oddsratio胜算比-中西医结合研究所.pptVIP

臨床論文解析 陳汶吉 前 題 這篇論文的作者是誰? 這篇論文登在哪一種雜誌上? (為什麼)要感謝誰? 實證醫學的實證等級: I. Evidence obtained from at least one properly randomized controlled trial or a well-conducted meta-analyses based on properly randomized controlled trials. II-1. Evidenced obtained from well-designed controlled trials without randomization. II-2. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. II-3. Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence. III. Opinions of respected authorities based on clinical experience, descriptive studies, and case reports, or reports of expect committees. Modified grading of recommendations. A.There is good evidence to support the recommendation. B. There is fair evidence to support the recommendation. C. There is insufficient evidence for or against, but recommendations may be made on other grounds. D. There is fair evidence to exclude the recommendation. E. There is good evidence to exclude the recommendation. From: Friedland DJ et al: Evidence-based medicine.1998; pp228-230. 前言 在臨床上重要嗎? 有公共衛生上的重要性嗎? 這個理論吸引人嗎?(證據) 是否有參考系統性回顧? 這個證據主要來自作者的研究團隊?還是引用相當範圍的證據,即使並不支持他的想法? 有許多臨床研究進行是因為現有證據常常相互矛盾.有證據顯示這進退兩難的困境,並在前言中清楚地說明嗎? 在沒有證據出現前,是不可能有答案的 這個證據不能應用於作者所考慮的情況 證據可能不齊全 證據的品質可能很差,因此不能根據它來下結論 目的研究目標和要檢驗的假設 假設(HYPOTHESIS) 只有在研究樣本數目夠大時，我們才能相信陰性的結果;否則有可能出現偽陰性，因此許多研究者會預估樣本數目，以避免這種錯誤。 陳述研究假設的傳統手法,包括使用虛無假設(null hypothesis)，再設計研究來推翻虛無假設(disprove or refute an hypothesis) 產生假設 (HYPOTHESIS GENERETION) 描述性研究 病例報告(case reports) 病例系列(case series) 橫斷面研究(cross-sectional studies) 縱向研究(longitudinal studies) 分析性研究 生態研究(ecological studies) 兩組的橫斷性研究 (cross-section, two-group studies) 病例對照研究 (case-control studies) 世代研究 (cohort studies) 介入性研究 試驗(trials) 隨機分組和隱匿資訊 (random allocation and its concealmen