Home  |  About us  |  Editorial board  |  Ahead of print  | Current issue  |  Archives  |  Submit article  |  Instructions |  Search  |   Subscribe  |  Advertise  |  Contacts  |  Login 
  Users Online: 1150Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

 Table of Contents      
STATISTICS
Year : 2015  |  Volume : 6  |  Issue : 3  |  Page : 169-170

Common pitfalls in statistical analysis: Clinical versus statistical significance


1 Department of Anaesthesiology, Division of Thoracic Surgery, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
2 Department of Surgical Oncology, Division of Thoracic Surgery, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
3 International Drug Development Institute, Hasselt University, Belgium

Date of Web Publication6-Jul-2015

Correspondence Address:
Priya Ranganathan
Department of Anaesthesiology, Tata Memorial Centre, Ernest Borges Road, Parel, Mumbai - 400 012, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-3485.159943

Rights and Permissions
   Abstract 

In clinical research, study results, which are statistically significant are often interpreted as being clinically important. While statistical significance indicates the reliability of the study results, clinical significance reflects its impact on clinical practice. The third article in this series exploring pitfalls in statistical analysis clarifies the importance of differentiating between statistical significance and clinical significance.

Keywords: Biostatistics, confidence intervals, data interpretation, statistical


How to cite this article:
Ranganathan P, Pramesh C S, Buyse M. Common pitfalls in statistical analysis: Clinical versus statistical significance. Perspect Clin Res 2015;6:169-70

How to cite this URL:
Ranganathan P, Pramesh C S, Buyse M. Common pitfalls in statistical analysis: Clinical versus statistical significance. Perspect Clin Res [serial online] 2015 [cited 2023 Mar 23];6:169-70. Available from: http://www.picronline.org/text.asp?2015/6/3/169/159943

One of the common problems faced by readers (and authors!) of medical articles is in the interpretation of the word "significance." The term "statistical significance" is often misinterpreted as a "clinically important" result. The confusion stems from the fact that many people equate "significance" with its literal meaning of "importance," whereas in statistics, it has a far more restrictive connotation. This article explains the idea of the statistical significance and differentiates it from clinical relevance or importance, which is an entirely different concept. In the previous article, in this series, we looked at different ways of expressing statistical significance ("P0" values versus confidence intervals). [1] Measures of statistical significance quantify the probability of a study's results being due to chance. Clinical significance, on the other hand, refers to the magnitude of the actual treatment effect (i.e., the difference between the intervention and control groups, also known as the "treatment effect size"), which will determine whether the results of the trial are likely to impact current medical practice. The "P" value, frequently used to measure statistical significance, is the probability that the study results are due to chance rather than to a real treatment effect. The conventional cut off for the "P0" value to be considered statistically significant is of 0.05 (or 5%). What a P < 0.05 implies is that the possibility of the results in a study being due to chance is <5%.

In clinical practice, the "clinical significance" of a result is dependent on its implications on existing practice-treatment effect size being one of the most important factors that drives treatment decisions. LeFort suggests that the clinical significance should reflect "the extent of change, whether the change makes a real difference to subject lives, how long the effects last, consumer acceptability, cost-effectiveness, and ease of implementation". [2] While there are established, traditionally accepted values for statistical significance testing, this is lacking for evaluating clinical significance. [3] More often than not, it is the judgment of the clinician (and the patient) which decides whether a result is clinically significant or not.

Statistical significance is heavily dependent on the study's sample size; with large sample sizes, even small treatment effects (which are clinically inconsequential) can appear statistically significant; therefore, the reader has to interpret carefully whether this "significance" is clinically meaningful. A study published in the Journal of Clinical Oncology compared overall survival in 569 patients with advanced pancreatic cancer who were randomised to receive erlotinib plus gemcitabine versus gemcitabine alone. [4] Median survival was found to be "significantly" prolonged in the erlotinib/gemcitabine arm (6.24 months vs. 5.91 months, P = 0.038). The P = 0.038 means that there is only a 3.8% chance that this observed difference between the groups occurred by chance (which is less than the traditional cut-off of 5%) and therefore, statistically significant. In this example, the clinical relevance of this "positive" study is the "treatment effect" or difference in median survival between 6.24 and 5.91 months - a mere 10 days, which most oncologists would agree is a clinically irrelevant "improvement" in outcomes, especially when considering the added toxicity and costs involved with the combination.

Most journals now endorse the use of the CONSORT statement for reporting of parallel-group randomized trials, which emphasizes the need for reporting of the estimated effect size and its precision (such as 95% confidence interval) for each primary and secondary outcome. [5] Readers should bear in mind that interpretation of study results should take into account the clinical significance by looking at the actual treatment effect (with confidence intervals) and should not just be based on "P" values and statistical significance.

 
   References Top

1.
Ranganathan P, Pramesh CS, Buyse M. Common pitfalls in statistical analysis: "P" values, statistical significance and confidence intervals. Perspect Clin Res 2015;6:116-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
LeFort SM. The statistical versus clinical significance debate. Image J Nurs Sch 1993;25:57-62.  Back to cited text no. 2
    
3.
Fethney J. Statistical and clinical significance, and how to use confidence intervals to help interpret both. Aust Crit Care 2010;23:93-7.  Back to cited text no. 3
    
4.
Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: A phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 2007;25:1960-6.  Back to cited text no. 4
    
5.
Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010;152:726-32.  Back to cited text no. 5
[PUBMED]    



This article has been cited by
1 Use of Bayesian Statistics to Reanalyze Data From the Pragmatic Randomized Optimal Platelet and Plasma Ratios Trial
Daniel Lammers, Joshua Richman, John B. Holcomb, Jan O. Jansen
JAMA Network Open. 2023; 6(2): e230421
[Pubmed] | [DOI]
2 Most-Cited Patient-Reported Outcome Measures Within Otolaryngology—Revisiting the Minimal Clinically Important Difference
Andrew M. Peterson, Brevin Miller, Patrick Ioerger, Firas Hentati, Michelle M. Doering, Dorina Kallogjeri, Jay F. Piccirillo
JAMA Otolaryngology–Head & Neck Surgery. 2023;
[Pubmed] | [DOI]
3 Using minimal clinically important differences to measure long-term transitions of osteosarcopenia: The New Mexico Aging Process Study
Lara Vlietstra, Ben Kirk, Gustavo Duque, Clifford Qualls, Bruno Vellas, Sandrine Andrieu, John E. Morley, Debra L. Waters
Experimental Gerontology. 2023; 173: 112106
[Pubmed] | [DOI]
4 Irving Kirsch opens a window on antidepressant medications
Emma Grace Chen, Alison Kate Oliver, Amir Raz
American Journal of Clinical Hypnosis. 2023; 65(3): 223
[Pubmed] | [DOI]
5 Child Opportunity Index and Hospital Utilization in Children With Traumatic Brain Injury Admitted to the PICU
Monica M. Gray, Sindhoosha Malay, Lawrence C. Kleinman, Kurt C. Stange, Elaine A. Borawski, Steven L. Shein, Katherine N. Slain
Critical Care Explorations. 2023; 5(2): e0840
[Pubmed] | [DOI]
6 Predictors of optimal uptake of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine and outcome of pregnancy in selected health facilities: a cross-sectional study in Northern Ghana
Yaa Nyarko Agyeman, Bougangue Bassoumah, Joseph Owusu-Marfo
Malaria Journal. 2023; 22(1)
[Pubmed] | [DOI]
7 Association of physical activity with physical function and quality of life in people with hip and knee osteoarthritis: longitudinal analysis of a population-based cohort
David G. Lopes, Daniela Costa, Eduardo B. Cruz, Nuno Mendonça, Ana Rita Henriques, Jaime Branco, Helena Canhão, Ana M. Rodrigues
Arthritis Research & Therapy. 2023; 25(1)
[Pubmed] | [DOI]
8 Evaluating validity and reliability of the Arabic-version low-vision quality-of-life questionnaire
Ali Mazyed Alsaqr, Saleh Ali Alribai, Khaled Humod Almutiri, Esam Saad Almutleb, Ali Ahmad Abusharha
British Journal of Visual Impairment. 2022; : 0264619622
[Pubmed] | [DOI]
9 Association of preconception dysmenorrhea with obstetric complications: the Japan Environment and Children’s Study
Tsuyoshi Murata, Yuta Endo, Toma Fukuda, Hyo Kyozuka, Shun Yasuda, Akiko Yamaguchi, Akiko Sato, Yuka Ogata, Kosei Shinoki, Mitsuaki Hosoya, Seiji Yasumura, Koichi Hashimoto, Hidekazu Nishigori, Keiya Fujimori, Michihiro Kamijima, Shin Yamazaki, Yukihiro Ohya, Reiko Kishi, Nobuo Yaegashi, Koichi Hashimoto, Chisato Mori, Shuichi Ito, Zentaro Yamagata, Hidekuni Inadera, Takeo Nakayama, Hiroyasu Iso, Masayuki Shima, Youichi Kurozawa, Narufumi Suganuma, Koichi Kusuhara, Takahiko Katoh
BMC Pregnancy and Childbirth. 2022; 22(1)
[Pubmed] | [DOI]
10 Association between indigenous status and Body Mass Index (BMI) in Australian adults: Does sleep duration affect the relationship?
Melissa Deacon-Crouch, Isabelle Skinner, Joseph Tucci, Steve Begg, Ruth Wallace, Timothy Skinner, Judith Katzenellenbogen
PLOS ONE. 2022; 17(2): e0263233
[Pubmed] | [DOI]
11 Ionised and total hypocalcaemia in pregnancy: An analysis of prevalence and risk factors in a resource-limited setting, Cameroon
Atem Bethel Ajong, Bruno Kenfack, Innocent Mbulli Ali, Martin Ndinakie Yakum, Ukaogo Prince Onydinma, Fulbert Nkwele Mangala, Loai Aljerf, Phelix Bruno Telefo, Frank T. Spradley
PLOS ONE. 2022; 17(5): e0268643
[Pubmed] | [DOI]
12 Cost-effectiveness of dehydrated human amnion/chorion membrane allografts in lower extremity diabetic ulcer treatment
William H Tettelbach, David G Armstrong, Thomas J Chang, Julie L De Jong, Paul M Glat, Jeffrey H Hsu, Martha R Kelso, Jeffrey A Niezgoda, Jonathan M Labovitz, Brandon Hubbs, R Allyn Forsyth, Benjamin G Cohen, Natalie M Reid, William V Padula
Journal of Wound Care. 2022; 31(Sup2): S10
[Pubmed] | [DOI]
13 Radiology Implementation Considerations for Artificial Intelligence (AI) Applied to COVID-19, From the AJR Special Series on AI Applications
Matthew D. Li, Ken Chang, Xueyan Mei, Adam Bernheim, Michael Chung, Sharon Steinberger, Jayashree Kalpathy-Cramer, Brent P. Little
American Journal of Roentgenology. 2022; : 1
[Pubmed] | [DOI]
14 An exploratory analysis of hardiness and health behaviours in Canadian Armed Forces (CAF) recruits
Samantha Carlucci, Heather McCuaig Edge
Journal of Military, Veteran and Family Health. 2022;
[Pubmed] | [DOI]
15 Effectiveness of bimodal auditory and electrical stimulation in patients with tinnitus: A feasibility study
Shikha Spencer, Marzena Mielczarek, Jurek Olszewski, Magdalena Sereda, Iris Joossen, Hanne Vermeersch, Annick Gilles, Sarah Michiels
Frontiers in Neuroscience. 2022; 16
[Pubmed] | [DOI]
16 Romantic Relationships and Mental Health During the COVID-19 Pandemic in Austria: A Population-Based Cross-Sectional Survey
Benedikt Till, Thomas Niederkrotenthaler
Frontiers in Psychology. 2022; 13
[Pubmed] | [DOI]
17 Effect of virtual group EcoMeditation on psychological conditions and flow states
Dawson Church, Peta Stapleton, Donna Gosatti, Tom O’Keefe
Frontiers in Psychology. 2022; 13
[Pubmed] | [DOI]
18 Hemostatic Activity of Canine Never-Frozen Liquid Plasma Collected for Transfusion
Daniela Proverbio, Roberta Perego, Luciana Baggiani, Eva Spada
Frontiers in Veterinary Science. 2022; 9
[Pubmed] | [DOI]
19 Randomized Controlled Trials in Lung, Gastrointestinal, and Breast Cancers: An Overview of Global Research Activity
J. Connor Wells, Adam Fundytus, Shubham Sharma, Wilma M. Hopman, Joseph C. Del Paggio, Bishal Gyawali, Deborah Mukherji, Nazik Hammad, C. S. Pramesh, Ajay Aggarwal, Richard Sullivan, Christopher M. Booth
Current Oncology. 2022; 29(4): 2530
[Pubmed] | [DOI]
20 Alleviating Surgeons’ Stress through Listening to Natural Sounds in a Half-Encapsulated Rest Space after an Operation: A Pilot, Longitudinal Field Study
Yasushi Suko, Tomoharu Shindo, Kaoru Saito, Norimasa Takayama, Shin’ichi Warisawa, Tetsuya Sakuma, Masaaki Ito, Pasi Kytölä, Tapio Nummi, Kalevi Korpela
International Journal of Environmental Research and Public Health. 2022; 19(19): 12736
[Pubmed] | [DOI]
21 Correlation of COVID-19 with severity of periodontitis-A clinical and biochemical study
Rupali Kalsi, Zoya Ahmad, Mallapragada Siddharth, KharidhiLaxman Vandana, SachitAnand Arora, Kumar Saurav
Indian Journal of Dental Research. 2022; 33(3): 307
[Pubmed] | [DOI]
22 Clinical tool to measure fluorescein patterns in orthokeratology
Marina López García Rosuero, Alejandro Arranz Bombin, Roberto Romero, Roberto Hornero, Raul Martin
PeerJ. 2022; 10: e14068
[Pubmed] | [DOI]
23 Variation in activation marker expression within the platelet population – a new parameter for evaluation of platelet flow cytometry data
Nahreen Tynngård, Aseel Alshamari, Freja Månsson, Sofia Ramström
Platelets. 2022; : 1
[Pubmed] | [DOI]
24 Relational leadership
Lucy Leclerc, K. Kie Strenge-McNabb, Traci Thibodeaux, Susan Campis, Kay Kennedy
Nursing Management. 2022; 53(7): 24
[Pubmed] | [DOI]
25 Comment on The Unbearable Lightness of Difference Between Statistical and Clinical Significance
Luca Bertolaccini, Oriana Ciani, Lorenzo Spaggiari
Annals of Surgery Open. 2022; 3(1): e114
[Pubmed] | [DOI]
26 Identifying alternative mental health interventions: a systematic review of randomized controlled trials of chanting and breathwork
Shikha Malviya, Pamela Meredith, Barbra Zupan, Lachlan Kerley
Journal of Spirituality in Mental Health. 2022; : 1
[Pubmed] | [DOI]
27 Health At Every Size intervention® under real-world conditions: the rights and wrongs of program implementation
Audrey Cloutier-Bergeron, Amélie Samson, Véronique Provencher, Lyne Mongeau, Marie-Claude Paquette, Mylène Turcotte, Catherine Bégin
Health Psychology and Behavioral Medicine. 2022; 10(1): 935
[Pubmed] | [DOI]
28 Leveraging confidence intervals to inform the clinical significance of interventions
Pamela Fernainy, Nadia Sourial
Family Practice. 2022;
[Pubmed] | [DOI]
29 An Efficient One-Step Moment Balancing Algorithm for Computing Medial and Lateral Knee Compartment Contact Forces
Kurt Manal, Thomas S. Buchanan
Journal of Biomechanical Engineering. 2022; 144(3)
[Pubmed] | [DOI]
30 Making the Sentencing Case: Psychological and Neuroscientific Evidence for Expanding the Age of Youthful Offenders
B.J. Casey, C. Simmons, L.H. Somerville, A. Baskin-Sommers
Annual Review of Criminology. 2022; 5(1): 321
[Pubmed] | [DOI]
31 Promoting Paraeducators’ Use of Evidence-Based Practices for Students With Autism
Ann M. Sam, Jessica R. Steinbrenner, Samuel L. Odom, Sallie W. Nowell, Victoria Waters, Yolanda Perkins, Mary White, Hariharan Swaminathan, H. Jane Rogers
Exceptional Children. 2022; : 0014402922
[Pubmed] | [DOI]
32 The Fragility Index of Statistically Significant Findings From Randomized Controlled Trials Comparing the Management Strategies of Anterior Shoulder Instability
Martin S. Davey, Eoghan T. Hurley, Tom R. Doyle, Hasan Dashti, Mohamed Gaafar, Hannan Mullett
The American Journal of Sports Medicine. 2022; : 0363546522
[Pubmed] | [DOI]
33 Psychosocial Effects of Remote Reading with Telephone Support versus In-Person Health Education for Diverse, Older Adults
Anjali R. Shah, Liang Ni, Allison A. Bay, Ariel R. Hart, Molly M. Perkins, Madeleine E. Hackney
Journal of Applied Gerontology. 2022; : 0733464822
[Pubmed] | [DOI]
34 Parent-Child Concordance and Discordance in Family Violence Reporting: A Descriptive Analysis from the Adolescent Brain Cognitive Development Study®
Jasara N. Hogan, Alexis M. Garcia, Rachel L. Tomko, Lindsay M. Squeglia, Julianne C. Flanagan
Journal of Interpersonal Violence. 2022; : 0886260522
[Pubmed] | [DOI]
35 Psychosocial and Health-Related Experiences of Individuals With Microtia and Craniofacial Microsomia and Their Families: Narrative Review Over 2 Decades
Alexis L Johns, Nicola M Stock, Bruna Costa, Kristin Billaud Feragen, Canice E Crerand
The Cleft Palate-Craniofacial Journal. 2022; : 1055665622
[Pubmed] | [DOI]
36 Remote versus In-Person Health Education: Feasibility, Satisfaction, and Health Literacy for Diverse Older Adults
Anjali R. Shah, Liang Ni, Allison A. Bay, Ariel R. Hart, Molly M. Perkins, Madeleine E. Hackney
Health Education & Behavior. 2022; : 1090198122
[Pubmed] | [DOI]
37 Responses to the Letter
Trabelsi Yassine, Mekki Marwa
American Journal of Men's Health. 2022; 16(3): 1557988322
[Pubmed] | [DOI]
38 The accuracy of teledentistry in caries detection in children – A diagnostic study
Mohammad AlShaya, Deema Farsi, Nada Farsi, Najat Farsi
DIGITAL HEALTH. 2022; 8: 2055207622
[Pubmed] | [DOI]
39 An evaluation of Anxiety UK's psychological therapy service outcomes
Su-Gwan Tham, Nicky Lidbetter, Rebecca Pedley, Dave Smithson, Beatrice Lukoseviciute, Patricia Gooding
Journal of Affective Disorders. 2022;
[Pubmed] | [DOI]
40 The Impact of Hospital Size and Teaching Status on Outcomes Following Total Ankle Arthroplasty
DiegoJ.L. Lima, Vani J. Sabesan, Graysen R. Petersen-Fitts, Maxwell L. Winkler, Matthew C. Sweet, Nikolas Bustamante Echeverry, James D. Whaley
The Journal of Foot and Ankle Surgery. 2022;
[Pubmed] | [DOI]
41 Selecting and Implementing Patient-Reported Outcome and Experience Measures to Assess Health System Performance
Claudia Bull, Helena Teede, Diane Watson, Emily J. Callander
JAMA Health Forum. 2022; 3(4): e220326
[Pubmed] | [DOI]
42 Performance criteria-based effect size ( PCES ) measurement of single-case experimental designs: A real-world data study
Orhan Aydin, René Tanious
Journal of Applied Behavior Analysis. 2022;
[Pubmed] | [DOI]
43 Reallocating time to physical activity and sleep: associations with quality of life in cancer survivors
Mary C. Hidde, Kate Lyden, Kim Henry, Heather J. Leach
Supportive Care in Cancer. 2022;
[Pubmed] | [DOI]
44 Identifying and elucidating the resistance of Staphylococcus aureus isolated from hospital environment to conventional disinfectants
Samreen Sarwar, Sidrah Saleem, Faheem Shahzad, Shah Jahan
American Journal of Infection Control. 2022;
[Pubmed] | [DOI]
45 Evidence of religious/spiritual singing and movement in mental health: A systematic review
Shikha Malviya, Barbra Zupan, Pamela Meredith
Complementary Therapies in Clinical Practice. 2022; : 101567
[Pubmed] | [DOI]
46 Patients Receiving Integrative Medicine Effectiveness Registry (PRIMIER) of the BraveNet practice-based research network: Outcomes of the PRIMIER cohort
Jeffery A. Dusek, Qi Gao, Ryung S. Kim, Donald I. Abrams, Benjamin Kligler, Natalie L. Dyer, Kathryn Hansen, M. Diane McKee
Complementary Therapies in Medicine. 2022; 71: 102904
[Pubmed] | [DOI]
47 Safety and efficacy of insulin detemir versus neutral protamine Hagedorn in the treatment of diabetes during pregnancy: systematic review and meta-analysis of randomized controlled trials
Kleoniki I. Athanasiadou, Stavroula A. Paschou, Theodosios Stamatopoulos, Evgenia Papakonstantinou, Anna-Bettina Haidich, Dimitrios G. Goulis
Diabetes Research and Clinical Practice. 2022; : 110020
[Pubmed] | [DOI]
48 Younger Age, Capsular Repair, and Larger Preoperative Alpha Angles are Associated With Earlier Achievement of Clinically Meaningful Improvement Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome
Vivian W. Ouyang, Benjamin R. Saks, David R. Maldonado, Andrew E. Jimenez, Hari K. Ankem, Payam W. Sabetian, Ajay C. Lall, Benjamin G. Domb
Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021;
[Pubmed] | [DOI]
49 Systematic Review of the Effect of Modification of Antecedents in the Treatment of Sleep Problems Among Children on the Autism Spectrum
Kate A. M. Ford, Laurie K. McLay, Karyn G. France, Neville M. Blampied, Rosina M. Gibbs
Advances in Neurodevelopmental Disorders. 2021;
[Pubmed] | [DOI]
50 Associations between diet quality and obesity in a nationally representative sample of Iranian households: A cross-sectional study
Sara Ebrahimi,Rebecca M. Leech,Sarah A. McNaughton,Morteza Abdollahi,Anahita Houshiarrad,Katherine M. Livingstone
Obesity Science & Practice. 2021;
[Pubmed] | [DOI]
51 p value variability and subgroup testing
Graham Horgan
European Journal of Nutrition. 2021;
[Pubmed] | [DOI]
52 Mirror therapy for phantom limb pain in moderate intellectual disability. A case report
Annabel Folch,Daniel Gallo,Jordi Miró,Luis Salvador-Carulla,Rafael Martínez-Leal
European Journal of Pain. 2021;
[Pubmed] | [DOI]
53 Effect of acute lower respiratory tract infection on pulmonary artery pressure in children with post-tricuspid left-to-right shunt
Sakshi Sachdeva,Shyam S. Kothari,Saurabh K. Gupta,Sivasubramanian Ramakrishnan,Anita Saxena
Cardiology in the Young. 2021; : 1
[Pubmed] | [DOI]
54 Growth differentiation factor 15 in pregnant women: A hero or villain?
Yiu-Tai Li,Wei-Ting Chao,Peng-Hui Wang
Taiwanese Journal of Obstetrics and Gynecology. 2021; 60(4): 593
[Pubmed] | [DOI]
55 Pointers and Pitfalls in Interpreting Nutrition and Dietetics Research: The Importance of Statistical and Clinical Significance
Jeffrey E. Harris, Jamie Zoellner
Journal of the Academy of Nutrition and Dietetics. 2021;
[Pubmed] | [DOI]
56 Potential Risks for Healthcare Disparities Among Individuals With Voice and Upper Airway Disorders: A Systematic Review
Mariah E. Morton, Shelby Easter, Michael Brown, Mary J. Sandage
Journal of Voice. 2021;
[Pubmed] | [DOI]
57 Methodological Gaps in Studying the Oral-Systemic Disease Connection
E. Raittio,J. Farmer
Journal of Dental Research. 2021; 100(5): 445
[Pubmed] | [DOI]
58 Skills for Preventing Injury in Youth: Evaluating Change in Adolescent Alcohol Use, Violence, and Road-Related Injuries
Lisa Buckley,Bianca Reveruzzi,Kelly Dingli,Rebekah L. Chapman,Mary Sheehan
Youth & Society. 2021; 53(6): 894
[Pubmed] | [DOI]
59 Standardized Nomenclature for Modified Rankin Scale Global Disability Outcomes: Consensus Recommendations From Stroke Therapy Academic Industry Roundtable XI
Jeffrey L. Saver,Napasri Chaisinanunkul,Bruce C.V. Campbell,James C. Grotta,Michael D. Hill,Pooja Khatri,Jaren Landen,Maarten G. Lansberg,Chitra Venkatasubramanian,Gregory W. Albers
Stroke. 2021;
[Pubmed] | [DOI]
60 When American Adults Do Move, How Do They Do So? Trends in Physical Activity Intensity, Type, and Modality: 1988–2017
Matthew A. Ladwig,Christopher N. Sciamanna,Brandon J. Auer,Tamara K. Oser,Jonathan G. Stine,Jennifer P. Agans
Journal of Physical Activity and Health. 2021; : 1
[Pubmed] | [DOI]
61 Dose-dependent association between xerostomia and number of medications among older adults
Tanner Storbeck,Fang Qian,Cindy Marek,Daniel Caplan,Leonardo Marchini
Special Care in Dentistry. 2021;
[Pubmed] | [DOI]
62 Factors determining nurses’ knowledge of evidence-based pressure ulcer prevention practices in Finland: a correlational cross-sectional study
Heidi Parisod,Arja Holopainen,Marita Koivunen,Pauli Puukka,Elina Haavisto
Scandinavian Journal of Caring Sciences. 2021;
[Pubmed] | [DOI]
63 The Interplay Between Postsynaptic Striatal D2/3 Receptor Availability, Adversity Exposure and Odd Beliefs: A [11C]-Raclopride PET Study
Lukasz Smigielski,Diana Wotruba,Valerie Treyer,Julian Rössler,Sergi Papiol,Peter Falkai,Edna Grünblatt,Susanne Walitza,Wulf Rössler
Schizophrenia Bulletin. 2021;
[Pubmed] | [DOI]
64 The predictors of sepsis-related acute kidney injury
Wen-Ling Lee,Fa-Kung Lee,Peng-Hui Wang
Journal of the Chinese Medical Association. 2021; 84(3): 243
[Pubmed] | [DOI]
65 The effectiveness of e-health interventions for the treatment of overweight or obesity in children and adolescents: A systematic review and meta-analysis
Liane B. Azevedo, John Stephenson, Louisa Ells, Shirley Adu-Ntiamoah, Ann DeSmet, Emma L. Giles, Anna Haste, Claire O'Malley, Daniel Jones, Li Kheng Chai, Tracy Burrows, Clare E. Collins, Amy Grieken, Michelle Hudson
Obesity Reviews. 2021;
[Pubmed] | [DOI]
66 The Step-Count Accuracy of Activity Monitors on Land and in the Water
Sandra Stevens, Natalie Norman Michaels, Marnie Vanden Noven, Jennifer Caputo, Samantha L. Johnson
Journal of Aquatic Physical Therapy. 2021; 29(2): 49
[Pubmed] | [DOI]
67 Changed ophthalmic workload following introduction of digital retinal photography for retinopathy of prematurity screening
Joshua S. Tram,Bernadette M. Golding,Christine Lim,Carl A. Kuschel,James E. Elder
Clinical & Experimental Ophthalmology. 2021;
[Pubmed] | [DOI]
68 The Effect of a High-Intensity PrO2Fit Inspiratory Muscle Training Intervention on Physiological and Psychological Health in Adults with Bronchiectasis: A Mixed-Methods Study
Jessica L. McCreery,Kelly A. Mackintosh,Rebekah Mills-Bennett,Melitta A. McNarry
International Journal of Environmental Research and Public Health. 2021; 18(6): 3051
[Pubmed] | [DOI]
69 Common Problematic Scholarly Activity Project Planning Expectations of Project Novices
Samuel J. Wisniewski, William D. Corser
Spartan Medical Research Journal. 2021; 6(1)
[Pubmed] | [DOI]
70 Remarks on the use of Pearson’s and Spearman’s correlation coefficients in assessing relationships in ophthalmic data
Ali M. Alsaqr
African Vision and Eye Health. 2021; 80(1)
[Pubmed] | [DOI]
71 Intermittent preventive treatment comparing two versus three doses of sulphadoxine pyrimethamine (IPTp-SP) in the prevention of anaemia in pregnancy in Ghana: A cross-sectional study
Yaa Nyarko Agyeman,Sam Newton,Raymond Boadu Annor,Ellis Owusu-Dabo,Adrian J.F. Luty
PLOS ONE. 2021; 16(4): e0250350
[Pubmed] | [DOI]
72 Analysis of the CONKO-001 trial: Is the validity of the study sufficient to recommend adjuvant chemotherapy for pancreatic cancer?
Katrin Bauer, Doris Henne-Bruns, Giulia Manzini
International Journal of Risk & Safety in Medicine. 2021; : 1
[Pubmed] | [DOI]
73 Are patient-reported outcomes the same following second-side surgery in primary hip and knee arthroplasty?
Adam Tucker,Jonathan M. Warnock,Roslyn Cassidy,Richard J. Napier,David Beverland
Bone & Joint Open. 2021; 2(4): 243
[Pubmed] | [DOI]
74 Knee registries: state of the art
Eran Beit Ner, Norimasa Nakamura, Christian Lattermann, Michael James McNicholas
Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. 2021; : jisakos-20
[Pubmed] | [DOI]
75 BMI trajectory in childhood is associated with asthma incidence at young adulthood mediated by DNA methylation
Rutu Rathod,Hongmei Zhang,Wilfried Karmaus,Susan Ewart,Latha Kadalayil,Caroline Relton,Susan Ring,S. Hasan Arshad,John W. Holloway
Allergy, Asthma & Clinical Immunology. 2021; 17(1)
[Pubmed] | [DOI]
76 Assessing responsiveness of the EQ-5D-3L, the Oxford Hip Score, and the Oxford Knee Score in the NHS patient-reported outcome measures
Sujin Kang
Journal of Orthopaedic Surgery and Research. 2021; 16(1)
[Pubmed] | [DOI]
77 Global trends of antimicrobial susceptibility to ceftaroline and ceftazidime–avibactam: a surveillance study from the ATLAS program (2012–2016)
Hui Zhang,Yingchun Xu,Peiyao Jia,Ying Zhu,Ge Zhang,Jingjia Zhang,Simeng Duan,Wei Kang,Tong Wang,Ran Jing,Jingwei Cheng,Yali Liu,Qiwen Yang
Antimicrobial Resistance & Infection Control. 2020; 9(1)
[Pubmed] | [DOI]
78 Impact of macronutrient supplements on later growth of children born preterm or small for gestational age: A systematic review and meta-analysis of randomised and quasirandomised controlled trials
Luling Lin,Emma Amissah,Gregory D. Gamble,Caroline A. Crowther,Jane E. Harding,Lars Åke Persson
PLOS Medicine. 2020; 17(5): e1003122
[Pubmed] | [DOI]
79 Comparison of the Effects of Cognitive Behavioral Therapy and Behavioral Treatment on Obesity Treatment by Patient Subtypes: A Systematic Review and Meta-analysis
Jin-Young Cha,Seo-Young Kim,In-Soo Shin,Young-Bae Park,Young-Woo Lim
Journal of Korean Medicine for Obesity Research. 2020; 20(2): 178
[Pubmed] | [DOI]
80

Relation of Corneal Astigmatism with Various Corneal Image Quality Parameters in a Large Cohort of Naïve Corneas

Mohamed Omar Yousif,Rania Serag Elkitkat,Noha Abdelsadek Alaarag,Abdelrhman Shams,Hesham Mohamed Gharieb
Clinical Ophthalmology. 2020; Volume 14: 2203
[Pubmed] | [DOI]
81 Effect of an E-Learning Module on Personal Protective Equipment Proficiency Among Prehospital Personnel: Web-Based Randomized Controlled Trial
Laurent Suppan,Mohamed Abbas,Loric Stuby,Philippe Cottet,Robert Larribau,Eric Golay,Anne Iten,Stephan Harbarth,Birgit Gartner,Mélanie Suppan
Journal of Medical Internet Research. 2020; 22(8): e21265
[Pubmed] | [DOI]
82 Anatomical consideration for optimal position of orthodontic miniscrews in the maxilla: a CBCT appraisal
Maha S. Al Amri,Hanadi M. Sabban,Doaa H. Alsaggaf,Fahad F. Alsulaimani,Ghassan A. Al-Turki,Mohammad S. Al-Zahrani,Khalid H. Zawawi
Annals of Saudi Medicine. 2020; 40(4): 330
[Pubmed] | [DOI]
83 Updates from the Literature, November/December 2020
Rebecca R.S. Clark
Journal of Midwifery & Women's Health. 2020; 65(6): 825
[Pubmed] | [DOI]
84 The Relationships Between Tooth-Supported Fixed Dental Prostheses and Restorations and the Periodontium
Carlo Ercoli,Dennis Tarnow,Carlo E. Poggio,Alexandra Tsigarida,Marco Ferrari,Jack G. Caton,Konstantinos Chochlidakis
Journal of Prosthodontics. 2020;
[Pubmed] | [DOI]
85 The effects of acculturation on neuropsychological test performance: A systematic literature review
Yi Wen Tan,Gerald H. Burgess,Robin J. Green
The Clinical Neuropsychologist. 2020; : 1
[Pubmed] | [DOI]
86 Considering Evidence From Studies With Findings Beyond the Sacred Cow of p  < .05 for Best Practice
Audra Hanners,Bernadette Melnyk,Jinhong Guo
Worldviews on Evidence-Based Nursing. 2020;
[Pubmed] | [DOI]
87 Deprivation matters: understanding associations between neighbourhood deprivation, unhealthy food outlets, unhealthy dietary behaviours and child body size using structural equation modelling
Victoria Egli,Matthew Hobbs,Jordan Carlson,Niamh Donnellan,Lisa Mackay,Daniel Exeter,Karen Villanueva,Caryn Zinn,Melody Smith
Journal of Epidemiology and Community Health. 2020; 74(5): 460
[Pubmed] | [DOI]
88 Adequate statistical analyses and inferences of Randomized Clinical Trial
Andrea Batista de Sousa Canheta,Annelisa Silva e Alves de Carvalho Santos,Jacqueline Danesio de Souza,Erika Aparecida Silveira
Clinical Nutrition. 2020;
[Pubmed] | [DOI]
89 Testing rimegepant for migraine—time to revise the trial design?
Sara Gasparini,Claudia Torino,Damiano Branca,Edoardo Ferlazzo,Umberto Aguglia
The Lancet. 2020; 395(10241): 1901
[Pubmed] | [DOI]
90 Comparison of Biochemical Test Results between Portable and Conventional Laboratory Analyzers in Chickens
Fernando Ruiz-Jimenez,Erika Gruber,Maria Correa,Rocio Crespo
Poultry Science. 2020;
[Pubmed] | [DOI]
91 Artificial Intelligence in Cardiology
Dipti Itchhaporia
Trends in Cardiovascular Medicine. 2020;
[Pubmed] | [DOI]
92 Role of Homeopathy in Epidemics: Paving Way for a Plausible Solution in the Management of COVID-19/SARS-CoV-2 Infection
Abhijit Dutta
Homœopathic Links. 2020; 33(04): 297
[Pubmed] | [DOI]
93 Metered-dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta-analysis
Laura Payares-Salamanca,Sandra Contreras-Arrieta,Victor Florez-García,Alexander Barrios-Sanjuanelo,Ivan Stand-Niño,Carlos E. Rodriguez-Martinez
Pediatric Pulmonology. 2020;
[Pubmed] | [DOI]
94 Statistical data presentation: a primer for rheumatology researchers
Durga Prasanna Misra,Olena Zimba,Armen Yuri Gasparyan
Rheumatology International. 2020;
[Pubmed] | [DOI]
95 Psychological Treatments in Adult ADHD: A Systematic Review
Tim Fullen,Sarah L Jones,Lisa Marie Emerson,Marios Adamou
Journal of Psychopathology and Behavioral Assessment. 2020;
[Pubmed] | [DOI]
96 Evidence Based Medicine V; how to use in clinical practice
Magdalena Fossum,Kathrine Herbst,Martin Kaefer,Luke Harper,Marco Castagnetti,Goedele Beckers,Nicolas Kalfa,Darius Bagli
Journal of Pediatric Urology. 2019;
[Pubmed] | [DOI]
97 Effects of kinesio taping alone versus sham taping in individuals with musculoskeletal conditions after intervention for at least one week: a systematic review and meta-analysis
Robinson Ramírez-Vélez,Ignacio Hormazábal-Aguayo,Mikel Izquierdo,Katherine González-Ruíz,Jorge Enrique Correa-Bautista,Antonio García-Hermoso
Physiotherapy. 2019;
[Pubmed] | [DOI]
98 Does the implementation of a care pathway for patients with hip or knee osteoarthritis lead to fewer diagnostic imaging and referrals by general practitioners? A pre-post-implementation study of claims data
Esther H. A. van den Bogaart,Mariëlle E. A. L. Kroese,Marieke D. Spreeuwenberg,Ramon P. G. Ottenheijm,Patrick Deckers,Dirk Ruwaard
BMC Family Practice. 2019; 20(1)
[Pubmed] | [DOI]
99 Ultrasound and Clinical Preoperative Characteristics for Discrimination Between Ovarian Metastatic Colorectal Cancer and Primary Ovarian Cancer: A Case-Control Study
Maciej Stukan,Juan Luis Alcazar,Jacek Gebicki,Elizabeth Epstein,Marcin Liro,Alexandra Sufliarska,Sebastian Szubert,Stefano Guerriero,Elena Ioana Braicu,Mariusz Szajewski,Malgorzata Pietrzak-Stukan,Daniela Fischerova
Diagnostics. 2019; 9(4): 210
[Pubmed] | [DOI]
100 Dental caries and developmental defects of enamel in individuals with chronic kidney disease: Systematic review and meta-analysis
Francisco Ivison Rodrigues Limeira,Monica Yamauti,Allyson Nogueira Moreira,Tuélita Marques Galdino,Cláudia Silami de Magalhães,Lucas Guimarães Abreu
Oral Diseases. 2018;
[Pubmed] | [DOI]
101 Statistical analysis of patient-reported outcome data in randomised controlled trials of locally advanced and metastatic breast cancer: a systematic review
Madeline Pe,Lien Dorme,Corneel Coens,Ethan Basch,Melanie Calvert,Alicyn Campbell,Charles Cleeland,Kim Cocks,Laurence Collette,Linda Dirven,Amylou C Dueck,Nancy Devlin,Hans-Henning Flechtner,Carolyn Gotay,Ingolf Griebsch,Mogens Groenvold,Madeleine King,Michael Koller,Daniel C Malone,Francesca Martinelli,Sandra A Mitchell,Jammbe Z Musoro,Kathy Oliver,Elisabeth Piault-Louis,Martine Piccart,Francisco L Pimentel,Chantal Quinten,Jaap C Reijneveld,Jeff Sloan,Galina Velikova,Andrew Bottomley
The Lancet Oncology. 2018; 19(9): e459
[Pubmed] | [DOI]
102 Regulatory-Accepted Drug Development Tools Are Needed to Accelerate Innovative CNS Disease Treatments
Stephen P. Arneric,Volker D. Kern,Diane T. Stephenson
Biochemical Pharmacology. 2018;
[Pubmed] | [DOI]
103 Association of Systemic Inflammatory and Anti-inflammatory Responses with Adverse Outcomes in Acute Pancreatitis: Preliminary Results of an Ongoing Study
Deepesh Sharma,Aparna Jakkampudi,Ratnakar Reddy,Panyala Balakumar Reddy,Aasish Patil,H. V. V. Murthy,G. Venkat Rao,D. Nageshwar Reddy,Rupjyoti Talukdar
Digestive Diseases and Sciences. 2017;
[Pubmed] | [DOI]
104 Reporting the results of meta-analyses: A plea for incorporating clinical relevance referring to an example
Ronald H.M.A. Bartels,Roland D. Donk,Wim I.M. Verhagen,Allard J.F. Hosman,André L.M. Verbeek
The Spine Journal. 2017;
[Pubmed] | [DOI]
105 Effect of dentin hypersensitivity treatment on oral health related quality of life — A systematic review and meta-analysis
Dhelfeson Willya Douglas-de-Oliveira,Glayson Pereira Vitor,Juliana Oliveira Silveira,Carolina Castro Martins,Fernando Oliveira Costa,Luís Otávio Miranda Cota
Journal of Dentistry. 2017;
[Pubmed] | [DOI]
106 Curricular Interventions to Promote Self-care in Prelicensure Nursing Students
Pamela F. Ashcraft,Susan L. Gatto
Nurse Educator. 2017; : 1
[Pubmed] | [DOI]
107 Acute effects of Kinesio taping on pain, disability and back extensor muscle endurance in patients with low back pain caused by magnetic resonance imaging-confirmed lumbar disc degeneration
Nai-Jen Chang,Willy Chou,Pei-Chi Hsiao,Wen-Dien Chang,Yi-Ming Lo
Journal of Back and Musculoskeletal Rehabilitation. 2017; : 1
[Pubmed] | [DOI]
108 Are the effects of Kinesio Taping clinically meaningful in patients with acute low back pain?
Amanda Costa Araújo,Leonardo Oliveira Pena Costa
Clinical Rehabilitation. 2016; 30(11): 1136
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    References

 Article Access Statistics
    Viewed69882    
    Printed485    
    Emailed0    
    PDF Downloaded6309    
    Comments [Add]    
    Cited by others 108    

Recommend this journal