Clinical Evidence如何协助实证医学实践范例 Clinical evidence.ppt

在Heart Failure的治療方法表，您可以找到病狀的臨床問題。在仔細看，您就能找到Angiotensin II receptor blockers. 在這裡它的效果是列爲有效的。 再點選治療方法。 In the condition summary, you will have the list of interventions to treat heart failure. In the case scenario, you are looking to reconfirm the use of ACE inhibitors together with Angiotensin II reception blocker. Look under Drug and invasive treatments and you can find Angiotensin II receptor blockers. It is listed as beneficial so whats the evidence? * 您就能看到治療方法的好壞。 我們現在要找出混合兩種藥物的證據。 在好處部分，能找到一個證據。它顯示了混合兩種藥物是能減少住院的可能性。 Reading through the summary, you can see the mention of ACE inhibitors with Angiotensin II receptor blockers. For details, you can scroll down to the benefits section. Here it tells you that 1 systematic review found that the combination of the 2 did reduce heart failure. * 再仔細讀，能多找到一個證據。它顯示了混合兩種藥物是能減少死亡的可能性。 Another review also showed that the combination of the 2 did significantly reduce morbidity and mortality compared to just using ACE inhibitors. * 那混合兩種藥物有害嗎？ 沒有。 You might also want to reconfirm that there is no harms associated with combining Angiotensin II receptor blockers plus ACE inhibitors. * 您也可以查看作者的背景。這可能對治療的選擇有影響。 As with any good appraisal process, Clinical Evidence will also list under the Author’s details, any competing interests he might have. This may have more effect on any evidence that is weaker. * 另外您還可以下載供病人閲讀使用的衛教單張。 * 那我能說Clinical Evidence容易使用了嗎？ * * * 在找尋證據的階段，我們會進入以下的一些database。 * 在病狀的内容裡，BMJ Clinical Evidence也會列出證據的尋找方式與來源。 Under each review, there is a Methods section that lists all sources for our search. Again, this emphasises the importance we place on transparency. A point to note is that BMJ Clinical Evidence also searches for Harms. This will give the practioner a balanced view of the treatment. * 很多時候醫護人員在尋找證據時，會忽略了治療的可能害處。 原因包括： systematic reviews 通常不會提供害處 RCTs不夠大或者時間不夠長所以害處有時不會出現 醫護人員有太多證據要評估 A lot of the times, harms are not documented in research findings. Quite often its because RCTs