推动实证医学课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,【,嘉義長庚醫院實證醫學中心介紹,】,新生期,萌芽期,成長期,舉辦教育訓練,workshop,認證,聘請外院專業講師,培訓種子老師,定期團隊會議,舉辦實證共識營,醫學演講實證化,建置專科資料庫,實證臨床指引,導入臨床醫療,導入醫學教學,實證醫學中心的成員包含相關部門與執行單位，除了基礎臨床醫療作業單位之外，仍須資訊單位建置網路學習園地、圖書館人員對資料庫的搜集整理等，均,有專責人員互相緊密配合，並且定期開會檢討。,92年成立實證醫學中心，推動教育訓練。,舉辦,EBM+PBL Tutor,種子教師研習營，推展至各單位。,小組方式教導住院醫師及實習醫學生實際演練。,年度,EBM,系列課程，推展至各醫事類人員。,建構具地方醫療特色之臨床診療指引。,【,成長足跡,】,2007,年：,本院初試啼聲，榮獲醫策會第八屆實證醫學文獻查證應用進階組金獎。,2009,年：,發表論文於,EBM,標竿刊物,Cochrane review。,參與第十屆實證醫學文獻查證進階組競賽，榮獲醫策會銅獎。,2010,年,第十一屆實證醫學文獻查證進階組競賽，榮獲醫策會銀獎。,榮獲醫策會實證醫學文獻查證進階組金銀銅獎,發表論文於標竿刊物-,Cochrane review,專屬網頁,實證醫學系列課程,【,推動實證醫學,】,【,參賽成員介紹,】,姓名,資歷簡介,組長,郭亮增,(,報告者,),長庚大學醫學系畢業,現職,:,嘉義長庚醫院 骨科部住院醫師,實證醫學推動小組成員,組員,林素如,長庚大學醫學系畢業,現職,:,嘉義長庚醫院 腎臟科總醫師,組員,林秀如,高雄醫學大學護理研究所碩士,現職,:,嘉義長庚醫院 護理部專科護理師,實證醫學 文獻查證競賽,臨床情境,王先生，,45,歲，身高,172,公分，體重,78,公斤,(BMI,約,26),，,血中膽固醇值,280mg/dl,，,三酸甘油脂,:348mg/dl,，,LDL,：,160mg/dl,，,HDL,：,30 mg/dl,，抽菸每週兩包，每次運動約,30,分，使用藥物有,Stilnox 10mg HS,及,Lipitor 10mg QD,；家族病史父親,65,歲因有冠狀動脈心臟病放置支架，母親有高血壓、中風及糖尿病史。擔心生活習慣對疾病的影響及家族疾病遺傳的可能性？,詢問食用麥片可否降低膽固醇及預防心臟病,？有無其他改善的方法？如改變生活型態或運動？,Estimation of Cardiovascular Risk,Coronary artery disease,Coronary Artery DiseaseMesh,Cereals,Cerealsmesh,臨床問題,Question Framing,病人,詢問食用麥片,是否有效降低膽固醇，達到預防心臟病發生？,問題一,建構問題,Question Framing,Keyword,P,atient,45,歲男性，,BMI 26,Framingham risk score,23,分，高膽固純，高血脂，有冠心症家族病史。,Coronary heart diseaseMesh,Framingham risk,hypercholesterol,hypertriglycemidemia,I,ntervention,麥片治療,CerealsMesh,hypercarbonate,C,omparison,非高穀物飲食,placebo,O,utcome,膽固醇程度，,CAD,風險,Total cholesterol,Hypertriglyceridemia,HDL,LDL,CAD risk,PICO,臨床問題,Question Framing,病人,運動,是否有效降低膽固醇達到預防心臟病發生？,問題二,建構問題,Question Framing,Keyword,P,atient,45,歲男性，,BMI 26,Framingham risk score,23,分，高膽固純，高血脂，有冠心症家族病史。,Coronary heart disease,Framingham risk,hypercholesterol,hypertriglycemidemia,I,ntervention,運動,Exercise,Sports,muscle training,C,omparison,不運動,Placebo,control,O,utcome,膽固醇程度，體重，,CAD,風險,Total cholesterol,Hypertriglyceridemia,HDL,LDL,Body weight,CAD risk,PICO,Level of evidence pyramid,(for therapy/prevention,aetiology/harm),Level 1,Level 2,Level 3,Level 4,Level 5,Different levels of evidence for different fields,Therapy/prevention,aetiology/harm,:,systematic review(SR)of RCTs,RCT,cohort study,.,Prognosis,:,SR(with homogeneity*)of inception cohort studies,validated Clinical Decision Rule(CDR),Economic and decision analyses:,SR(with homogeneity*)of Level 1 economic studies,Diagnosis,:,SR(with homogeneity*)of Level 1 diagnostic studies;CDR,Differential diagnosis/symptom prevalence study,:,SR(with homogeneity*)of prospective cohort studies,Search strategy,Databases,Key word,Secondary database,CerealsMesh)AND Coronary Artery DiseaseMesh,CerealsMesh)AND Coronary Artery DiseaseMesh,Primary database,CerealsMesh)AND Coronary Artery DiseaseMesh and 2009,CerealsMesh)AND Coronary Artery DiseaseMesh and 2009,(CerealsMesh)AND Coronary Artery DiseaseMesh,1/5,(Cereal*Mesh)AND Coronary Artery DiseaseMesh,2009:1/10,Medline,Cereal*and Coronary artery disease and 2009 and RCT and Systemic review,1/1,Literature Selection Process,1 Publication type is systematic review or meta-analysis,1/5,10,Pubilication,type is systematic review or meta-analysis,1 not relevant,(1/10),1 lack full text,1,Pubilication,type is RCTs or systematic review,1 not relevant,(1),1 related(,與,Pubmed,重複,),解讀證據,Critical Appraisal,文獻結果是否有效度：,Validity,文獻結果是否有臨床重要性：,Importance,文獻結果是否適用於我們的病人：,Applicability,Table 1,Basic information about the trial,First author,Kelly SAM,Publication year,2009,Title,Wholegrain cereals for coronary heart disease,Country,Multicountries,Funding source,None,Table 2 What the trial is about?,Participants/,Problem,Non-,institutionalised,adults,of either sex,with diagnosed,CHD,or,with at,least one major risk factor for CHD,were included.,Major risk factors for CHD include overweight(body mass index 25),abdominal obesity,diabetes,family history of CHD,raised blood pressure,hypertension,abnormal lipid levels(high density lipoproteins(HDL)and low density lipoproteins(LDL)cholesterol,triglycerides or total cholesterol),impaired glucose tolerance,reduced insulin sensitivity,insulin resistance,hyperinsulinaemia,hyperglycaemia,or abnormal clotting factors.,Intervention,Wholegrain cereals foods,or diets high in wholegrain foods,Comparison,Other diets or foods,with lower levels or no,wholegrains,.,Outcome,Primary outcomes,(1)Total CHD mortality.,(2)Combined CHD events and morbidity,(3)Changes in major risk factors for CHD,Secondary outcomes,(1)Measures of quality of life and attitudes to diets.,(2)harms such as bloating,nausea,weight gain,difficulty,in eating out,difficulty in,preparingmeals,excessive weight,loss,intention to continue diet,were noted.,Are the results of the trial valid?,Item 1,Appraisal,Comments,Is this a systematic review of,randomised,trials?,Yes,Unclear,No,所有,enrolled,的,study,為,RCT,Item 2,Appraisal,Comments,Does it describe a comprehensive and detailed search for relevant trials?,Yes,Unclear,No,Comprehensive and detailed search,Are the results of the trial valid?,Item