Evidence map›Paper›PMID 34378458›Full record

ArticleMedical decision making : an international journal of the Society for Medical Decision Making2022

Testing for a Sweet Spot in Randomized Trials.

Donald A Redelmeier, Deva Thiruchelvam, Robert J Tibshirani

Open access · hybridAbstract read
In one paragraph

Article in Medical decision making : an international journal of the Society for Medical Decision Making, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.5field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 2 institutions in 2 countries.

Donald A RedelmeierDepartment of Medicine, University of Toronto, Toronto, ON, Canada.ORCID 0000-0003-4147-3544
Deva ThiruchelvamEvaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
Robert J TibshiraniDepartment of Biomedical Data Sciences, Stanford University, Stanford, CA, USA.
Sunnybrook Health Science Centre · CAStanford University · US

Funding

CIHR
6 · The paper itself

Abstract

introductionRandomized trials recruit diverse patients, including some individuals who may be unresponsive to the treatment. Here we follow up on prior conceptual advances and introduce a specific method that does not rely on stratification analysis and that tests whether patients in the intermediate range of disease severity experience more relative benefit than patients at the extremes of disease severity (sweet spot).

methodsWe contrast linear models to sigmoidal models when describing associations between disease severity and accumulating treatment benefit. The Gompertz curve is highlighted as a specific sigmoidal curve along with the Akaike information criterion (AIC) as a measure of goodness of fit. This approach is then applied to a matched analysis of a published landmark randomized trial evaluating whether implantable defibrillators reduce overall mortality in cardiac patients (

resultsThe linear model suggested a significant survival advantage across the spectrum of increasing disease severity (β = 0.0847,

conclusionSystematic methods are available beyond simple stratification for identifying a sweet spot according to disease severity. The approach can assess whether some patients experience more relative benefit than other patients in a randomized trial.[Box: see text].

Indexed as

Research DesignHumansLinear ModelsRandomized Controlled Trials as TopicSeverity of Illness Indexdisease severityGompertz functionpersonalized medicineprecision medicinerandomized trialtreatment responsiveness

Identifiers

PMID34378458
PMCPMC8777310
OpenAlexW3192788213

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.