Notice bibliographique
Résumé
The author responds: Dr. Wolfson1 highlights important nuances to my discussion2 of using randomized clinical trials (RCTs) to estimate causal effects in the clinical setting. We agree on the following points: A deception RCT (where patients are deceived into believing a treatment is effective) matches the clinical context when a patient is offered a choice between two “active” treatments, with only one actually being effective. The unblinded RCT matches the clinical context where patients are offered active treatment or no treatment. The unblinded RCT cannot distinguish between effects mediated through physiological processes versus psychological processes (which themselves, may be mediated through physiological or behavioral processes). A “covert” RCT measures a biological effect corresponding to the context where subjects believe they will receive inactive treatment. A covert RCT is one type of deception RCT. In a deception RCT, subjects believe they will receive a treatment (reference); the reference treatment may be active (eg, caffeinated coffee) or inactive (eg, decaffeinated coffee). Furthermore, subjects may not even know they are in a study. We differ in some minor areas. Dr. Wolfson’s definition of biological effect1 is restricted to causal effects when subjects do not know they are receiving active treatment. However, one could envision a medication that lowers sympathetic activity (heart rate) when sympathetic activity is elevated (eg, subjects believe they will receive caffeine) but not when sympathetic activity is “normal” (eg, subject believe they will not receive caffeine). The “biological” effect would be different for each level of the variable “sympathetic activity,” with each effect measured by a different deception RCT. Considering one variable level as more important than another variable level is a value judgment. Although deception RCTs may “generally be regarded as unethical”1 when evaluating treatments with unknown side-effect profiles, the method is applicable where the risk of adverse effects is nil or the minimal effects considered minor. Although clinicians may sometimes choose between offering versus not offering treatment, I believe they usually choose between several possible treatments that are potentially active. For example, there are many exercise programs promoted as effective treatment for ankle sprains, and effective treatment options for an anterior cruciate ligament tear include exercise, as well as several surgical procedures. In these contexts, the deception RCT where subjects are told a treatment is effective mimics the context of interest. One should evaluate on a case-by-case basis whether traditional RCTs or observational studies provide the less-biased estimate for the causal effect of interest. Ian Shrier Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada, [email protected]
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».