1. 2009/02/25 1 實證醫學 - 藥學領域之應用 高雄榮民總醫院 藥劑部 林佩津 藥師

2. 2009/02/25 2內容大綱 實證醫學概論 實證醫學在臨床藥物治療之應用 實證醫學在藥委會進藥之應用 實證醫學在臨床指引之應用

3. 2009/02/25 3 EBM: five linked ideas Ask a clinical question Search evidences Appraise those evidences (critical appraisal) Translated into actions (application) Evaluation

4. 2009/02/25 4 Questions: PICOD What type of Participants? What types of Interventions? What types of Comparison? What types of Outcomes? What types of study design? These components can be adapted, in part of whole, to different types of clinical question (etiology, causation, therapy and prognosis)

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6. 6 How to perform EBM practice? Systematic review? Meta-analysis One randomized controlled-trial Systematic review Cochrane (collaboration,CDSR journal) British medical journal (BMJ journal) One randomized controlled-trial ACP journal club (journal) Evidence-based medicine (EBM journal) Bandolier

7. 2009/02/25 7 Critical appraise CATS CEBM

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14. 2009/02/25 14 實證醫學在 臨床藥物治療之應用

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18. 2009/02/25 18 實證醫學在 藥委會進藥之應用

19. 2009/02/25 19實證醫學在藥委會進藥之應用 Alendronate 70mg tab 新藥 Alendronate 70mg + Cholecalciferol 2600IU Superiority of a combined treatment of Alendronate and Alfacalcidol compared to the combination of Alendronate and plain vitamin D or Alfacalcidol alone in established postmenopausal or male osteoporosis (AAC-Trial)

20. 2009/02/25 20實證醫學在藥委會進藥之應用 the combination therapy with Alendronate and Alfacalcidol exhibited superiority in terms of BMD, overall fractures, rate of falls and back pain over either Alendronate in combination with plain vitamin D or Alfacalcidol alone. The overall safety profiles of the three treatment regimens were found to be not different in this study

21. 2009/02/25 21 實證醫學在 臨床指引之應用 Penicillin skin test? Do ? Not do?

22. 2009/02/25 22 Penicillin skin test reagents 2004 Pre-Pen ® withdrawn from the US and Canadian markets by Hollister-Stier 2005 Allergopharma ceased production of a penicilloyl-polylysine reagent in Europe 2005 AllerQuest obtained the legal rights to Pre-Pen ® including the FDA license to manufacture this reagent in US and Canada MMWR Morb Mortal Wkly Rep 2006; 55(RR-11):33-5

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24. 2009/02/25 24檢驗結果

25. 2009/02/25 25 Evidence-based discussion 有過敏史 PST (+): 14-72%, 產生反應的機率 50-70% PST (-), 產生反應的機率 1-3% 無過敏史 PST (+): 0.9%, 產生反應的機率 9% PST (-), 產生反應的機率 0.5% Clin Allergy 1988;18:515-40

26. 2009/02/25 26 Evidence-based discussion JAMA 2001; 285:2498-505 history (+): skin testing (positive likelihood ratio, 1.9; 95% CI, 1.5-2.5) History (-): skin test (negative likelihood ratio, 0.5; 95% CI, 0.4-0.6)

27. 2009/02/25 27 Clinical pathway ( 臨床路徑 )

28. 2009/02/25 28 Thanks for your attention