Biomedical subjects

D Reitman

Publications and source records attributed to D Reitman.

23 records · Page 2Linked to original sources

PubMed1981

A method for assessing the quality of a randomized control trial.

A system has been constructed to evaluate the design, implementation, and analysis of randomized control trials (RCT). The degree of quadruple blinding (the randomization process, the physicians and patients as to therapy, and the physicians as to ongoing results) is considered to be the most important aspect of any trial. The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies. Description of the patient and treatment materials and the measurement of various controls of quality have less weight. An index of quality of a RCT is proposed with its pros and cons. If published papers were to approximate these principles, there would be a marked improvement in the quality of randomized control trials. Finally, a reasonable standard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials.

Clinical Trials as Topic↗

PubMedDate not supplied

Meta-analysis of clinical trials as a scientific discipline. I: Control of bias and comparison with large co-operative trials.

Meta-analysis is an important method of bridging the gap between undersized randomized control trials and the treatment of patients. However, as in any retrospective study, the opportunities for bias to distort the results are widespread. Attempts must be made to introduce the controls found in prospective studies by blinding the selection of papers and extraction of data and making blinded duplicate determinations. Informal and personalized methods of obtaining data are probably more liable to error and bias than employing only published data. Publication bias is a serious problem requiring further research. There also need to be more comparisons of meta-analysed small studies with large co-operative trials.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Meta-analysis of clinical trials as a scientific discipline. II: Replicate variability and comparison of studies that agree and disagree.

The replicate variability of meta-analyses of controlled clinical trials has been assessed as a measure of scientific precision. 46 of 91 known meta-analysis papers were divided into 20 cohorts of studies of the same therapies. Ten cohorts contained meta-analyses with different statistical conclusions; 14 contained differing clinical conclusions with a wider spread than the statistically differing studies. Possible causes of variability, such as different trials included, different policies regarding the inclusion of non-randomized and unpublished trials, and different statistical methodologies, were not obvious causes of differing conclusions. Further work in this area should include multivariate analyses in order to explore possible interactions in the factors accounting for the variability found in replicate meta-analyses.

Clinical Trials as Topic↗

PubMedDate not supplied

Problem social behavior in the workplace: an analysis of social behavior problems in a supported employment setting.

The social skills problems that may influence the work-related success of supported employees has been only infrequently documented in the research literature. Though a multitude of research describes the performance-related challenges faced by supported employees, few papers address the interpersonal difficulties encountered by supported employees in the workplace. The present paper uses job trainer or "coaches" logs and two promising rating scales (the Psychopathology Instrument for Mentally Retarded Adults [PIMRA and PIMRA-S]) to describe the social problems encountered by some supported employees. Job coach's logs indicated that approximately 58% of supported employees had experienced one or more incidents of interpersonal difficulty during their employment tenure and that 40% of the problems experienced by these individuals could be described as sexuality-related. Overall, about 25% of all supported employees had reported incidents of conflict with employees or customers that seemed sexuality-related. In addition, social and developmental factors that might contribute to the interpersonal problems found in the present research are discussed.

Adult↗

PubMedDate not supplied

Meta-analysis: an update.

A fairly new type of research, termed meta-analysis, attempts to analyze and combine the results of previous reports. In 1992 we updated our 1987 survey of 86 meta-analyses of randomized control trial reports in the english language literature with an additional 78. We evaluated the quality of these meta-analyses using a scoring method that lists 23 items in six major areas: study design, combinability, control of bias, statistical analysis, sensitivity analysis, and application of results. Of the 23 individual items, the mean number satisfactorily addressed was 7.63 +/- 2.84 (mean +/- S.D.) for 40 papers published from 1955 through 1982, 6.80 +/- 3.86 for 66 papers published from 1983 through 1986, and 11.91 +/- 4.79 for 58 papers published from 1987 through 1990 (F = 31.3, p < .001). We noted that methodology has definitely improved since our first survey of meta-analyses, but an urgent need still exists for a better search of the literature, quality evaluation of trials, and a synthesis of the results. Recently, meta-analysis has expanded to cover non-randomized studies, including evaluation of diagnostic tests and pooling of epidemiologic studies. There is growing concern for standards, and several methodologic issues remain unresolved.

Bias↗