Journal of clinical epidemiology
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Meta Analysis Comparative Study
Adjustment for compliance behavior in trials of epidural analgesia in labor using instrumental variable meta-analysis.
Intention-to-treat (ITT) analysis of randomized controlled trials (RCTs) may cause bias when compliance is poor. Noncompliance describes failure to comply with allocation in the intervention arm, and contamination describes uptake of the intervention in the control arm. Instrumental variable (IV) analysis can be applied in addition to the primary ITT analysis to estimate the causal effect adjusted for noncompliance and contamination, assuming that noncompliers would have had the same treatment benefit as compliers. We aimed to compare ITT and IV meta-analysis of the association between epidural analgesia in labor and cesarean section. ⋯ ITT meta-analysis underestimates the effect of receiving epidural analgesia in labor on cesarean section compared with IV meta-analysis.
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To identify factors associated with the implementability of clinical practice guidelines (CPGs) and to determine what characteristics improve their uptake. ⋯ Our work represents a comprehensive and interdisciplinary effort toward better understanding, which attributes of guidelines have the potential to improve uptake in clinical practice. We also created codebooks and narratives of key concepts, which can be used to create tools for developing better guidelines to promote better care.
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We aimed to compare nonlinear modeling methods for handling continuous predictors for reproducibility and transportability of prediction models. ⋯ Flexible nonlinear modeling methods led to better model performance at internal validation. However, when application of the model is intended across a wide range of settings, less flexible functions may be more appropriate to maximize external validity.