[교육정보]메타분석의 이해와 활용: 초급 및 중급과정

데이타솔루션에서 주최하는 메타분석 교육입니다.

2015.01.20~01.21 양일간 진행하는 교육으로, 황성동 교수님께서 강의하시네요.

2~3달전에 황성동 교수님의 메타분석 교육을 들었는데, 좋았던 기억이 납니다.
특히 평소 궁금했던 고정효과모형과 무선효과모형에 대해 자세히 설명해주셔서 좋았습니다.
다만 초급과정인지라 실습시간이 턱없이 부족해서 아쉬웠습니다.
이번엔 중급과정도 있어서 실습 위주로 할 수 있겠네요. 게다가 R로 하는 메타분석도 가르쳐주시네요!

기회되면 꼭 들어보시면 좋을 것 같습니다^^

PRP- systematic review

The American Journal of Sports Medicine에서 PRP에 대한 systematic review article이 나왔네요!

제가 알기로는 PRP에 대한 시스테마틱리뷰는 최초라서 반가운 마음에 올려봅니당

2014년 12월 18일에 출판된 논문이네요.

내용을 다 보지는 않았지만, forest plot까지 있는 걸 보니 시스테마틱리뷰 뿐만 아니라 메타분석까지 했나보네요!

곧 리뷰하도록 하겠습니다^^

제 9회 코크란 리뷰 워크샵

제 9회 코크란리뷰 워크샵 공지가 떴네요!
고려대학교에서 진행되며, 날짜는 2015.01.23~24 이틀 입니다.
비용은 교육기관 및 공공기관은 30만원, 일반은 40만원으로 비싼감이 있지만
작년에 가서 들어보니 기본적인 문헌고찰부터 실제 메타분석 프로그램 실습까지 이틀 동안 꼼꼼하게 가르쳐 주시더라구요.
물론 실제로 획득한 연구 데이터를 리브만 프로그램에 적용시키기에 어려움은 있었지만요.
코크란 한국지부장이신 안형식 교수님과 김현정 교수님께서 직접 가르쳐 주시니 메타분석 배우고자 하는 분들께 좋은 기회인 것 같습니다^^!

합병증은 최소침습 척추수술의 초기 학습곡선과 연관성이 있다 Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review

Brief review

최소침습적인 척추수술의 Learning curve(학습곡선)을 주요 항목으로 하여 체계적 문헌고찰을 시행한 연구 입니다.

Pubmed에서 검색된 논문을 정해진 프로토콜대로 리뷰하여 최종적으로 15개의 논문이 선택되었습니다.

각 연구별로 complication, procedure time, fusion rate, estimated blood loss, level of evidence, sample size, intervention, study design등을 조사하여 정리하였습니다.

decompressive procedure에서는 durotomy, 그리고 fusion에서는 implant malposition,neural injury, and nonunion가 가장 흔한 합병증이라는 결과가 나왔습니다.

또 수술 후의 전체적인 합병증 발병률은 11%입니다.

아래 링크 따라가시면 전문 보실 수 있습니다^^

*Title: Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review

합병증은 최소침습 척추수술의 초기 학습곡선과 연관성이 있다: 체계적 문헌고찰

*Authors: Sclafani JA, Kim CW

*Bibliography: Clin Orthop Relat Res. 2014Jun;472(6):1711-7.

BACKGROUND

-There is an inherently difficult learning curve associated with minimally invasive surgical (MIS) approaches to spinal decompression and fusion.

-The association between complication rate and the learning curve remains unclear.

QUESTIONS/PURPOSES

-Evaluated the learning curves of MIS procedures for the spine

-Defined as the change in frequency of complications and length of surgical time as case number increased, for five types of MIS for the spine.

METHODS

▶Searching protocol: PubMed database

-terms: "minimally invasive spine surgery AND complications AND learning curve”

▶Clinical outcome and learning curve metrics were categorized for analysis by surgical procedure (MIS lumbar decompression procedures, MIS transforaminal lumbar interbody fusion, percutaneous pedicle screw insertion, laparoscopic anterior lumbar interbody fusion, and MIS cervical procedures).

▶Procedure time and complication rate: the most consistent parameters to evaluate the learning curve

▶total 15 original studies are remained.

 

RESULTS

-The most common learning curve complication for decompressive procedures was durotomy.

-For fusion procedures, the most common complications were implant malposition, neural injury, and nonunion.

-The overall postoperative complication rate was 11% (109 of 966 cases).

-The learning curve was overcome for operative time and complications as a function of case numbers in 20 to 30 consecutive cases for most techniques discussed within this review.

CONCLUSIONS

-The quantitative assessment of the procedural learning curve for MIS techniques for the spine remains challenging because the MIS techniques have different learning curves and because they have not been assessed in a consistent manner across studies.

-Complication rates may be underestimated by the studies we identified because surgeons tend to select patients carefully during the early learning curve period.

-The field of MIS would benefit from a standardization of study design and collected parameters in future learning curve investigations.

Do Authors Report Surgical Expertise in Open Spine Surgery Related Randomized Controlled Trials?

Brief review

이 논문은 개방척추수술에 대한 무작위대조연구(RCT)에서 보고하는 수술적 기술의 quality를 체계적 문헌고찰을 통해 평가하는 논문 입니다.

2005년부터 2010년에 출판된 RCT논문 중 MEDLINE, Cochrane Library, EMBASE을 통해 검색된  논문을 가지고 사전에 설정한 inclusion, exclusion criteria에 맞추어 총 99개의 논문을 정했습니다 (method에 첨부된 flow chart참고).

이 99개의 RCT논문을 토대로 13개의 질문을 통해 논문에 보고된 내용의 quality를 평가하였습니다 (질문내용: 연구참여자들은 적절히 blinded 되었는가? 모든 치료법들은 무작위로 배정된 그룹에 동일하게 적용되었는가?등. 아래 bibliography에 링크된 사이트로 가서 본문 내용을 참고하세요).

평가결과, 전체의 10%에 해당하는 논문만이 learning curve와 관련하여 수술적 기술 및 경험을  설명한 것으로 나타났습니다.

개방척추수술에 대한 RCT논문에서 수술기술과 논문에 대한 정보는 거의 보고되어 있지 않으며, 이렇게 저자들이 기초적인 안전성 보호에 대해 보고하지 않으면 전문기술의 편차가 나타날 수도 있다는 결론 입니다.

*Title: Do Authors Report Surgical Expertise in Open Spine Surgery Related Randomized Controlled Trials?: A Systematic Review on Quality of Reporting

저자들은 무작위대조연구와 관련된 개방척추수술에서 수술적인 전문기술을 보고하는가?: 보고의 질에 대한 체계적 고찰.

*Authors: Jakob van Oldenrijk, Youri van Berkel, Gino M. M. J. Kerkhoffs, Mohit Bhandari, Rudolf W. Poolman

*Bibliography: Spine (Phila Pa 1976). 2013 May1;38(10):857-64.

STUDY DESIGN

A systematic review of published trials in orthopedic spine literature.

OBJECTIVE

To determine the quality of reporting in open spine surgery randomized controlled trials (RCTs) with special focus on the reporting of surgical skill or expertise (2005~2010).

SUMMARY OF BACKGROUND DATA

In spine surgery, a surgeon's skill and expertise is important role in the outcome of the procedure.

To appraise the reported treatment effect of spine surgery related RCTs adequately, any potential skill or experience bias must be reported.

METHODS

-MEDLINE, Cochrane Library, EMBASE were systematically searched for open spine surgery RCTs published (2005.1.1~2010.12.31)

>searching word: spine, surgery, spine surgery

>Inclusion criteria:

1) nonpharmaceutical RCT dealing with open surgical interventions of the spine on patients in an operating room.

(2) published between 2005.1.1~2010.12.31 in the English, French, German, or Dutch language.

>Exclusion criteria:

1) Percutaneous techniques

2) Studies dealing with animals, cadavers, manipulation, or acupuncture.

3) Studies summarizing results of a previously published study.

-To determined the quality of reporting eligible studies, using the checklist.

-The reporting of surgeons' skill and experience was scored additionally.

-Subsequently, all authors were surveyed to determine if any information on methodological safeguards was omitted from their reports.

-All data were analyzed in 2-year time frames.

RESULTS

-99 RCTs were included.

10 studies (10%) described surgical skill or experience, mostly as a description of the learning curve.

-The majority of publications were unclear about "concealment of treatment allocation" (77%), "blinding of participants" (68%), "blinding of outcome assessors" (77%), and "adhering to the intention-to-treat principle" (67%).

-Of the 99 surveys, we received 22 (22%) completed questionnaires.

In these questionnaires, information about essential methodological safeguards was often available, although not reported in the primary publication.

CONCLUSION

-In open spine surgery RCTs information on skill and experience is scarcely reported.

-Authors often fail to report essential methodological safeguards.

-Therefore these studies may be prone to expertise bias.