ebmdemonstration.pptVIP

EBM demonstration 小港醫院神經科 藍聖星主治醫師 實證醫學的步驟 提出一個好的問題 可以被回答的問題 搜尋資料庫 嚴謹的研判所找到的證據 整合到臨床所遇到的問題上面，給出答案 稽核 Clinical Problem 給中風病人使用抗凝血劑，對未來會不會比較好 PICO Patient: 目標是哪些病人？ Intervention: 使用了哪一種治療方法？ Comparison: 要跟什麼比？ Outcome: 要比什麼？ 容易解答的問題 Patient Stroke patients Intervention Anti-coagulation That will go WRONG ! Comparison (跟什麼比？) Standard treatment: Anti-platelet Unclear: Placebo Outcome (比什麼？) Morbidity vs Mortality Long term prognosis Recurrent rate ? ADF ? Complication rate ? Co-morbidity ? ………. 比較容易回答的題目 對於中風後的病患來說，使用抗凝血劑的治療，比起使用抗血小板藥物的治療，是否在中風的復發率會有不同的影響 Show Me the PICO !! Patient: Stroke Intervention: Anti-coagulation Comparison: Anti-Platelet Outcome: Recurrent rate 實證醫學的步驟 提出一個好的問題 搜尋資料庫 Guideline EBM Reviews Pubmed 嚴謹的研判所找到的證據 整合到臨床所遇到的問題上面，給出答案 稽核 Databases…………Orz… …that may go WRONG !! Search priority Key words Broaden? Narrow? Expressions Key Words Shift the WORDs Aspirin Antiplatelet Coumadin Anticoagulation Stroke CVA DO NOT Use shortcuts Guideline National Clearing House www.GUIDELINE.gov www.NGC.org Always search for published guidelines A guideline is any document that aims to streamline particular processes according to a set routine Guideline Guideline 33 hits 5 Selected EBM Reviews Cochrane Review Groups ACP Journal Club UpToDate POEMS … ACP Journal Club ACP Journal Club ACP Journal CLUB ACP Journal Club ACP Journal CLub 12 hits, 4 selected Cochrane Review Group Cochrane Library Cochrane Library Cochrane Review Group 33 hits 5 selected 實證醫學的步驟 提出一個好的問題 搜尋資料庫 嚴謹的研判所找到的證據 這個結果的 Level of Evidence NNT NNH (Number Needs to Treat) 整合到臨床所遇到的問題上面，給出答案 稽核 Conclusions Long-term anticoagulation may be more effective than antiplatelet treatment for preventing nonfatal stroke but not other vascular events in patients with nonrheumatic AF. In patients with acute ischemic stroke, anticoagulants used alone or with antiplatelet agents are not superior to antiplatelet agents used alone. There is no evidence that stroke patients with a normal heart rhythm bene