COPD病人長期使用吸入型類固醇是否會增加罹患肺炎風險PPT.pptVIP

* 實證醫學文獻查證:COPD病人長期使用吸入型類固醇是否會增加罹患肺炎風險 胸腔內科 許育彰醫師 背景 GOLD guideline, 2009，建議第三期(severe) COPD 及第四期(very severe)的COPD病人，若有反覆急性發作時，使用吸入型類固醇以減少急性發作的頻率。 問題： 慢性阻塞性肺病的病人長期使用吸入型類固醇是否會增加罹患肺炎機會？ 實證醫學(Evidence Based Medicine)五大步驟 第一步驟：提出可回答的臨床問題 第二步驟：搜尋最佳實證文獻資料 第三步驟：謹慎的文獻評讀 第四步驟：臨床應用 第五步驟：評估改善 一、提出可回答的臨床問題 Patient or Problem COPD (chronic obstructive pulmonary disease) Intervention or exposure Inhaled corticosteroid (fluticasone, budesonide) Comparison Placebo Outcome Pneumonia 二、搜尋最佳實證文獻資料 搜尋策略 : Seconday database ? Primary database Design: Systemic review or Meta-analysis Primary Database : PubMed Secondary Database: Cochrane Collaboration and Library Secondary Database: Cochrane Collaboration COPD AND (inhaled corticosteroid OR fluticasone OR budesonide) AND pneumonia AND (systemic review OR meta-analysis) Primary Database: Pub Med Reference 8 Reference 4 ? ? 相同作者 Reference 11 Reference 9 Reference 12 三、謹慎的文獻評讀 在文獻評讀方面最主要有三個主要步驟，即為VIP：V（Validity/Reliability）效度/信度 I（Importance/Impact）重要性 P（Practice/Applicability）臨床適用性 Users Guides to the Medical Literature: JAMA 1994; 272: 1367-1371 三、謹慎的文獻評讀: 使用評讀工具 Public Health Resource Unit, England (2006): Critical Appraisal Skills Programme (CASP) University of Oxford, 2005: - Systematic Review Appraisal Sheet - CAT maker (software) University of Birmingham: CASP (critical appraisal skill programme) 三、謹慎的文獻評讀: 使用評讀工具 三、謹慎的文獻評讀: 使用評讀工具 What question (PICO) did the systematic review address? What is best? Where do I find the information? The main question being addressed should be clearly stated. The exposure, such as a therapy or diagnostic test, and the outcome(s) of interest will often be expressed in terms of a simple relationship. The Title, Abstract or final paragraph of the Introduction should clearly state the question. If you still cannot ascertain what the focused question is after reading these