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薬剤疫学 PowerPoint PPT Presentation


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薬剤疫学. 日本薬剤疫学会. 2010 年 8 月. 1. 1. 薬学の中の薬剤疫学 薬物療法の変遷とこれからの 薬剤師職能の展開. 2. 薬物療法の過去. 医師の独自の裁量により医薬品が選択され、患者は医師の指示通りに使用する。 薬剤師による医薬品情報活動により、より客観的な薬物療法が行われるようになった。 患者の自己決定権、セカンドオピニオンの採用、医療訴訟などを背景にインフォームドコンセント(説明、理解と同意)のもとに薬物療法が行われるようになってきた。. 3. 薬物療法の現在.

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  • up-to-date

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http://www.jspe.jp/index.html

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2.

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Strom

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  • Five TOOs

    • Too Few)

    • Too Simple)

    • Too brief)

    • Too median-aged)

    • Too Narrow)

      Rogers A.S., Drug Intel Clin Pharm., 21: 915-20 (1987)

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Pharmacovigilance

  • Pharmacovigilance

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Pharmacovigilance

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Pharmacovigilance

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  • (

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  • Randomized Controlled Trial:RCT)

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  • ITTintent-to-treatintention-to-treat)

  • PP(per protocol, protocol compatible)

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  • (point prevalence)

  • (period prevalence)

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  • incidence rate)

    time at risk

=

Time at risk

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(relative risk: RR)

  • (cumulative incidence rate ratio)

  • (risk ratio)

  • incidence rate ratiorate ratio)

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(odds ratio: OR)

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(attributable risk: AR)

  • (cumulative incidence rate difference)risk difference

  • (incidence rate difference)

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95%

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n1n0

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Risk RatioRR)95%CI(confidence interval)

b = n1 - a, d = n0 - c

Risk DifferenceRD)95%CI(confidence interval)

Risk DifferenceRisk Difference

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Relative RiskRate RatioRiskRatioOdds Ratio

Modern EpidemiologyPage 67

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R1R0

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RRRR:rate ratio)95%CI(confidence interval)

Rate DifferenceRD)95%CI(confidence interval)

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Absolute RiskCumulative incidenceIncidence rateAbsolute rate

Modern Epidemiology 3redition P 40

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t1t0

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2

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  • NNT

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2/2000-5/2000=0.0015

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40%

1/0.0015=667

NNT667

6671

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(attributable fraction, AF)

(population attributable risk, PAR)

(population attributable fraction, PAFAFp)

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  • 95%

  • 95%95%CI

  • 95%05%

  • 95%15%

  • 01

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5.1

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  • Ca

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  • NSAIDs

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NSAIDs

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  • :

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    • 80%)

    • ITTPP

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    • 80%

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