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Meta-analysis, a term originally coined in 1976 , refers to structured and validated statistical methods for combining and contrasting the findings of multiple, different studies, usually randomized trials of interventions, addressing a common research question in order to provide a more precise quantitative estimate of an outcome (e.g.treatment effect), giving due consideration to study size and event rate (weighting), variability (heterogeneity) and quality.(For long-term harms the duration of follow-up must be sufficient.) Level may be graded down on the basis of study quality, imprecision or indirectness (study PICO does not match questions PICO) because of inconsistency between studies or because the absolute effect size is very small.Level may be graded up if there is a large or very large effect size.Organizations such as Cochrane ( have well-established methodologies for this type of evidence searching, particularly with regards to randomized controlled trials (RCTs).
patients with heavy proteinuria)  or different treatment regimens (e.g. Similarly, meta-analysis may be able to demonstrate and quantify harms of treatment that were not revealed in the contributing studies .
Given that the volume of nephrology RCTs (currently numbering in the many thousands) is too large and increasing too rapidly for most clinicians and health care policy makers to reasonably assimilate, systematic reviews and meta-analyses offer a very efficient means of communicating a comprehensive, balanced and robust summarization of the findings and quality of existing research for a particular clinical problem.
Although many systematic reviews and meta-analyses may generate inconclusive findings because of the paucity and/or poor quality of existing studies, the information gleaned from systematic reviews and meta-analyses, such as overall and sub-group findings, may help to generate hypotheses and inform future study designs and sample size calculations.
However, to maximize their considerable value, it is essential that all clinicians have the skills to critically appraise, carefully interpret and judiciously apply meta-analyses in their practice.
Clinical research trials of various sizes, designs, methodologies and quality are being conducted in different populations around the world and published in ever-increasing numbers.