Guide

指南
  • 文章类型: Journal Article
    甲状腺结节在高达67%的人群中通过超声检查被发现非常普遍,根据目前的手术原则,即使在高容量中心,对于有症状的大良性结节或自主功能结节也需要进行肺叶切除术,从而导致甲状腺功能减退或喉返神经损伤的风险。射频消融(RFA)的引入允许良性和自主功能甲状腺结节的热消融,发病率最低。移动射击技术是进行甲状腺结节RFA的最成熟的技术,并且被证明是安全的,有效的,在经验丰富的临床医生中准确和成功。本文的目的是提出在临床实践中利用移动射击技术对甲状腺结节进行RFA时使用新颖的指南。
    RFA提出的技术涉及使用连接到18G导管的10MHz线性超声探头,该探头可提供7厘米或10厘米射频探头尖端的可靠线性可视化(STARmed,首尔,韩国)利用跨岛移动射击技术。已图解说明了指南的几何分析。
    使用18G射频探头导板(CIVCOInfinitiPlus™针头导板)可在高达28cm2的横截面上保持射频探头的直线可视化,从而在甲状腺结节射频消融期间促进概念亚基的有效和完全消融。
    甲状腺结节的射频消融可以安全有效地使用所提出的新型射频探针引导进行,我们认为该引导可能会提高准确性和整体效率。以及操作员对保持探针尖端可视化的信心,因此,我们认为为希望开始进行甲状腺结节RFA的临床医生提供了宝贵的补充。
    UNASSIGNED: Thyroid nodules are extremely common being detected by ultrasonography in up to 67% of the population, with current surgical tenet maintaining that lobectomy is required for large symptomatic benign nodules or autonomously functionally nodules resulting in a risk of hypothyroidism or recurrent laryngeal nerve injury even in high volume centres. The introduction of radiofrequency ablation (RFA) has allowed thermal ablation of both benign and autonomously functioning thyroid nodules with minimal morbidity. The moving shot technique is the most well-established technique in performing RFA of thyroid nodules, and has proven to be safe, efficacious, accurate and successful amongst experienced clinicians. The purpose of this article to propose the use of a novel guide when performing RFA of thyroid nodules in clinical practice utilizing the moving shot technique.
    UNASSIGNED: The technique proposed of RFA involves the use of a 10MHz linear ultrasound probe attached to an 18G guide which provides robust in line visualisation of a 7cm or 10cm radiofrequency probe tip (STARmed, Seoul, Korea) utilizing the trans isthmic moving shot technique. A geometric analysis of the guide has been illustrated diagrammatically.
    UNASSIGNED: The use of an 18G radiofrequency probe guide (CIVCO Infiniti Plus™ Needle Guide) maintains in line visualisation of the radiofrequency probe over a cross-sectional area up to 28cm2, facilitating efficient and complete ablation of conceptual subunits during RFA of thyroid nodules.
    UNASSIGNED: Radiofrequency ablation of thyroid nodules can be performed safely and effectively using the novel radiofrequency probe guide proposed which we believe potentially improves both accuracy and overall efficiency, along with operator confidence in maintaining visualisation of the probe tip, and hence we believe provides a valuable addition to the armamentarium of clinicians wishing to embark on performing RFA of thyroid nodules.
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  • 文章类型: Journal Article
    背景:患者专用瞄准装置(PSAD)可能会提高全肩关节置换术中关节盂部件定位的精度和准确性,尤其是在退行性腺样体中。这项研究的目的是比较使用PSAD和标准指南将导丝定位到不同关节盂模型中的精度和准确性。
    方法:三位经验丰富的肩关节外科医师将2.5mmK线插入WalchA型聚氨酯铸型关节盂模型中,B和C(共180种型号)。每位外科医生在组(I)中使用DePuySynthes的标准指南,在组(II)中使用PSAD,将导丝放入每种类型的10个腺体中。偏离计划版本,测量了倾斜度和进入点,以及可能的学习曲线的调查。
    结果:(I)中B-和C-腺体的最大版本偏差为20.3°,(II)中4.8°(p<0.001),倾斜度为20.0°(I)中3.7°(p<0.001)。对于B关节盂,与(II)中≤2.2°相比,(I)中超过50%的导丝的版本偏差在11.9°至20.3°之间(p<0.001)。(I)中50%的B-和C-腺样体显示中值倾斜度偏差为4.6°(0.0°-20.0°;p<0.001),而(II)中的1.8°(0.0°-4.0°;p<0.001)。使用PSAD时,与进入点的偏差始终小于5.0mm,而标准指南的最大偏差为7.7mm,在C型中最明显(p<0.001)。
    结论:与体外标准指南相比,PSAD提高了导丝放置的精度和准确性,特别是对于变形的B型和C型腺体。PSAD没有学习曲线。然而,这项研究的发现不能直接转化为临床现实,需要进一步的佐证。
    BACKGROUND: Patient-specific aiming devices (PSAD) may improve precision and accuracy of glenoid component positioning in total shoulder arthroplasty, especially in degenerative glenoids. The aim of this study was to compare precision and accuracy of guide wire positioning into different glenoid models using a PSAD versus a standard guide.
    METHODS: Three experienced shoulder surgeons inserted 2.5 mm K-wires into polyurethane cast glenoid models of type Walch A, B and C (in total 180 models). Every surgeon placed guide wires into 10 glenoids of each type with a standard guide by DePuy Synthes in group (I) and with a PSAD in group (II). Deviation from planned version, inclination and entry point was measured, as well as investigation of a possible learning curve.
    RESULTS: Maximal deviation in version in B- and C-glenoids in (I) was 20.3° versus 4.8° in (II) (p < 0.001) and in inclination was 20.0° in (I) versus 3.7° in (II) (p < 0.001). For B-glenoid, more than 50% of the guide wires in (I) had a version deviation between 11.9° and 20.3° compared to ≤ 2.2° in (II) (p < 0.001). 50% of B- and C-glenoids in (I) showed a median inclination deviation of 4.6° (0.0°-20.0°; p < 0.001) versus 1.8° (0.0°-4.0°; p < 0.001) in (II). Deviation from the entry point was always less than 5.0 mm when using PSAD compared to a maximum of 7.7 mm with the standard guide and was most pronounced in type C (p < 0.001).
    CONCLUSIONS: PSAD enhance precision and accuracy of guide wire placement particularly for deformed B and C type glenoids compared to a standard guide in vitro. There was no learning curve for PSAD. However, findings of this study cannot be directly translated to the clinical reality and require further corroboration.
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  • 文章类型: Journal Article
    同行评审过程对于保持质量至关重要,可靠性,新奇,和科学文献的创新。然而,科学同行评议的教学很少是正式科学或临床培训的组成部分,甚至最有经验的同行评审员也对继续教育表示兴趣。这篇评论文章的目的是总结经验丰富的期刊编辑关于如何在逐步指南中成为一名优秀审稿人的集体观点,该指南可以作为科学手稿同行评审绩效的资源。
    这是一个叙述性的回顾。
    提供了对历史的回顾和对现代同行评审过程的概述,并注意了审阅者所扮演的角色,包括参与科学同行评审的重要原因。描述了科学同行评审的一般组成部分,并提供了一个如何构建同行评审报告的模型。这些概念也在审阅者检查表中进行了总结,该检查表可用于实时开发和在提交审阅者报告之前对其进行仔细检查。
    同行评审是保持科学文献质量的一项至关重要的服务。科学手稿的同行评审和相关评审员的报告应评估与准确性相关的具体细节,有效性,新奇,以及对研究结果的解释。我们希望本文将作为科学手稿同行评审绩效的各级经验审稿人的资源和指南。
    UNASSIGNED: The peer review process is critical to maintaining quality, reliability, novelty, and innovation in the scientific literature. However, the teaching of scientific peer review is rarely a component of formal scientific or clinical training, and even the most experienced peer reviewers express interest in continuing education. The objective of this review article is to summarize the collective perspectives of experienced journal editors about how to be a good reviewer in a step-by-step guide that can serve as a resource for the performance of peer review of a scientific manuscript.
    UNASSIGNED: This is a narrative review.
    UNASSIGNED: A review of the history and an overview of the modern-day peer review process are provided with attention to the role played by the reviewer, including important reasons for involvement in scientific peer review. The general components of a scientific peer review are described, and a model for how to structure a peer review report is provided. These concepts are also summarized in a reviewer checklist that can be used in real-time to develop and double-check one\'s reviewer report before submitting it.
    UNASSIGNED: Peer review is a critically important service for maintaining quality in the scientific literature. Peer review of a scientific manuscript and the associated reviewer\'s report should assess specific details related to the accuracy, validity, novelty, and interpretation of a study\'s results. We hope that this article will serve as a resource and guide for reviewers of all levels of experience in the performance of peer review of a scientific manuscript.
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  • 文章类型: Journal Article
    背景:教育计划评估是一个复杂的问题,在整个过程中,必须了解潜在的挑战和解决方案。本研究旨在确定规划中的影响因素,实施,和医学教育计划的评估管理,然后提供应用指南,以保证教育计划评估人员的最佳评估。
    方法:这项描述性研究分三个步骤进行。首先,规划的有效组成部分,实施,并对医学教育计划的评估管理进行了综述。第二,专家们通过焦点小组讨论就上述组件提出了意见。第三,关于遵守的应用指南,使用检查表调查了40位医学教育专家和项目评估专家的意见。
    结果:规划应用指南,实施,医学教育项目的评估管理包括八个阶段:确定评估问题和标准,确定所需信息的类型,确定收集信息的资源,确定收集信息的方法和工具,确定数据分析方法,确定报告的时间和频率,确定适当的报告方式,并确定维护数据源合作的策略。
    结论:医学院校教育计划的普及导致对计划评估的需求日益增加,以提供其有效性和改进的证据。本研究提供了一个应用指南,通过使用一组概念来使教育计划的评估变得可行,原则,方法,理论,和模型。
    BACKGROUND: Educational program evaluation is a complex issue, and it is essential to have knowledge of the potential challenges and solutions during the whole process. The present study aimed to identify the influential components in planning, implementation, and evaluation management of educational programs in medical sciences and then provide an applied guide to guarantee the best possible evaluation by evaluators of educational programs.
    METHODS: This descriptive study was conducted in three steps. First, the effective components in planning, implementation, and evaluation management of educational programs in medical sciences were reviewed. Second, experts\' opinion was asked through a focus group discussion regarding the mentioned components. Third, regarding the complied applied guide, the opinions of 40 medical educationist and program evaluation experts were investigated using a checklist.
    RESULTS: An applied guide for planning, implementation, and evaluation management of educational programs in medical sciences consists of eight stages: determining the evaluation questions and standards, determining the type of information required, determining resources to collect information, determining methods and tools to collect information, determining data analysis methods, determining the timing and frequency of reporting, determining the appropriate ways of reporting, and determining strategies to maintain the cooperation of data sources.
    CONCLUSIONS: The spread of educational programs in medical sciences universities leads to an increasing need for program evaluation to provide evidence of their effectiveness and improvement. The present research provided an applied guide to make the evaluation of educational programs feasible by using a set of concepts, principles, methods, theories, and models.
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  • 文章类型: Journal Article
    大多数终末期肾病患者接受血液透析(HD)治疗。启动HD可以构成物理姿势,社会,以及对患者的心理挑战,头6个月内的死亡率过高,与强化HD方案有关的潜在因素。以增量方式开始HD,考虑残余肾功能(RKF),可能允许一个温和的开始与降低透析强度。然后,透析强度(会话时间或频率)可以随着RKF降低而按比例增加。观察性研究中已经报道了这种开始HD的方法,以提高患者自我报告的生活质量并降低成本。现在,一些确定的随机对照试验正在进行中,比较传统的每周三次模式的增量方法。医生担心透析不足的风险,随之而来的是紧急入院人数的增加,以及如何估计RKF和实施增量透析的实际挑战阻碍了广泛采用。解决这些挑战对于增加增量HD的摄取至关重要。仔细选择患者是成功的增量HD计划的核心。一般来说,残余尿素清除率>3ml/min/1.73m2的患者可以被认为适合从增量HD开始,只要他们符合液体摄入量。盐和其他饮食建议。从常规的透析间尿液收集中计算RKF并适当调整会期HD清除目标是实际和概念上的挑战。在本报告中,我们旨在解决这些复杂性,并为患者选择和调整透析会期目标提供逐步指导。
    The majority of end-stage kidney disease patients are treated with haemodialysis (HD). Starting HD can pose physical, social, and psychological challenges to patients, and mortality rates within the first 6 months are disproportionately high, with intensive HD regimens implicated as a potential factor. Starting HD with an incremental approach, taking residual kidney function (RKF) into account, potentially allows for a gentle start with reduced dialysis intensity. Dialysis intensity (session time or frequency) can then be proportionally increased as RKF reduces. This approach to starting HD has been reported in observational studies to result in better patient self-reported health quality of life and reduced costs, and now several definitive randomised controlled trials are underway comparing an incremental approach to the conventional thrice weekly paradigm. Physician concerns over the risk of inadequate dialysis, with consequent increased emergency admissions, and practical challenges of how to estimate RKF and implement incremental dialysis have impeded widespread adoption. Addressing these challenges is paramount to increasing the uptake of incremental HD. Careful patient selection lies at the heart of a successful incremental HD programme. Generally, patients with a residual urea clearance of > 3 ml/min/1.73 m2 can be considered suitable for starting with incremental HD provided they comply with fluid intake, salt and other dietary recommendations. Calculating RKF from regular interdialytic urine collections and appropriately adjusting sessional HD clearance targets are practical and conceptual challenges. In this report we aim to disentangle these complexities and provide a step-by-step guide for patient selection and adjusting dialysis sessional targets.
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  • 文章类型: Journal Article
    OBJECTIVE: This study compared the accuracy of the guide-supported and the microscope-assisted fiber post removal systems by using the extracted teeth. These new idea and theory can be used by clinicians to remove fiber posts.
    METHODS: Twenty-eight human extracted premolars were randomly divided into the guide and microscope groups. After root canal treatment and fiber post restoration, the fiber posts were removed by using a digital guide and via microscope-assisted ultrasonic instrument, respectively. Mimics 10.0 was used to measure the deviation, and the accuracy of the two fiber post removal systems were compared.
    RESULTS: In the guide group, the apical vertical deviation was 0.99 mm±0.52 mm, the apical horizontal deviation was 0.75 mm±0.19 mm, the angle deviation was 2.32°±0.64°, and the volume loss was 8.09 mm3±1.42 mm3. In the microscope group, the apical vertical deviation was 0.44 mm±0.23 mm, the apical horizontal deviation was 0.23 mm±0.07 mm, the angle deviation was 0.64°±0.31°, and the volume loss was 15.25 mm3±3.94 mm3. No significant difference was found in the apical vertical deviation between the two groups (P>0.05), whereas the apical horizontal deviation, the angle deviation, and the volume loss were significantly different between the two groups (P<0.05).
    CONCLUSIONS: The removal of fiber post supported by a digital guide helped reduce the volume loss of post-core restoration teeth, but its accuracy was lower than that of removal by using a microscope-assisted ultrasonic instrument.
    目的: 通过离体牙模型对导板支持与显微镜辅助2种纤维桩拆除系统的精确度进行比较,为临床医师拆除纤维桩提供新思路和理论依据。方法: 将28颗人类离体前磨牙随机分为导板组与显微镜组,进行根管治疗及纤维桩修复治疗后,分别采用数字化导板与显微镜辅助超声器械进行纤维桩拆除。利用Mimics 10.0软件测量拆除后的偏差值,比较2种纤维桩拆除系统的精确度。结果: 导板组的尖端垂直偏差为0.99 mm±0.52 mm,尖端水平偏差为0.75 mm±0.19 mm,角度偏差为2.32°±0.64°,体积损失为8.09 mm3±1.42 mm3;显微镜组的尖端垂直偏差为0.44 mm±0.23 mm,尖端水平偏差为0.23 mm±0.07 mm,角度偏差为0.64°±0.31°,体积损失为15.25 mm3±3.94 mm3。2组的尖端水平偏差、角度偏差和体积损失的差异有统计学意义(P<0.05),尖端垂直偏差的差异无统计学意义(P>0.05)。结论: 在数字化导板的支持下拆除纤维桩有助于减少桩核修复后牙的体积损失,但精确度较显微镜辅助超声器械拆除低。.
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  • 文章类型: Journal Article
    背景:医疗保健中临床数据的自动分析需要分类。很少有关于健康科学中使用的分类学开发方法的评论。本系统综述旨在描述与患者安全相关的可用分类范围。用于分类学开发的方法,以及这些方法的优点和局限性。本系统综述的目的是指导未来的分类学发展项目。
    方法:TheCINAHL,PubMed,Scopus,从2012年1月至2023年4月25日,搜索了WebofScience数据库的研究。两位作者使用纳入和排除标准以及关键评估清单选择了研究。数据进行了归纳分析,结果以叙述方式报告。
    结果:整个医疗保健领域的研究(n=13)主要涉及不良事件和药物安全性的分类,但很少涉及专业领域和信息技术。关键评估表明,对所用分类学开发方法的报告不足。确定了分类学发展的十个阶段:(1)定义目的;(2)发展的理论基础,(3)相关数据源的识别,(4)主要术语的识别和定义,(5)项目编码和汇集,(6)编码和/或编码的可靠性和有效性评估,(7)发展层次结构,(8)测试结构,(9)试行分类法;(10)报告最终分类法的应用和验证。使用了十七个统计测试和七个软件系统,但是很少使用自动数据提取方法。多方法和多利益相关者方法,代码和层次结构测试和试点是优势和时间消耗和小样本测试的局限性。
    结论:与患者安全相关的不同专业和信息技术需要新的分类法。分类学开发需要结构化方法,报告和评估,以加强分类质量。提出了一个新的分类学发展指南,需要进行测试。Prospero注册号CRD42023411022。
    BACKGROUND: Taxonomies are needed for automated analysis of clinical data in healthcare. Few reviews of the taxonomy development methods used in health sciences are found. This systematic review aimed to describe the scope of the available taxonomies relative to patient safety, the methods used for taxonomy development, and the strengths and limitations of the methods. The purpose of this systematic review is to guide future taxonomy development projects.
    METHODS: The CINAHL, PubMed, Scopus, and Web of Science databases were searched for studies from January 2012 to April 25, 2023. Two authors selected the studies using inclusion and exclusion criteria and critical appraisal checklists. The data were analysed inductively, and the results were reported narratively.
    RESULTS: The studies (n = 13) across healthcare concerned mainly taxonomies of adverse events and medication safety but little for specialised fields and information technology. Critical appraisal indicated inadequate reporting of the used taxonomy development methods. Ten phases of taxonomy development were identified: (1) defining purpose and (2) the theory base for development, (3) relevant data sources\' identification, (4) main terms\' identification and definitions, (5) items\' coding and pooling, (6) reliability and validity evaluation of coding and/or codes, (7) development of a hierarchical structure, (8) testing the structure, (9) piloting the taxonomy and (10) reporting application and validation of the final taxonomy. Seventeen statistical tests and seven software systems were utilised, but automated data extraction methods were used rarely. Multimethod and multi-stakeholder approach, code- and hierarchy testing and piloting were strengths and time consumption and small samples in testing limitations.
    CONCLUSIONS: New taxonomies are needed on diverse specialities and information technology related to patient safety. Structured method is needed for taxonomy development, reporting and appraisal to strengthen taxonomies\' quality. A new guide was proposed for taxonomy development, for which testing is required. Prospero registration number CRD42023411022.
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  • 文章类型: Journal Article
    了解颜色在自然界中的众多作用仍然是许多进化和生态研究的中心焦点。然而,准确地表征并比较个体或物种之间的颜色或图案一直是历史上的挑战。近年来,已经开发了无数的新资源,使研究人员能够表征生物的颜色和图案,特别是来自数字图像。然而,每种资源都有自己的优势和劣势,回答一个特定的问题,并需要详细了解它的功能如何正确使用。这些细微差别会使导航这个新兴领域变得相当困难。在这里,我们评估了几种分析生物着色的新技术,特别关注数字图像。首先,我们介绍了在设计和实施着色研究时要考虑的有关光和感知的基本背景知识。然后,我们将展示如何对图像进行大量修改,以确保在分析之前进行一致的格式化。之后,我们描述了许多新的图像分析方法及其各自的功能,强调他们可以解决的研究问题的类型。我们演示了如何将这些不同的技术结合在一起,以检查新的研究问题并测试特定的假设。最后,我们概述了颜色模式研究的潜在未来方向。我们的目标是为希望从数字图像中研究生物颜色模式的研究人员提供一个起点和途径。
    Understanding the numerous roles that colouration serves in the natural world has remained a central focus in many evolutionary and ecological studies. However, to accurately characterise and then compare colours or patterns among individuals or species has been historically challenging. In recent years, there have been a myriad of new resources developed that allow researchers to characterise biological colours and patterns, specifically from digital imagery. However, each resource has its own strengths and weaknesses, answers a specific question and requires a detailed understanding of how it functions to be used properly. These nuances can make navigating this emerging field rather difficult. Herein, we evaluate several new techniques for analysing biological colouration, with a specific focus on digital images. First, we introduce fundamental background knowledge about light and perception to be considered when designing and implementing a study of colouration. We then show how numerous modifications can be made to images to ensure consistent formatting prior to analysis. After, we describe many of the new image analysis approaches and their respective functions, highlighting the type of research questions that they can address. We demonstrate how these various techniques can be brought together to examine novel research questions and test specific hypotheses. Finally, we outline potential future directions in colour pattern studies. Our goal is to provide a starting point and pathway for researchers wanting to study biological colour patterns from digital imagery.
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  • 文章类型: Journal Article
    从动态敏感性对比(DSC)灌注MR成像(pMRI)得出的相对脑血容量(rCBV)已被证明是神经放射学肿瘤负荷的强大标志。最近pMRI采集策略的共识建议为pMRI纳入不同患者护理中心提供了途径。无论大小或经验。然而,即使正确实施和执行DSC-MRI协议,将会出现许多中心可能不容易识别或意识到的问题。此外,在产生的rCBV图像中,错过的pMRI问题并不总是明显的,加强不准确或错过的放射学诊断。因此,我们从DSC-MRI数据集数据库中收集,真实的例子展示了收购中的故障,后处理,和解释,以及可能的适当缓解策略。解决的pMRI问题包括与图像采集和后处理相关的问题,重点是造影剂管理,定时,和率,信噪比质量,和易感性伪影。这项工作的目标是提供指导,以最大程度地减少和识别pMRI问题,以确保仅解释质量数据。
    Relative cerebral blood volume (rCBV) derived from dynamic susceptibility contrast (DSC) perfusion MR imaging (pMRI) has been shown to be a robust marker of neuroradiological tumor burden. Recent consensus recommendations in pMRI acquisition strategies have provided a pathway for pMRI inclusion in diverse patient care centers, regardless of size or experience. However, even with proper implementation and execution of the DSC-MRI protocol, issues will arise that many centers may not easily recognize or be aware of. Furthermore, missed pMRI issues are not always apparent in the resulting rCBV images, potentiating inaccurate or missed radiological diagnoses. Therefore, we gathered from our database of DSC-MRI datasets, true-to-life examples showcasing the breakdowns in acquisition, postprocessing, and interpretation, along with appropriate mitigation strategies when possible. The pMRI issues addressed include those related to image acquisition and postprocessing with a focus on contrast agent administration, timing, and rate, signal-to-noise quality, and susceptibility artifact. The goal of this work is to provide guidance to minimize and recognize pMRI issues to ensure that only quality data is interpreted.
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  • 文章类型: Journal Article
    为了使临床规范与循证实践保持一致,牙科研究人员需要具备阅读和评估荟萃分析的能力。此外,牙科临床医生应准备好领导纳入荟萃分析的调查。本文概述了将使牙科研究人员从事荟萃分析工作的原则和实践。解决了荟萃分析的六个要素:制定研究问题,搜索文献,收集数据,聚合数据,分析数据,解释结果和绘制概括。读者被引导通过这些阶段的研究,以便他们能够识别和实施健壮的,可重复的荟萃分析工作。
    In order to keep clinical norms aligned with evidence-based practices, dental researchers need to be equipped to read and evaluate meta-analyses. Moreover, clinician scientists in dentistry should be prepared to lead investigations that incorporate meta-analysis. This article provides an overview of the principles and practices that will equip dental researchers to engage in meta-analysis work. Six elements of meta-analysis are addressed: formulating a research question, searching the literature, collecting the data, aggregating the data, analyzing the data, and interpreting results and drawing generalizations. Readers are guided through each of these stages of research so that they can recognize and implement robust, reproducible meta-analysis work.
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