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These findings could be based on selection bias, if the interns were not true novices or the consultants were not true experts.
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Although we do not have external data to estimate the magnitude of selection bias, the results of hypothetical sensitivity analyses based on a selection bias factor defined by Rothman and Greenland (1998) suggest that the ORs obtained in this study are more likely to have been underestimated than overestimated.
So we think this survival benefit is based on a selection bias.
However, we consider it unlikely that the entire preference for pen-and-paper questionnaires is based on such selection bias.
Some patterns (e.g. A+T-rich regions) are like cellular automata, based on non-selection biases in nucleotide changes at genomic regions with specific base compositions, while other patterns are formed by a strong fixation bias (presumably positive selection of functional regions) that preserve particular base enrichments in corresponding regions (e.g. G+C-, purine-, and pyrimidine-rich).
Thereby, the report fills an information gap, as most prior registries include predominantly patients managed by cardiologists and/or in hospitals [ 2, 4, 17, 24, 27], which likely induced a selection bias based on center selection.
The methodological quality of each article was classified according to three categories (strong, moderate, or weak) based on six aspects: selection bias, study design, confounders, blinding, data collection, and withdrawals and dropouts.
Consequently, an alternative explanation based on bias having been introduced into sites or hospital selection is less tenable.
Risks of bias were assessed with the following items: 1) Selection bias (cases and controls selections; selections based on disease subtypes), 2) Information bias (genotyping quality control procedures, genotyping under blind conditions and phenotype misclassification rate), 3) Confounding factors (ethnic origin between cases and controls, age and gender distribution between cases and controls).
We considered selective reporting of interactions based on positive results and selection bias related to availability of genotyping (Supplementary Data).
The results were therefore not affected by selection bias based on exposure, nor by recall bias as in case-control studies.
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