"Les métaanalyses et les essais contrôlés randomisés représentent le gold standard dans le paradigme de la médecine basée sur les preuves. En radiothérapie, ces essais sont cependant difficiles à mettre en oeuvre pour des raisons essentiellement financières, institutionnelles , d'implication médicale et d'évolution rapide des techniques dont peuvent bénéficier favorablement les patients . Les essais comparant deux techniques d'irradiation par exemple (classique et innovante) peinent à inclure. "
[Show abstract][Hide abstract] ABSTRACT: Stereotactic body radiation therapy for lung cancer is now well established for patients who are not eligible to surgery. These patients can benefit from a curative treatment, which is a new therapeutic indication. Protocols are effective and well tolerated even for the most fragile patients. Three randomized trials comparing stereotactic body radiation therapy and surgery failed due to poor accrual. However, taking into account the favourable available data, the choice of stereotactic body radiation therapy in first intention arises. The treatment decision has to be discussed in a multidisciplinary way, while considering the opinion of the patient, who must be clearly informed about the principle of both therapeutic options.
"CER assists all healthcare stakeholders in healthcare in making informed decisions to improve outcomes at the individual and population levels. The contrasting merits between randomized control trials (RCTs), the gold standard in CER, and observational studies have recently been highlighted as they pertain to specific challenges in oncology such as rising costs and rapidly evolving technology  . The challenges of performing RCTs, even when there is a good clinical question, have been clearly illustrated in lung SABR. "
"posttraumatic stress disorder (PTSD), because dropout is unlikely to occur at random, inferences drawn from these data may not be valid without statistical adjustment; however, such adjustments may not be feasible. For example, the use of inverse probability weighting requires that the weights appropriately model the true pattern of dropout , which is difficult to do without knowing the reasons for dropout. Patients may drop out for several reasons, including early improvement , failure to improve, or other reasons . "
[Show abstract][Hide abstract] ABSTRACT: A large body of comparative effectiveness research (CER) focuses on the use of observational and quasi-experimental approaches. We sought to examine the use of clinical trials as a tool for CER, particularly in mental health.
Examination of three ongoing randomized clinical trials in psychiatry addressing issues that would pose difficulties for nonexperimental CER methods.
Existing statistical approaches to nonexperimental data appear insufficient to compensate for biases that may arise when the pattern of missing data cannot be properly modeled such as when there are no standards for treatment, when affected populations have limited access to treatment, or when there are high rates of treatment dropout.
Clinical trials should retain an important role in CER, particularly in cases of high disorder prevalence, large expected effect sizes, difficult-to-reach populations, or when examining sequential treatments or stepped-care algorithms. Progress in CER on mental health will require careful consideration of appropriate selection between clinical trials and nonexperimental designs and on allocation of research resources to optimally inform key treatment decisions for each patient.
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