PICO l l P Population or Patients I

步驟一： 形成可以回答的臨床問題 ¡ 將臨床情境或問題, 以PICO來呈現 l l P: Population or Patients I: Intervention or exposure C: Comparison O: Outcome 4

PICO︰ ¡ 使用含葡萄糖之透析液進行血液透析, 是 否可以減少透析中低血糖次數? l l P: DM nephropathy, uremia with hemodialysis I: glucose-add dialysate C: glucose-free dialysate O: frequency of hypoglycemia episode 7

¡ 服用降膽固醇的藥物是否可預防血液透析 患者的心肌梗塞？ l l P: CGN, hemodialysis, hyperlipidemia, smoker, no hypertension I: statin C: placebo O: cardiovascular event, mortality 9

¡ 進階︰ l Statin: HMG-Co. A reductase inhibitor, lipidlowering agent, Lovastatin, Pravastatin, Simvastatin, Fluvastatin, Atorvastatin, Rosuvastatin, …. l Mortality: 5 -year mortality l Cardiovascular event : Coronary artery disease、 Coronary heart disease、ischemia heart disease 、 myocardial ischemia、myocardial infarction l Primary prevention (secondary prevention) 10

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Usefulness (value) = Validity × Relevance / Work 醫學文獻種類 Prefiltered databases Up. To. Date、Dyna. Med、First Consult、ACP PIER、BMJ Clinical Evidence ACP journal club、Evidence-Based Medicine Cochrane database of systematic reviews 、Other systematic reviews Unfiltered databases 中華民國期刊論文、Medline 、Pub. Med 、Pro. Quest 、 CINAHL, …. 14 14

Usefulness (value) = Validity × Relevance / Work 以 5 S步驟取得實證資訊 Systems 實證臨床資訊決策系統 More time is needed as we go down the pyramid 整合證據提供特定臨床問題之概述與建議 Summaries Prefiltered Synopses Syntheses Up. To. Date Dyna. Med First Consult ACP PIER BMJ Clinical Evidence 對單篇研究及回顧性文獻做摘要與評述 ACP journal club Evidence-Based Medicine 系統性評論文獻 Cochrane database of systematic reviews Other systematic reviews Unfiltered 15 Studies 原始研究文獻 中華民國期刊論文Medline 、Pub. Med 、Pro. Quest 、 CINAHL 15 Modified from R Brian Haynes et al, 2006

Filtered Resources Critical-Appraised Individual Articles ¡ ¡ ¡ ¡ ¡ 濃縮單篇原始研究為精簡EBM評論 ¡ ¡ ¡ ACP Journal Club Evidence Based Medicine Bandolier Evidence-Based Cardiovascular Medicine Evidence-Based Dentistry Evidence-Based Eye Care Evidence-Based Gastroenterology Evidence-Based Health Policy & Management Evidence-Based Healthcare Evidence-Based Mental Health Evidence-Based Nursing Evidence-Based Obstetrics & Gynecology Evidence-Based Oncology International Journal of Evidence-Based Healthcare Journal of Evidence Based Dental Practice … 16 16

Filtered Resources The Cochrane Library ¡ The Cochrane Library為一個實證醫學全文型 資料庫，製作單位為 The Cochrane Collaboration。其下又分為 7個資料庫，由 Cochrane專業團體或國際組織對文獻進行系 統性評論、控制實驗與生統分析。 l The Cochrane Database of Systematic Reviews (Cochrane Reviews) - 提供超過1, 800種完整的 評論(Reviews) 17

Scenario A 1 -year-old girl is admitted to the pediatrics department with bronchiolitis, where she is given a course of steroids. This prompts the doctor on duty to find out whethere is any evidence that corticosteroids lead to fewer hospital stays or improved recovery where bronchiolitis is concerned. 23

PICO P I C O Bronchiolitis OR Wheez* OR Respiratory syncytial virus Corticosteroid* OR Steroid* OR Glucocorticoid* OR Beclometasone OR Betamethasone OR … None Stays OR Hospitalization OR Improvement OR Recovery 24

布氏運算符號與布林邏輯 arthritis NOT letter salmonella AND hamburger OR eggs 由左到右來順序連接 football OR hockey OR soccer salmonella AND (hamburger OR eggs) 括弧內的用詞視為一個單位先進行連接 26 26

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