Commentary: Seeing the faces in Rubin's vase

Central MessageSurgeons should be familiar with the principles and caveats of trial sequential analysis, an emerging statistical methodology that offers a unique view meta-analysis data.See Article page 167. Surgeons data. See As surgeons increasingly turn to published literature guide clinical practice, Chan Harky1Chan J.H. Harky A. Trial analysis in meta-analyses: clinically oriented approach real-world example.J Thorac Cardiovasc Surg. 2021; 162: 167-173Abstract Full Text PDF Scopus (7) Google Scholar provide timely tutorial on analyzing data using (TSA). TSA is essentially same as interim which allows investigators trials analyze it accumulates “real time” rather than having wait for final accounting all anticipated results.2Wetterslev J. Jakobsen J.C. Gluud C. systemic reviews meta-analyses.BMC Med Res Methodol. 2017; 17: 39Crossref PubMed (466) Scholar,3Pallmann P. Bedding A.W. Choodari-Oskooei B. Dimairo M. Flight L. Hampson L.V. et al.Adaptive designs trials: why use them, how run report them.BMC Med. 2018; 16: 29Crossref (219) The authors showcase recently by Woldendorp colleagues subclinical valve thrombosis (SCVT), stroke, different antithrombotic strategies patients who underwent transcatheter insertion.4Woldendorp K. Doyle M.P. Black D. Ng Keech Grieve S.M. al.Subclinical aortic implantation: systematic review meta-analysis.J February 19, 2020; ([Epub ahead print])Abstract (11) Using 12 studies from original publication, reconfigure forest plots into diagrams. Although information same, distinctly new perspective emerges. With TSA, one can visualize contribution each individual study, added over time, march toward finite answer. In case association SCVT diagram presented didactic suggests we ponder this question no further; significance boundary, set query whether was associated at least 100% increase stroke compared normal leaflet motion, crossed several ago. Additional investigation unlikely alter conclusions. However, interested differences between regimens dual- versus single-antiplatelet therapy see that, relative risk reduction (RRR) 20%, strength currently available renders unanswerable present time—and possibly long time coming. lest rush celebrate vehicle hope will drive us definite solutions these other pressing questions—or perhaps discourage even starting journey, caution some potential pitfalls TSA. illustrated their tutorial, major caveat applying vital importance carefully considered effect size, or RRR. Chosen inappropriately, RRR has undesirable erroneously render conclusion unattainable offer conclusions are but meaningless. Also, methodologies examine 30,000 feet above, granularity lost only restored clinician. After all, understanding half task; bigger challenge lies such pertains patient. increasing horizon,5Ge X. Wang W. Hou Yang Fa Inspiratory muscle training decreased postoperative pulmonary complications: evidence randomized trials.J 156: 1290-1300.e5Abstract (25) Scholar, 6Taylor R.S. Long Mordi I.R. Madsen M.T. Davies E.J. Dalal H. al.Exercise-based rehabilitation heart failure: cochrane review, meta-analysis, analysis.JACC Heart Fail. 2019; 7: 691-705Crossref (71) 7Chen Z. Liu Huang Zeng Lin Zhu R. al.Clinical efficacy extracorporeal cardiopulmonary resuscitation adults cardiac arrest: analysis.Biomed Int. 2019: 6414673PubMed wake day find comfortable extinct replaced aesthetic? Doubtful. Even so, sure become strong complement used methods It helps faces Rubin's vase (Figure 1)8Rubin's Millodot: Dictionary Optometry Visual Science, 7th edition. © 2009 Butterworth-Heinemann. free dictionary.https://medical-dictionary.thefreedictionary.com/Rubin%27s+vaseDate accessed: June 21, 2020Google and, doing achieve fuller portrait. A exampleThe Journal Thoracic Cardiovascular SurgeryVol. 162Issue 1PreviewRanked high hierarchy evidence, meta-analyses important summaries existing literature, often influencing practice guidelines. accumulates, random errors may times lead spuriously significant results, frequency testing increases likelihood being reported; is, type 1 error.1 Therefore, (TSA) been developed adjust error. Full-Text