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第十屆實證醫學文獻查證類競賽

第十屆實證醫學文獻查證類競賽. 組別 : 進階組 參賽編號 : AC00061 三軍總醫院 陳成桃、葉爵榮、楊翔宇 98.09.20. 臨床情 境 一位 45 歲的科技業研發工程師,工作時間很長,長期失眠且疏於運動。身高 172 公皆、體重 78 公斤( BMI 約 26 ),在最瑄一次公司所安排的例行性體檢中發現:血中膽固醇值為 280mg/dl 、三酸甘油脂 348mg/dl 、 LDL (低密度脂蛋白膽固醇) 160mg/dl 、 HDL (高密度脂蛋白膽固醇) 30mg/dl ,其他檢查結果無特殊發現。

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第十屆實證醫學文獻查證類競賽

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  1. 第十屆實證醫學文獻查證類競賽 組別: 進階組 參賽編號: AC00061 三軍總醫院 陳成桃、葉爵榮、楊翔宇 98.09.20

  2. 臨床情境 一位45歲的科技業研發工程師,工作時間很長,長期失眠且疏於運動。身高172公皆、體重78公斤(BMI約26),在最瑄一次公司所安排的例行性體檢中發現:血中膽固醇值為280mg/dl、三酸甘油脂348mg/dl、LDL(低密度脂蛋白膽固醇)160mg/dl、HDL(高密度脂蛋白膽固醇)30mg/dl,其他檢查結果無特殊發現。 這位工程師主訴:家人都屬肥胖體質,父親有冠狀動脈心臟病,在65歲時植入心臟血管支架,目前規則服藥控制中。母親有高血壓、中風及糖尿病。自已因為晚上睡不著,近兩年來斷續使用藥物治療:睡眠障礙(Stilnox 10mg HS)與高脂血症(Lipitor 10mg QD)。過去曾因腎結石採用ESWL治療兩次。 本身沒有飲酒習慣,但壓力大時,

  3. 臨床情境 • 沒有飲酒,每週約2包。學生時代有運動習慣(每週跑操場約5公里) ,開始工作後,有空會以Wii健身,一次約30分鐘。最近半年每天平均工作時間超過14小時,每天約喝500cc黑咖啡提神,吃完宵夜,回家倒頭就睡。

  4. What are the patient’s concern?

  5. Five Steps of EBM

  6. Step 1. Asking answerable Clinical Question?

  7. PICO - 1

  8. PICO - 2

  9. Step 2. Tracking down the best Evidence

  10. Systems Secondary database Summaries Synopses Syntheses Studies Primary database Search Databases

  11. Search Databases

  12. Hyperlipidemia treatment

  13. Hyperlipidemia treatment

  14. Hyperlipidemia treatment

  15. Searching database

  16. Determining Question Type ?

  17. From: Oxford Center for Evidence-based Medicine Levels of Evidence (May 2001)

  18. Step 3. Critical appraisal Evidence Appraising systematic reviews Can the results help me? Is the systematic review valid Are the result Important?

  19. Treatment Better Control better

  20. Treatment Better Control better

  21. Treatment Better Control better

  22. Treatment Better Control better

  23. Can you apply this valid, important evidence from a systematic review in caring for your patient?

  24. 不同臨床決策對醫療品質的影響

  25. 給病患貼心的建議

  26. Thanks for your attention

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