实证医学文献查证应用.ppt

實證醫學文獻查證應用 感染管制中心 張麗珍 臨床病理科 陳玉娟 健康管理中心 曾雅玲 Scenario PICO type :Harm P : Patients/ Problems No infected MRSA who inpatient Intervention: contact precaution Comparison: contact and droplet precautions Outcome: MRSA Infection rate 搜尋EBM Primary Database 1.PubMed 2.OVID/Medline Secondary Database 1.Cochrane Library 2.ACP Journal Club 3.Bandolier 4.National Guideline Clearinghouse 5.MDConsult PubMed Key words ? contact and droplet precautions and MRSA Level of evidence : 2 著者做一項前瞻性研究，比較加護病房與非加護病房內， 只採接觸防護措施或採接觸及飛沫防護措施其院內MRSA感染的發生率。 Mangini E, Segal-Maurer S, Burns J, et al: Impact of contact and droplet precautions on the incidence of hospital-acquired methicillinresistant Staphylococcus aureus infection.Infect Control Hosp Epidemiol 2007;28:1261-6. 文獻評讀Critical appraisal topic 研究品質製表 作者 年度 隨機分配 盲法 退出研究者之描述 族群完整的診斷檢查步驟 結果一年之後續追蹤 實證等級 Ed Mangini 2007 適當 適當 不清楚 適當 不清楚 2 (CASP) - Critical Appraisal Skills Programme Screening Questions 1.Did the review ask a clearly-focused question? (明確的重點問題) Yes Patient / Problems :Impact of contact and droplet precautions on the incidence of hospital-acquired methicillinresistant Staphylococcus aureus infection. Intervention:contact precaution Comparison:contact and droplet precautions Outcome:The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection 2.Did the review include the right type of study? (正確類型的研究) Yes To identify inpatients infected or colonized with MRSA (prospective study ) (CASP) - Detailed Questions-1 3.Did the reviewers try to identify all relevant studies? (試圖找出所有相關的研究) Yes 4.Did the reviewers assess the quality of the included studies? (評估納入研究的質量) Yes 5.If the results of the studies have been combined, was it reasonable to do so? (研究的結果，已被合併，這樣做是否合理) Yes (CASP) - Detailed Questions-2 6. How are the results presented and what is the main result?(提出和主要結果是什麼) The implementation of contact precautions significantly decreased t