6.治疗性研究和评价.pdfVIP

治疗性研究证据的评价与应用 陈 进 卫生部中国循证医学中心 循证医学教育部网上合作研究中心 四川大学华西医院循证医学与临床流行病学中心 主要内容 一、提出临床治疗性问题 二、查询治疗性最佳证据 三、治疗性研究文献评价 四、证据的应用 五、后效评价 临床病案 A 75-year-old man, after being discharged from hospital 2 weeks previously During this admission he underwent a carotid endarterectomy after suffering a transient ischemic attack (TIA) Diagnosed with significant carotid stenosis. His discharge medications included metoprolol (50 mg Bid) for hypertension and aspirin 81 mg daily Today, he has brought us an article from the Internet describing the benefits of statins for stroke prevention He wonders what this medication is and if he should take it His last visit showed total cholesterol: 5mmol/L HDL-cholesterol: 2.0mmol/L LDL-cholesterol was 2mmol/L His examination was unremarkable 一. 提出临床治疗性问题 In a patient with history of TIA, carotid endarterectomy, hypertension, and normal lipid profile, does therapy with a statin decrease risk of stroke? P: history of TIA, carotid endarterectomy, hypertension, and normal lipid profile I: statin C: no treatment/placebo O: risk of stroke 二.查询最佳治疗性证据 证据 S ystem s S ynopse s C lin ical Evid en ce* *W e som etim es in clu d e a search o f E B O C at th is stag e, but w e m u st ↓ bear in m in d th at it hasn ’t been u pd ated recen tly so its eviden ce m ay n ot be cu rren t.