执行EBM的效率.PPT

外科實證醫學課程 Somatostatin Analogues for Acute Bleeding Esophageal Varices 執行EBM的五個步驟 ( I ) 1.問問題（可以回答的問題） Converting the need for information into an answerable question. 2.找資料（可獲得最好的證據資訊） Search the database and tracking down the best evidence. 3.分析判斷（文獻的效度與重要性） Critical appraising that evidence for its validity and importance. 執行EBM的五個步驟 ( II ) 4.臨床應用（整合三大層面） Integrating the critical appraising with our clinical expertise and our patient’s unique biology, values and circumstances. 5.評估成果（執行EBM的效率） Evaluating our effectiveness and efficiency in executing step 1- 4 and seeking ways to improve them both for next time. Case 王xx 56 y/o male Hepatitis B Hx for 20+ years Liver cirrhosis since 3+ years UGI bleeding 2 episodes = Gastroendoscope: EV bleeding Admission due to 3rd GI bleeding Background Knowledge Treatment Medications Vasopressin (血管加壓素) Terlipressin Somatostatin (體抑素) Octreotide Octreotide Sandostatin 0.1mg/1ml/Amp Long-acting somatostatin analog 降低奇靜脈血流 半衰期: 90 min IV bolus 50-250 ug, continuous 50-250 ug/h Side effects: hyper or hypoglycemia, Abd. pain, nausea, diarrhea, headache Objectives To study whether somatostatin or analogues improve survival or reduce the need for blood transfusions in patients with bleeding oesophageal varices. How to Ask Clinical Question You Can Answer? 問題以PICO形式呈現 搜 尋 技 巧 與 策 略 資料庫的選擇 關鍵字的設定 學習各種資料庫的搜尋方法 圖書館定期開課 Diagnostic study important Sensitivity Specificity Likelihood ratio for a positive test result Likelihood ratio for a negative test result Positive predictive value Negative predictive value Pre-test probability (prevalence) Pre-test odds = prevalence/(1-prevalence) Post-test odds = pre-test odds ? LR Therapeutic study important Control event rate (CER) Experimental event rate (EER) Relative risk reduction (RRR) Absolute risk reduction (ARR) Number needed to treat (NNT) The Evidence Pyramid Seach Result Cochrane標誌及其意義 Cochrane協作網標誌（見圖）由一個圓形圖以及圍繞圓形圖的兩個粗體同心半環圖共同構成。 每一橫線代表一個試驗結果的可信區間，橫線越短則試驗精度越高，結