PPT-門諾醫院艾可諾圖書館.ppt

謝謝大家 ! * * * * * * * * * * * 實證醫學專題報告 服用綜合維他命，未來發生心血管疾病的機率有多少? 報告者：Intern 張邦彥 潘泊諺 指導者：王啟忠 主任 門諾醫院 家醫科 March 12th, 2013 情境 王先生今年 62 歲，高血壓已服藥 (CCB) 將近 10 年，血壓控制良好。體重過重 (BMI:26)，是個老菸槍，常常咳嗽有濃痰。 王先生年過60歲，開始擔心身體狀況，他想知道每天服用綜合維他命，自己未來發生心血管疾病的機率有多少？ 問題形成 病人：服用綜合維他命，未來發生心血管疾病 的機率 介入或暴露 ： 服用綜合維他命 比較：沒有服用綜合維他命 臨床結果：心血管疾病的發病率及死亡率 這是關於 「治療」的問題 文獻搜尋 關鍵字 : multivitamin, cardiovascular disease, men 資料庫 : PubMed, ACP journal club 優先順序 : Systematic review/Meta-analysis RCT… The Oxford 2011 Levels of Evidence Systematic review Meta-analysis RCT ACP journal club 文獻評讀 1. 病人的治療分派是隨機的嗎？ YES! A total of 14641 men were randomized and stratified by age, prior diagnosis of cancer, prior diagnosis of CVD, etc. 2. 對照組與實驗組在進 入試驗時是否相似？ YES! 3. 病人、醫生、研究者是否對治療不知情？ YES! The PHS II was a randomized, double-blind, placebo-controlled trial evaluating the balance of risks and benefits of a multivitamin (Centrum Silver or placebo daily). 4. 病人的追蹤是否夠久、夠充足完整？ YES! The trial began in 1997 with continued treatment and follow-up through June 1, 2011(a mean of 11.2 years of treatment and follow-up in 14 641 men) Morbidity and mortality follow-up in PHS II were high—98.2% and 99.9%, respectively. In addition, morbidity and mortality follow-up as a percentage of person-time each exceeded 99.9%. 5. 是否所有的病人都被放到原先分派的組別中做分析？ YES! All primary analyses were based on the intention-to-treat principle. 6. 所有組別是否被平等對待？ Yes! Every 6 months for the first year, then annually thereafter, PHS II participants were sent monthly calendar packs containing a multivitamin or placebo. Annual mailed questionnaires asked about adherence, adverse events, end points, and risk factors. 文獻評讀之效度/信度 Multivitamins in the Prevention of Cardiovascular Disease in Men JAMA, November 7, 2012 病人的治療分派是隨機 ○ 對照組與實驗組在進入試驗時相似 ○ 病人、醫生、研究者對治療不知情 ○ 病人的追蹤夠久、夠充足完整 ○ 所有的病人都被放到原先分派的組別中做分析 ○ 所有組別被平等對待 ○ 研究結果 During a median follow-up of 11.2 (interquartile range, 10.7-13.3) years