates. Simulations were performed to compare the proposed test with existing methods. Power calculation strategy was also developed for the proposed test at the design stage. The mixture-model based approach was developed to identify and study the sub-populations with different treatment effects from an intervention. A latent binary variable was used to indicate whether or not a subject was in a sub-population with average treatment benefit. The mixture-model combines a logistic formulation of the latent variable with proportional hazards models. The parameters in the mixture-model were estimated by the EM algorithm. The properties of the estimators were then studied by the simulations. Finally, all above methods were applied to a real randomized study in a low ejection fraction population that compared the Implantable Cardioverter Defibrillator (ICD) with conventional medical therapy in reducing total mortality.

Download or read book Comparative Effectiveness Review Methods written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-05-17 with total page 226 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Agency for Healthcare Research and Quality (AHRQ) commissioned the RTI International–University of North Carolina at Chapel Hill (RTI-UNC) Evidence-based Practice Center (EPC) to explore how systematic review groups have dealt with clinical heterogeneity and to seek out best practices for addressing clinical heterogeneity in systematic reviews (SRs) and comparative effectiveness reviews (CERs). Such best practices, to the extent they exist, may enable AHRQ's EPCs to address critiques from patients, clinicians, policymakers, and other proponents of health care about the extent to which “average” estimates of the benefits and harms of health care interventions apply to individual patients or to small groups of patients sharing similar characteristics. Such users of reviews often assert that EPC reviews typically focus on broad populations and, as a result, often lack information relevant to patient subgroups that are of particular concern to them. More important, even when EPCs evaluate literature on homogeneous groups, there may be varying individual treatment for no apparent reason, indicating that average treatment effect does not point to the best treatment for any given individual. Thus, the health care community is looking for better ways to develop information that may foster better medical care at a “personal” or “individual” level. To address our charge for this methods project, the EPC set out to answer six key questions (KQ). Key questions for methods report on clinical heterogeneity include: 1. What is clinical heterogeneity? a. How has it been defined by various groups? b. How is it distinct from statistical heterogeneity? c. How does it fit with other issues that have been addressed by the AHRQ Methods Manual for CERs? 2. How have systematic reviews dealt with clinical heterogeneity in the key questions? a. What questions have been asked? b. How have they pre-identified population subgroups with common clinical characteristics that modify their intervention-outcome association? c. What are best practices in key questions and how these subgroups have been identified? 3. How have systematic reviews dealt with clinical heterogeneity in the review process? a. What do guidance documents of various systematic review groups recommend? b. How have EPCs handled clinical heterogeneity in their reviews? c. What are best practices in searching for and interpreting results for particular subgroups with common clinical characteristics that may modify their intervention-outcome association? 4. What are critiques in how systematic reviews handle clinical heterogeneity? a. What are critiques from specific reviews (peer and public) on how EPCs handled clinical heterogeneity? b. What general critiques (in the literature) have been made against how systematic reviews handle clinical heterogeneity? 5. What evidence is there to support how to best address clinical heterogeneity in a systematic review? 6. What questions should an EPC work group on clinical heterogeneity address? Heterogeneity (of any type) in EPC reviews is important because its appearance suggests that included studies differed on one or more dimensions such as patient demographics, study designs, coexisting conditions, or other factors. EPCs then need to clarify for clinical and other audiences, collectively referred to as stakeholders, what are the potential causes of the heterogeneity in their results. This will allow the stakeholders to understand whether and to what degree they can apply this information to their own patients or constituents. Of greatest importance for this project was clinical heterogeneity, which we define as the variation in study population characteristics, coexisting conditions, cointerventions, and outcomes evaluated across studies included in an SR or CER that may influence or modify the magnitude of the intervention measure of effect (e.g., odds ratio, risk ratio, risk difference).

Download or read book Statistical Methods for Studying Heterogeneous Treatment Effects with Instrumental Variables written by Michael William Johnson and published by . This book was released on 2021 with total page 130 pages. Available in PDF, EPUB and Kindle. Book excerpt: There is a growing interest in estimating heterogeneous treatment effects in randomized and observational studies. However, most of the work relies on the assumption of ignorability, or no unmeasured confounding on the treatment effect. While instrumental variables (IV) are a popular technique to control for unmeasured confounding, there has been little research conducted to study heterogeneous treatment effects with the use of an IV. This dissertation introduces methods using an IV to discover novel subgroups, estimate their heterogeneous treatment effects, and identify individualized treatment rules (ITR) when ignorability is expected to be violated. In Chapter 2, we present a two-part algorithm to estimate heterogeneous treatment effects and detect novel subgroups using an IV with matching. The first part uses interpretable machine learning techniques, such as classification and regression trees, to discover potential effect modifiers. The second part uses closed testing to test for statistical significance of each effect modifier while strongly controlling the familywise error rate. We apply this method on the Oregon Health Insurance Experiment, estimating the effect of Medicaid on the number of days an individual's health does not impede their usual activities by using a randomized lottery as an instrument. In Chapter 3, we generalize methods to identify ITR using a binary IV to using multiple, discrete valued instruments, or equivalently, multilevel instruments. Several new problems arise when generalizing to multilevel instruments, requiring novel solutions. In particular, multilevel IV give rise to many latent subgroups that may experience heterogeneous treatment effects. Additionally, it may be unclear how to combine and compare the different levels of the IV to estimate treatment heterogeneity. We provide methods that use a prediction of the latent subgroup to identify optimal ITR, and methods to dynamically combine levels of the multilevel IV to estimate the heterogeneous treatment effects, effectively individualizing estimation of an ITR. Further, we provide and discuss necessary and sufficient conditions to identify an optimal ITR using a multilevel IV. We apply our methods to identify an ITR for two competing treatments, carotid endarterectomy and carotid artery stenting, on preventing stroke or death within 30 days of their index procedure.

Download or read book Cochrane Handbook for Systematic Reviews of Interventions written by Julian P. T. Higgins and published by Wiley. This book was released on 2008-11-24 with total page 672 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare providers, consumers, researchers and policy makers are inundated with unmanageable amounts of information, including evidence from healthcare research. It has become impossible for all to have the time and resources to find, appraise and interpret this evidence and incorporate it into healthcare decisions. Cochrane Reviews respond to this challenge by identifying, appraising and synthesizing research-based evidence and presenting it in a standardized format, published in The Cochrane Library (www.thecochranelibrary.com). The Cochrane Handbook for Systematic Reviews of Interventions contains methodological guidance for the preparation and maintenance of Cochrane intervention reviews. Written in a clear and accessible format, it is the essential manual for all those preparing, maintaining and reading Cochrane reviews. Many of the principles and methods described here are appropriate for systematic reviews applied to other types of research and to systematic reviews of interventions undertaken by others. It is hoped therefore that this book will be invaluable to all those who want to understand the role of systematic reviews, critically appraise published reviews or perform reviews themselves.

Download or read book Small Clinical Trials written by Institute of Medicine and published by National Academies Press. This book was released on 2001-01-01 with total page 221 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical trials are used to elucidate the most appropriate preventive, diagnostic, or treatment options for individuals with a given medical condition. Perhaps the most essential feature of a clinical trial is that it aims to use results based on a limited sample of research participants to see if the intervention is safe and effective or if it is comparable to a comparison treatment. Sample size is a crucial component of any clinical trial. A trial with a small number of research participants is more prone to variability and carries a considerable risk of failing to demonstrate the effectiveness of a given intervention when one really is present. This may occur in phase I (safety and pharmacologic profiles), II (pilot efficacy evaluation), and III (extensive assessment of safety and efficacy) trials. Although phase I and II studies may have smaller sample sizes, they usually have adequate statistical power, which is the committee's definition of a "large" trial. Sometimes a trial with eight participants may have adequate statistical power, statistical power being the probability of rejecting the null hypothesis when the hypothesis is false. Small Clinical Trials assesses the current methodologies and the appropriate situations for the conduct of clinical trials with small sample sizes. This report assesses the published literature on various strategies such as (1) meta-analysis to combine disparate information from several studies including Bayesian techniques as in the confidence profile method and (2) other alternatives such as assessing therapeutic results in a single treated population (e.g., astronauts) by sequentially measuring whether the intervention is falling above or below a preestablished probability outcome range and meeting predesigned specifications as opposed to incremental improvement.

Download or read book Doing Meta Analysis with R written by Mathias Harrer and published by CRC Press. This book was released on 2021-09-15 with total page 500 pages. Available in PDF, EPUB and Kindle. Book excerpt: Doing Meta-Analysis with R: A Hands-On Guide serves as an accessible introduction on how meta-analyses can be conducted in R. Essential steps for meta-analysis are covered, including calculation and pooling of outcome measures, forest plots, heterogeneity diagnostics, subgroup analyses, meta-regression, methods to control for publication bias, risk of bias assessments and plotting tools. Advanced but highly relevant topics such as network meta-analysis, multi-three-level meta-analyses, Bayesian meta-analysis approaches and SEM meta-analysis are also covered. A companion R package, dmetar, is introduced at the beginning of the guide. It contains data sets and several helper functions for the meta and metafor package used in the guide. The programming and statistical background covered in the book are kept at a non-expert level, making the book widely accessible. Features • Contains two introductory chapters on how to set up an R environment and do basic imports/manipulations of meta-analysis data, including exercises • Describes statistical concepts clearly and concisely before applying them in R • Includes step-by-step guidance through the coding required to perform meta-analyses, and a companion R package for the book

Download or read book Statistical Methods for Clinical Trials written by Mark X. Norleans and published by CRC Press. This book was released on 2000-11-08 with total page 278 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Summarizes graphical analysis, analysis of variance, meta-analysis, and design of comparable treatment groups. Streamlines the analytical techniques for continuous, categorical, longitudinal, and survival data-focusing on generalized linear models, GEEs, and mixed linear models, -ahd highlihgts p-value, and more."

Download or read book Applied Meta Analysis with R written by Ding-Geng (Din) Chen and published by CRC Press. This book was released on 2013-05-03 with total page 331 pages. Available in PDF, EPUB and Kindle. Book excerpt: In biostatistical research and courses, practitioners and students often lack a thorough understanding of how to apply statistical methods to synthesize biomedical and clinical trial data. Filling this knowledge gap, Applied Meta-Analysis with R shows how to implement statistical meta-analysis methods to real data using R. Drawing on their extensiv

Download or read book Handbook of Meta Analysis written by Christopher H. Schmid and published by CRC Press. This book was released on 2020-09-07 with total page 570 pages. Available in PDF, EPUB and Kindle. Book excerpt: 1. Provides a comprehensive overview of meta-analysis methods and applications. 2. Divided into four major sub-topics, covering univariate meta-analysis, multivariate, applications and policy. 3. Designed to be suitable for graduate students and researchers new to the field. 4. Includes lots of real examples, with data and software code made available. 5. Chapters written by the leading researchers in the field.

Download or read book Statistical Methods for Learning Patients Heterogeneity and Treatment Effects to Achieve Precision Medicine written by Tianchen Xu and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The burgeoning adoption of modern technologies provides a great opportunity for gathering multiple modalities of comprehensive personalized data on individuals. The thesis aims to address statistical challenges in analyzing these data, including patient-specific biomarkers, digital phenotypes and clinical data available from the electronic health records (EHRs) linked with other data sources to achieve precision medicine. The first part of the thesis introduces a dimension reduction method of microbiome data to facilitate subsequent analysis such as regression and clustering. We adopt the proposed zero-inflated Poisson factor analysis (ZIPFA) model on the Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS) and provide valuable insights into the relation between subgingival microbiome and periodontal disease. The second part focuses on modeling the intensive longitudinal digital phenotypes collected by mobile devices. We develop a method based on a generalized state-space model to estimate the latent process of patient's health status.

Download or read book Introduction to Statistical Methods for Clinical Trials written by Thomas D. Cook and published by CRC Press. This book was released on 2007-11-19 with total page 465 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical trials have become essential research tools for evaluating the benefits and risks of new interventions for the treatment and prevention of diseases, from cardiovascular disease to cancer to AIDS. Based on the authors’ collective experiences in this field, Introduction to Statistical Methods for Clinical Trials presents various statistical topics relevant to the design, monitoring, and analysis of a clinical trial. After reviewing the history, ethics, protocol, and regulatory issues of clinical trials, the book provides guidelines for formulating primary and secondary questions and translating clinical questions into statistical ones. It examines designs used in clinical trials, presents methods for determining sample size, and introduces constrained randomization procedures. The authors also discuss how various types of data must be collected to answer key questions in a trial. In addition, they explore common analysis methods, describe statistical methods that determine what an emerging trend represents, and present issues that arise in the analysis of data. The book concludes with suggestions for reporting trial results that are consistent with universal guidelines recommended by medical journals. Developed from a course taught at the University of Wisconsin for the past 25 years, this textbook provides a solid understanding of the statistical approaches used in the design, conduct, and analysis of clinical trials.

Download or read book Statistics Applied to Clinical Trials written by Ton J. Cleophas and published by Springer Science & Business Media. This book was released on 2013-11-11 with total page 105 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 1948 the first randomized controlled trial was published by the English Medical Research Council in the British Medical Journal. Until then, observations had been uncontrolled. Initially, trials frequently did not confirm the hypotheses to be tested. This phenomenon was attributed to low sensitivity due to small samples, as well as inappropriate hypotheses based on biased prior trials. Additional flaws were recognized and, subsequently, were better accounted for: carryover effects due to insufficient washout from previous treatments, time effects due to external factors and the natural history of the condition under study, bias due to asymmetry between treatment groups, lack of sensitivity due to a negative correlation between treatment responses, and so on. Such flaws, mainly of a technical nature, have been largely corrected and led to trials after 1970 being of significantly higher quality. The past decade has focused, in addition to technical aspects, on the need for circumspection in the planning and conducting of clinical trials. As a consequence, prior to approval, clinical trial protocols are now routinely scrutinized by different circumstantial organs, including ethics committees, institutional and federal review boards, national and international scientific organizations, and monitoring committees charged with conducting interim analyses. This book not only explains classical statistical analyses of clinical trials, but also addresses relatively novel issues, including equivalence testing, interim analyses, sequential analyses, and meta-analyses, and provides a framework of the best statistical methods currently available for such purposes. This book is not only useful for investigators involved in the field of clinical trials, but also for all physicians who wish to better understand the data of trials as currently published.

Download or read book Introduction to Meta Analysis written by Michael Borenstein and published by John Wiley & Sons. This book was released on 2011-08-24 with total page 350 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a clear and thorough introduction to meta-analysis, the process of synthesizing data from a series of separate studies. Meta-analysis has become a critically important tool in fields as diverse as medicine, pharmacology, epidemiology, education, psychology, business, and ecology. Introduction to Meta-Analysis: Outlines the role of meta-analysis in the research process Shows how to compute effects sizes and treatment effects Explains the fixed-effect and random-effects models for synthesizing data Demonstrates how to assess and interpret variation in effect size across studies Clarifies concepts using text and figures, followed by formulas and examples Explains how to avoid common mistakes in meta-analysis Discusses controversies in meta-analysis Features a web site with additional material and exercises A superb combination of lucid prose and informative graphics, written by four of the world’s leading experts on all aspects of meta-analysis. Borenstein, Hedges, Higgins, and Rothstein provide a refreshing departure from cookbook approaches with their clear explanations of the what and why of meta-analysis. The book is ideal as a course textbook or for self-study. My students, who used pre-publication versions of some of the chapters, raved about the clarity of the explanations and examples. David Rindskopf, Distinguished Professor of Educational Psychology, City University of New York, Graduate School and University Center, & Editor of the Journal of Educational and Behavioral Statistics. The approach taken by Introduction to Meta-analysis is intended to be primarily conceptual, and it is amazingly successful at achieving that goal. The reader can comfortably skip the formulas and still understand their application and underlying motivation. For the more statistically sophisticated reader, the relevant formulas and worked examples provide a superb practical guide to performing a meta-analysis. The book provides an eclectic mix of examples from education, social science, biomedical studies, and even ecology. For anyone considering leading a course in meta-analysis, or pursuing self-directed study, Introduction to Meta-analysis would be a clear first choice. Jesse A. Berlin, ScD Introduction to Meta-Analysis is an excellent resource for novices and experts alike. The book provides a clear and comprehensive presentation of all basic and most advanced approaches to meta-analysis. This book will be referenced for decades. Michael A. McDaniel, Professor of Human Resources and Organizational Behavior, Virginia Commonwealth University

Download or read book Individual Participant Data Meta Analysis written by Richard D. Riley and published by John Wiley & Sons. This book was released on 2021-06-08 with total page 38 pages. Available in PDF, EPUB and Kindle. Book excerpt: Individual Participant Data Meta-Analysis: A Handbook for Healthcare Research provides a comprehensive introduction to the fundamental principles and methods that healthcare researchers need when considering, conducting or using individual participant data (IPD) meta-analysis projects. Written and edited by researchers with substantial experience in the field, the book details key concepts and practical guidance for each stage of an IPD meta-analysis project, alongside illustrated examples and summary learning points. Split into five parts, the book chapters take the reader through the journey from initiating and planning IPD projects to obtaining, checking, and meta-analysing IPD, and appraising and reporting findings. The book initially focuses on the synthesis of IPD from randomised trials to evaluate treatment effects, including the evaluation of participant-level effect modifiers (treatment-covariate interactions). Detailed extension is then made to specialist topics such as diagnostic test accuracy, prognostic factors, risk prediction models, and advanced statistical topics such as multivariate and network meta-analysis, power calculations, and missing data. Intended for a broad audience, the book will enable the reader to: Understand the advantages of the IPD approach and decide when it is needed over a conventional systematic review Recognise the scope, resources and challenges of IPD meta-analysis projects Appreciate the importance of a multi-disciplinary project team and close collaboration with the original study investigators Understand how to obtain, check, manage and harmonise IPD from multiple studies Examine risk of bias (quality) of IPD and minimise potential biases throughout the project Understand fundamental statistical methods for IPD meta-analysis, including two-stage and one-stage approaches (and their differences), and statistical software to implement them Clearly report and disseminate IPD meta-analyses to inform policy, practice and future research Critically appraise existing IPD meta-analysis projects Address specialist topics such as effect modification, multiple correlated outcomes, multiple treatment comparisons, non-linear relationships, test accuracy at multiple thresholds, multiple imputation, and developing and validating clinical prediction models Detailed examples and case studies are provided throughout.

Download or read book Meta Analysis with R written by Guido Schwarzer and published by Springer. This book was released on 2015-10-08 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a comprehensive introduction to performing meta-analysis using the statistical software R. It is intended for quantitative researchers and students in the medical and social sciences who wish to learn how to perform meta-analysis with R. As such, the book introduces the key concepts and models used in meta-analysis. It also includes chapters on the following advanced topics: publication bias and small study effects; missing data; multivariate meta-analysis, network meta-analysis; and meta-analysis of diagnostic studies.

Download or read book Applied Meta Analysis with R and Stata written by Ding-Geng (Din) Chen and published by CRC Press. This book was released on 2021-03-30 with total page 457 pages. Available in PDF, EPUB and Kindle. Book excerpt: Review of the First Edition: The authors strive to reduce theory to a minimum, which makes it a self-learning text that is comprehensible for biologists, physicians, etc. who lack an advanced mathematics background. Unlike in many other textbooks, R is not introduced with meaningless toy examples; instead the reader is taken by the hand and shown around some analyses, graphics, and simulations directly relating to meta-analysis... A useful hands-on guide for practitioners who want to familiarize themselves with the fundamentals of meta-analysis and get started without having to plough through theorems and proofs. —Journal of Applied Statistics Statistical Meta-Analysis with R and Stata, Second Edition provides a thorough presentation of statistical meta-analyses (MA) with step-by-step implementations using R/Stata. The authors develop analysis step by step using appropriate R/Stata functions, which enables readers to gain an understanding of meta-analysis methods and R/Stata implementation so that they can use these two popular software packages to analyze their own meta-data. Each chapter gives examples of real studies compiled from the literature. After presenting the data and necessary background for understanding the applications, various methods for analyzing meta-data are introduced. The authors then develop analysis code using the appropriate R/Stata packages and functions. What’s New in the Second Edition: Adds Stata programs along with the R programs for meta-analysis Updates all the statistical meta-analyses with R/Stata programs Covers fixed-effects and random-effects MA, meta-regression, MA with rare-event, and MA-IPD vs MA-SS Adds five new chapters on multivariate MA, publication bias, missing data in MA, MA in evaluating diagnostic accuracy, and network MA Suitable as a graduate-level text for a meta-data analysis course, the book is also a valuable reference for practitioners and biostatisticians (even those with little or no experience in using R or Stata) in public health, medical research, governmental agencies, and the pharmaceutical industry.