CAJ | 학술논문

目的以<新英格兰医学杂志>、<美国医学会杂志>、<柳叶刀>和<英国医学杂志>2009年发表的"论著"型文章为例,讨论不同的研究方法在循证医学证据体系中的价值.方法通过上述杂志的官方网站逐期检索其刊载的论著及系统综述和Meta分析.用Epidata 3.1软件建立信息摘录表,摘录"文献题目"、"第一作者所在国家"、"临床问题"及"研究类型"等内容.用SPSS13.0软件进行描述性分析.结果共纳入844篇论著,其中RCT占35.7%,系统综述和Meta分析占9.4%,其他研究54.9%.在临床问题方面,探讨"治疗"(34.2%)、"病因或危险因素"(19.7%)、"预防"(13.7%)、"疾病频率"(6.0%)和"预后"(5.1%)的文献较多,与之对应的最常见研究类型分别为RCT(70.6%)、队列研究(44.6%)、RCT(68.1%)、横断面研究(56.9%)和队列研究(93.0%).结论高水平的临床证据不限于RCT和系统综述,各种研究方法均有其独特的价值.研究者应根据所针对的临床问题或研究阶段等具体情况的不同来选择最适宜的研究设计类型.
목적 이<신영격란의학잡지>、<미국의학회잡지>、<류협도>화<영국의학잡지>2009년발표적"론저"형문장위례,토론불동적연구방법재순증의학증거체계중적개치.방법 통과상술잡지적관방망참축기검색기간재적론저급계통종술화Meta분석.용Epidata 3.1연건건립신식적록표,적록"문헌제목"、"제일작자소재국가"、"림상문제"급"연구류형"등내용.용SPSS13.0연건진행묘술성분석.결과 공납입844편론저,기중RCT점35.7%,계통종술화Meta분석점9.4%,기타연구54.9%.재림상문제방면,탐토"치료"(34.2%)、"병인혹위험인소"(19.7%)、"예방"(13.7%)、"질병빈솔"(6.0%)화"예후"(5.1%)적문헌교다,여지대응적최상견연구류형분별위RCT(70.6%)、대렬연구(44.6%)、RCT(68.1%)、횡단면연구(56.9%)화대렬연구(93.0%).결론 고수평적림상증거불한우RCT화계통종술,각충연구방법균유기독특적개치.연구자응근거소침대적림상문제혹연구계단등구체정황적불동래선택최괄의적연구설계류형.
Objective To discuss the levels of evidence provided by different study designs.Methods Websites of N Engl J Med, JAMA, Lancet, and BMJ were accessed to identify research articles (systematic review and meta-analysis included) published in 2009. A standardized data collection form was established using Epidata 3. 1 software to extract the "title", "country of lead author", "clinical problem" (such as treatment, diagnosis, etc. ) and "study design" of eligible studies. Descriptive statistics was conducted with SPSS 13.0. Results Over all, 844 studies were included, among which 35.7% were RCT,9. 4% systematic review and Meta-analysis, and 54. 9% other types of studies. Regarding clinical problems,34. 2%, 19. 7%, 13.7%, 6. 0% and 5. 1% of the included researches addressed the issues of treatment,etiology/risk factors, prevention, disease frequency and prognosis, respectively. The study designs that were most frequently adopted to explore these problems were RCT (70.6%), cohort study (44. 6% ), RCT (68. 1% ), cross-sectional study ( 56. 9% ), and cohort study ( 93.0% ), respectively. Conclusions High-level evidence does not come exclusively from RCT and systematic review, as each type of study may have its unique value in health related research. The clinical problem of interest, the previous work that has been done to approach the same issue, as well as other factors should be taken into account when deciding whether the selected study design is appropriate.