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.

[1]  F. Pedersen,et al.  EFFECT OF ALPRENOLOL ON MORTALITY AMONG PATIENTS WITH DEFINITE OR SUSPECTED ACUTE MYOCARDIAL INFARCTION Preliminary Results , 1979, The Lancet.

[2]  T. Chalmers,et al.  A Note on Fatality in Serum Hepatitis , 1965 .

[3]  L Mutch,et al.  Perusing the literature: comparison of MEDLINE searching with a perinatal trials database. , 1985, Controlled clinical trials.

[4]  A Liberati,et al.  A quality assessment of randomized control trials of primary treatment of breast cancer. , 1986, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  S. Yusuf.  Obtaining medically meaningful answers from an overview of randomized clinical trials. , 1987, Statistics in medicine.

[6]  W. M. Smith,et al.  PROTECTIVE EFFECT OF PROPRANOLOL IN THREATENED MYOCARDIAL INFARCTION , 1978, The Lancet.

[7]  T A Louis,et al.  Findings for public health from meta-analyses. , 1985, Annual review of public health.

[8]  Pentecost Bl,et al.  Intravenous and oral practolol in the acute stages of myocardial infarction. , 1978 .

[9]  R Collins,et al.  Avoidance of large biases and large random errors in the assessment of moderate treatment effects: the need for systematic overviews. , 1987, Statistics in medicine.

[10]  R Peto,et al.  Effect of intravenous streptokinase on acute myocardial infarction: pooled results from randomized trials. , 1982, The New England journal of medicine.

[11]  M. Morgan,et al.  PHENOBARBITONE TO PREVENT INTRAVENTRICULAR HAEMORRHAGE , 1981, The Lancet.

[12]  T. Hegyi,et al.  Phenobarbitone prophylaxis of intraventricular haemorrhage. , 1986, Archives of disease in childhood.

[13]  R. Miller,et al.  Effect of Phenobarbital on Motor Activity and Intraventricular Hemorrhage in Preterm Infants with Respiratory Disease Weighing Less Than 1500 Grams , 1985, American journal of perinatology.

[14]  G. Goldstein,et al.  Further observations on the use of phenobarbital to prevent neonatal intracranial hemorrhage. , 1982, Pediatrics.

[15]  R. Norris,et al.  PREVENTION OF VENTRICULAR FIBRILLATION DURING ACUTE MYOCARDIAL INFARCTION BY INTRAVENOUS PROPRANOLOL , 1984, The Lancet.

[16]  K. Woods.  MEDICARE: A NEW HEALTH INSURANCE PROGRAMME FOR AUSTRALIA , 1984, The Lancet.

[17]  S. Ayres,et al.  Propranolol decreases sympathetic nervous activity reflected by plasma catecholamines during evolution of myocardial infarction in man. , 1980, The Journal of clinical investigation.

[18]  H. Keen,et al.  ORAL HYPOGLYCÆMICS IN DIABETES MELLITUS , 1975, The Lancet.

[19]  P. Armitage,et al.  Design and analysis of randomized clinical trials requiring prolonged observation of each patient. I. Introduction and design. , 1976, British Journal of Cancer.

[20]  J. Jürgensen,et al.  Limitation of myocardial infarct size in patients less than 66 years treated with alprenolol. , 1981, British heart journal.

[21]  G. Sloman,et al.  Beta-adrenergic blockade and cardiac arrhythmias. , 1967, British medical journal.

[22]  J. Hirsh,et al.  Australian multicentre trial of streptokinase in acute myocardial infarction. , 1973, The Medical journal of Australia.

[23]  J. Baglivo,et al.  Neonatal intracranial hemorrhage and phenobarbital. , 1986, Pediatrics.

[24]  R Peto,et al.  Why do we need systematic overviews of randomized trials? , 1987, Statistics in medicine.

[25]  Glatt Mm,et al.  Letter: Scientific medicine. , 1974 .

[26]  G. Glass.  Primary, Secondary, and Meta-Analysis of Research1 , 1976 .

[27]  P. Brandt,et al.  Treatment of acute myocardial infarction with propranolol. Further studies on enzyme appearance and subsequent left ventricular function in treated and control patients with developing infarcts. , 1980, British heart journal.

[28]  F. Mosteller,et al.  Reporting standards and research strategies for controlled trials , 1980 .

[29]  H O Conn,et al.  Nonassociation of adrenocorticosteroid therapy and peptic ulcer. , 1976, The New England journal of medicine.

[30]  E. Christensen,et al.  Aspects of the natural history of gastrointestinal bleeding in cirrhosis and the effect of prednisone. , 1981, Gastroenterology.

[31]  R. Rosenthal.  The file drawer problem and tolerance for null results , 1979 .

[32]  R. Peto,et al.  Beta blockade during and after myocardial infarction: an overview of the randomized trials. , 1985, Progress in cardiovascular diseases.

[33]  J. Gardin,et al.  A randomized controlled trial of intravenous streptokinase in evolving acute myocardial infarction. , 1986, American heart journal.

[34]  J. Gormsen.  BIOCHEMICAL EVALUATION OF STANDARD TREATMENT WITH STREPTOKINASE IN ACUTE MYOCARDIAL INFARCTION , 1972, Acta medica Scandinavica.

[35]  T C Chalmers,et al.  Bias in treatment assignment in controlled clinical trials. , 1983, The New England journal of medicine.

[36]  P. Mannucci,et al.  Controlled trial of streptokinase and heparin in acute myocardial infarction. , 1971, Lancet.

[37]  T. Chalmers,et al.  Meta-analyses of randomized controlled trials. , 1987, The New England journal of medicine.

[38]  R Peto,et al.  Why do we need some large, simple randomized trials? , 1984, Statistics in medicine.

[39]  R. Peto,et al.  EARLY INTRAVENOUS ATENOLOL TREATMENT IN SUSPECTED ACUTE MYOCARDIAL INFARCTION Preliminary Report of a Randomised Trial , 1980, The Lancet.

[40]  V. Ruth.  Brain Protection by Phenobarbitone in Very Low Birthweight (VLBW) Prematures - A Controlled Trial , 1985, Klinische Padiatrie.

[41]  R. Peto,et al.  Early intravenous beta-blockade in myocardial infarction. , 1982, British journal of clinical pharmacology.

[42]  M. Verstraete.  Streptokinase in Recent Myocardial Infarction: A Controlled Multicentre Trial , 1971, British medical journal.

[43]  T C Chalmers,et al.  A method for assessing the quality of a randomized control trial. , 1981, Controlled clinical trials.

[44]  D. Roloff,et al.  PREVENTION OF INTRAVENTRICULAR HAEMORRHAGE IN PRETERM INFANTS BY PHENOBARBITONE A Controlled Trial , 1981, The Lancet.

[45]  D. Mikhailidis,et al.  Effect of timolol on changes in serum potassium concentration during acute myocardial infarction. , 1985, British heart journal.

[46]  R. Cooke,et al.  Does phenobarbitone prevent periventricular hemorrhage in very low-birth-weight babies?: a controlled trial. , 1982, Pediatrics.

[47]  R. Smart.  The importance of negative results in psychological research. , 1964 .

[48]  S. Yusuf,et al.  Reduction of ventricular arrhythmias by early intravenous atenolol in suspected acute myocardial infarction. , 1983, British medical journal.

[49]  T C Chalmers,et al.  Association of adrenocorticosteroid therapy and peptic-ulcer disease. , 1983, The New England journal of medicine.

[50]  T. Chalmers,et al.  Loss of patients in clinical trials that measure long-term survival following myocardial infarction. , 1986, Controlled clinical trials.

[51]  T. Peter,et al.  Reduction of Enzyme Levels by Propranolol After Acute Myocardial Infarction , 1978, Circulation.

[52]  PHENOBARBITONE AND NEONATAL INTRAVENTRICULAR HAEMORRHAGE , 1982, The Lancet.

[53]  C B Begg,et al.  A measure to aid in the interpretation of published clinical trials. , 1985, Statistics in medicine.

[54]  H. Mustaniemi,et al.  Fibrinolytic treatment in acute myocardial infarction. , 2009, Acta medica Scandinavica.

[55]  L. Dubowitz,et al.  PHENOBARBITONE FOR PREVENTION OF PERIVENTRICULAR HAEMORRHAGE IN VERY LOW BIRTH-WEIGHT INFANTS A Randomised Double-blind Trial , 1983, The Lancet.

[56]  M. Pike,et al.  Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. , 1977, British Journal of Cancer.

[57]  R N SMITH,et al.  Smog: 1962 v. 1952. , 1963, The Lancet.

[58]  L Mutch,et al.  The Oxford Database of Perinatal Trials: developing a register of published reports of controlled trials. , 1986, Controlled clinical trials.

[59]  S. Shankaran,et al.  Effect of prophylactic phenobarbital on intraventricular hemorrhage in high-risk infants. , 1984, Pediatrics.

[60]  R. Collins,et al.  Intravenous and intracoronary fibrinolytic therapy in acute myocardial infarction: overview of results on mortality, reinfarction and side-effects from 33 randomized controlled trials. , 1985, European heart journal.