Arsyeja e shkrimit t\u00eb nj\u00eb teksti p\u00ebr t\u00eb shpjeguar konceptin e r\u00ebnd\u00ebsis\u00eb statistikore n\u00eb studimet klinike nga nj\u00eb mjek \u00ebsht\u00eb konstatimi n\u00eb konferenca mjek\u00ebsore, n\u00eb diskutime shkencore, por edhe n\u00eb deklaratat e shkenc\u00ebtar\u00ebve q\u00eb jan\u00eb an\u00ebtar\u00eb t\u00eb komisioneve t\u00eb vler\u00ebsimit dhe autoriteteve rregullatore se ky koncept nuk kuptohet plot\u00ebsisht, si dhe m\u00ebnyra se si rezulton se nj\u00eb medikament \u00ebsht\u00eb efektiv p.sh. n\u00eb parandalimin e migren\u00ebs. K\u00ebshtu q\u00eb mund t\u00eb lexohet n\u00eb vijim si nj\u00eb tekst i nj\u00eb mjeku p\u00ebr mjek\u00ebt ose p\u00ebr njer\u00ebzit q\u00eb p\u00ebrpiqen t\u00eb kuptojn\u00eb se si funksionojn\u00eb k\u00ebrkimet klinike dhe ve\u00e7an\u00ebrisht studimet n\u00eb mjek\u00ebsi sot.<\/p>\n
Fillimisht, le t\u00eb theksojm\u00eb se probabilitetet dhe statistikat nuk jan\u00eb koncepte t\u00eb pranueshme leht\u00ebsisht nga truri yn\u00eb. Gj\u00ebrat q\u00eb duken t\u00eb vet\u00ebkuptueshme ose t\u00eb par\u00ebnd\u00ebsishme ose t\u00eb r\u00ebnd\u00ebsishme p\u00ebr ne, matematika e probabilitetit dhe statistikat D\u00cbSHON t\u00eb jen\u00eb pik\u00ebrisht t\u00eb kund\u00ebrt\u00ebn. Nj\u00eb shembull i leht\u00eb: n\u00ebse pyetemi n\u00eb nj\u00eb familje me kat\u00ebr f\u00ebmij\u00eb se cili \u00ebsht\u00eb kombinimi m\u00eb i mundsh\u00ebm i djemve dhe vajzave (duke qen\u00eb se \u00e7do f\u00ebmij\u00eb ka 50% p\u00ebr nj\u00eb seks), shumica prej nesh do t\u00eb p\u00ebrgjigjen: 2 djem dhe 2 vajza. Gabim! Kombinimi m\u00eb i mundsh\u00ebm \u00ebsht\u00eb 3 f\u00ebmij\u00eb t\u00eb nj\u00ebr\u00ebs gjini dhe 1 t\u00eb tjetr\u00ebs (leht\u00ebsisht me laps dhe let\u00ebr do ta kuptoni... gabimin).<\/p>\n
Nga ana tjet\u00ebr, nj\u00eb mjeke sot, e \u00e7do specialiteti, nuk mund t\u00eb kuptoj\u00eb rezultatet e nj\u00eb studimi q\u00eb do t\u00eb lexoj\u00eb ose q\u00eb do t\u00eb prezantohet n\u00eb nj\u00eb konferenc\u00eb n\u00ebse nuk njeh parimet baz\u00eb t\u00eb matematik\u00ebs s\u00eb probabilitetit dhe statistikave mjek\u00ebsore. Ai nuk mund t\u00eb b\u00ebj\u00eb asnj\u00eb studim, asnj\u00eb doktoratur\u00eb
\ntez\u00eb ose botim pa njohuri baz\u00eb t\u00eb analiz\u00ebs statistikore. S\u00eb shpejti treni i mjek\u00ebsis\u00eb s\u00eb bazuar n\u00eb prova do t\u00eb niset dhe do ta l\u00ebr\u00eb vet\u00ebm p\u00ebr t\u00eb par\u00eb. Sa i p\u00ebrket konceptit t\u00eb probabilitetit, tashm\u00eb n\u00eb shekullin e 19-t\u00eb mjeku i madh William Osler (1849-1919) e kishte kuptuar r\u00ebnd\u00ebsin\u00eb e tij dhe kishte th\u00ebn\u00eb shum\u00eb.
\nme men\u00e7uri se mjek\u00ebsia \u00ebsht\u00eb "arti i probabilitetit dhe shkenca e pasiguris\u00eb".<\/p>\n
Sot probabiliteti perceptohet si nj\u00eb frekuenc\u00eb relative e cila \u00ebsht\u00eb interpretimi dominues n\u00eb k\u00ebrkimet klinike mjek\u00ebsore. Probabiliteti p\u00ebrcaktohet si frekuenca margjinale afatgjat\u00eb e ngjarjeve t\u00eb ngjashme n\u00eb nj\u00eb grup ngjarjesh. Pra, n\u00ebse kemi nj\u00eb monedh\u00eb dhe b\u00ebjm\u00eb rrokullisje, duam t\u00eb shohim n\u00eb planin afatgjat\u00eb numrin e rrokullisjeve sa her\u00eb do t\u00eb shfaqet "kurora" dhe sa "g\u00ebrm\u00eb". Dhe themi afatgjat\u00eb sepse n\u00ebse
\nn\u00ebse e hedhim monedh\u00ebn 3 her\u00eb mund t\u00eb kemi "Kuror\u00eb" t\u00eb tri her\u00eb, nd\u00ebrsa n\u00ebse e hedhim 1000 her\u00eb do t\u00eb jet\u00eb rreth 500 her\u00eb "kuror\u00eb" dhe 500 "shkronj\u00eb".<\/p>\n
P\u00ebrpara se t'i referohemi r\u00ebnd\u00ebsis\u00eb statistikore, duhen th\u00ebn\u00eb disa fjal\u00eb p\u00ebr studimet me t\u00eb cilat miratohet nj\u00eb medikament, si jan\u00eb strukturuar ato n\u00eb m\u00ebnyr\u00eb q\u00eb studiuesit t\u00eb mund t\u00eb p\u00ebrdorin m\u00eb pas rezultatet p\u00ebr t\u00eb p\u00ebrcaktuar n\u00ebse ka r\u00ebnd\u00ebsi statistikore, dometh\u00ebn\u00eb n\u00ebse nj\u00eb ila\u00e7 ndikon n\u00eb nj\u00eb s\u00ebmundje. K\u00ebto studime jan\u00eb studime t\u00eb rast\u00ebsishme dyfish t\u00eb verb\u00ebr. N\u00eb studimet e dyfishta t\u00eb verb\u00ebra dhe t\u00eb rast\u00ebsishme, pjes\u00ebmarr\u00ebsit n\u00eb nj\u00eb studim ndahen n\u00eb dy grupe n\u00eb m\u00ebnyr\u00eb t\u00eb rast\u00ebsishme me nj\u00eb dizajn n\u00eb m\u00ebnyr\u00eb q\u00eb dallimet individuale t\u00eb pjes\u00ebmarr\u00ebsve t\u00eb p\u00ebrfaq\u00ebsohen n\u00eb m\u00ebnyr\u00eb t\u00eb barabart\u00eb n\u00eb t\u00eb dy grupet. Kjo do t\u00eb thot\u00eb "randomizim". P.sh. n\u00eb k\u00ebto dy grupe mosha mesatare e pjes\u00ebmarr\u00ebsve duhet t\u00eb jet\u00eb af\u00ebrsisht e nj\u00ebjt\u00eb dhe dit\u00ebt e migren\u00ebs n\u00eb muaj gjithashtu. Tashm\u00eb randomizimi b\u00ebhet nga programet kompjuterike dhe asnj\u00eb studiues nuk \u00ebsht\u00eb i p\u00ebrfshir\u00eb. Ky proces m\u00eb n\u00eb fund mund\u00ebson analiz\u00ebn statistikore t\u00eb rezultateve dhe \u00ebsht\u00eb gjithashtu mjaft i sigurt
\np\u00ebrgjith\u00ebsimi i k\u00ebtyre rezultateve p\u00ebr popullat\u00ebn e p\u00ebrgjithshme n\u00ebse numri i pjes\u00ebmarr\u00ebsve \u00ebsht\u00eb i madh (zakonisht > 500 n\u00eb secilin grup). Nj\u00ebri grup do t\u00eb marr\u00eb ila\u00e7in e studimit dhe tjetri nj\u00eb placebo. Askush, as pjes\u00ebmarr\u00ebsit dhe as studiuesit, nuk do ta din\u00eb se kush po merr mjekim dhe kush po merr nj\u00eb placebo.<\/p>\n
Kjo do t\u00eb thot\u00eb "i verb\u00ebr". Pas nj\u00eb periudhe kohore p.sh. Pas 12 jav\u00ebsh dhe regjistrimit t\u00eb sulmeve t\u00eb migren\u00ebs n\u00eb nj\u00eb ditar elektronik, p\u00ebrcaktohet n\u00ebse grupi q\u00eb ka marr\u00eb ila\u00e7in ka pasur nj\u00eb reduktim m\u00eb t\u00eb madh se grupi q\u00eb ka marr\u00eb placebo. N\u00ebse ky reduktim ishte i r\u00ebnd\u00ebsish\u00ebm statistikisht, do t\u00eb thot\u00eb se ila\u00e7i funksionon dhe nuk \u00ebsht\u00eb nj\u00eb fenomen i rast\u00ebsish\u00ebm. Studimet e k\u00ebtij lloji jan\u00eb nj\u00eb metod\u00eb q\u00eb pranohet p\u00ebr t\u00eb siguruar pretendime dhe hipoteza shkak\u00ebsore n\u00eb lidhje me aft\u00ebsin\u00eb e nj\u00eb ila\u00e7i p\u00ebr t\u00eb prodhuar efekte klinike.<\/p>\n
Kjo r\u00ebnd\u00ebsi statistikore sh\u00ebnohet matematikisht me t\u00eb ashtuquajtur\u00ebn vler\u00eb p, e cila n\u00ebse \u00ebsht\u00eb m\u00eb e vog\u00ebl se 0,05 do t\u00eb thot\u00eb se di\u00e7ka \u00ebsht\u00eb statistikisht e r\u00ebnd\u00ebsishme (me siguri 95%). Disa, madje edhe mjek\u00eb, duke par\u00eb rezultatet e studimeve, komentojn\u00eb se efekti i nj\u00eb ila\u00e7i t\u00eb ri mund t\u00eb jet\u00eb statistikisht
\ne r\u00ebnd\u00ebsishme, por q\u00eb p.sh. ndryshonte vet\u00ebm me 2 dit\u00eb migren\u00eb n\u00eb muaj n\u00eb krahasim me placebo. Kjo do t\u00eb thot\u00eb, grupi placebo mund t\u00eb ket\u00eb reduktuar dit\u00ebt e migren\u00ebs nga 9 n\u00eb muajin para marrjes s\u00eb placebos n\u00eb 7 dit\u00eb pas, nd\u00ebrsa grupi i barnave shkoi nga 9 dit\u00eb n\u00eb 5 dit\u00eb. Ata pretendojn\u00eb se "vet\u00ebm" \u00ebsht\u00eb ulur me 2 dit\u00eb n\u00eb krahasim me Placebo, k\u00ebshtu q\u00eb \u00ebsht\u00eb "pak" statistikisht i r\u00ebnd\u00ebsish\u00ebm.<\/p>\n
Gabimi i madh k\u00ebtu \u00ebsht\u00eb se nuk \u00ebsht\u00eb kuptuar q\u00eb nj\u00eb studim i caktuar \u00ebsht\u00eb i projektuar (dhe i mbik\u00ebqyrur nga autoritetet rregullatore) q\u00eb t\u00eb na p\u00ebrgjigjet n\u00eb lidhje me disa synime q\u00eb ai vendos, n\u00ebse i p\u00ebrmbush ato n\u00eb nj\u00eb periudh\u00eb t\u00eb caktuar kohore. Dmth n\u00ebse ila\u00e7i q\u00eb po hulumtoni funksionon apo jo. Vet\u00ebm se. N\u00ebse efekti i tij \u00ebsht\u00eb statistikisht i r\u00ebnd\u00ebsish\u00ebm n\u00eb krahasim me placebo, ila\u00e7i vepron n\u00eb s\u00ebmundjen q\u00eb studiohet. Ky \u00ebsht\u00eb informacioni i vet\u00ebm. P\u00ebr ta th\u00ebn\u00eb me fjal\u00ebt e nj\u00eb statisticieni t\u00eb njohur:
\n\u201c\u2026nuk ka asnj\u00eb ndryshim midis nj\u00eb vlere p prej 0,049 dhe nj\u00eb vlere p prej 0,00001. T\u00eb dyja ofrojn\u00eb t\u00eb nj\u00ebjt\u00ebn shkall\u00eb provash kund\u00ebr hipotez\u00ebs zero. Nuk ka kuptim t\u00eb thuhet se nj\u00eb rezultat \u00ebsht\u00eb statistikisht "shum\u00eb" ose "shum\u00eb" dometh\u00ebn\u00ebs. Nj\u00eb rezultat ose \u00ebsht\u00eb i r\u00ebnd\u00ebsish\u00ebm statistikisht ose nuk \u00ebsht\u00eb.\u201d
\nSalsburg David (1993) \u201cP\u00ebrdorimi i metodave statistikore n\u00eb analiz\u00ebn e studimeve klinike. Gazeta e epidemiologjis\u00eb klinike<\/p>\n
Dhe s\u00eb fundi, di\u00e7ka q\u00eb n\u00eb nj\u00eb studim 12-javor ka nj\u00eb vler\u00eb p prej 0,001, n\u00ebse e zgjasim studimin n\u00eb 52 jav\u00eb, mund t\u00eb ket\u00eb nj\u00eb vler\u00eb p prej 0,049 e k\u00ebshtu me radh\u00eb. Pik\u00ebrisht p\u00ebr k\u00ebt\u00eb arsye kryhen studime afatgjata.
\nSi p\u00ebrfundim, leximi i sakt\u00eb i rezultateve t\u00eb nj\u00eb studimi nuk \u00ebsht\u00eb nj\u00eb detyr\u00eb e leht\u00eb, sepse k\u00ebrkon njohuri p\u00ebr interpretim t\u00eb sakt\u00eb. Dhe k\u00ebt\u00eb njohuri e siguron statistika mjek\u00ebsore e cila \u00ebsht\u00eb po aq e nevojshme n\u00eb mjek\u00ebsin\u00eb moderne sa \u00e7eki\u00e7i i neurologut.<\/p>","protected":false},"excerpt":{"rendered":"
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