Ebm style journal reading
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ㄧ般內科 實 證 期 刊 閱 讀 報 告 EBM-style Journal Reading PowerPoint PPT Presentation


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ㄧ般內科 實 證 期 刊 閱 讀 報 告 EBM-style Journal Reading. 報告人:蔡杰璋 Email: [email protected] 指導臨床教師:何昌益 日期: 2009/4/30 地點:ㄧ般內科醫研室. Clinical Scenario (臨床情境).

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ㄧ般內科 實 證 期 刊 閱 讀 報 告 EBM-style Journal Reading

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Ebm style journal reading

ㄧ般內科實 證 期 刊 閱 讀 報 告EBM-style Journal Reading

報告人:蔡杰璋 Email: [email protected]

指導臨床教師:何昌益

日期:2009/4/30

地點:ㄧ般內科醫研室


Clinical scenario

Clinical Scenario (臨床情境)

  • 82-year-old woman with history of atrial fibrillation, heart failure, CAD s/p PCI, type II DM, hypertension, chronic kidey disease and hyperlipidemia .

  • She was admitted for consiousness drowsy, and emotion incontinence was noted in the ward. The brain MRI revealed acute ischemia infarction.


Clinical uncertainty pico

Clinical Uncertainty → PICO 問題

  • In patient with atrial fibrillation, could wafarin treatment prevent stroke?


Ebm style journal reading

臨床個案的PICO

Type of Question: Therapy


Search terms strategy

Search Terms & Strategy:(搜尋關鍵字與策略)

  • 資料庫: PubMed

  • 搜尋日期: 980420

  • 搜尋關鍵字與隅策略:

    • #4 Search (#1)and(#2)and(#3)

    • #2 Search (atrial fibrillation) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))

    • #1 Search (warfarin) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))

    • #3 Search (cerebral ischemia) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))

    • Field: Title/Abstract 共17篇


Best available evidence

Best available evidence:(挑選可獲得之最佳研究證據)

  • Citation/s:Ann Intern Med. 2003;138:831-838. Lessons from the Stroke Prevention in Atrial Fibrillation Trials

  • Lead author's name : Robert G. Hart, MD; Jonathan L. Halperin, MD; Lesly A. Pearce, MS; David C. Anderson, MD; Richard A. Kronmal, PhD; Ruth McBride, BS;Elaine Nasco, BA; David G. Sherman, MD; Robert L. Talbert, PharmD; and John R. Marler, MD,


The study 1

The Study: (研究效度)- 1

  • The Stroke Prevention in Atrial Fibrillation (SPAF) studies, sponsored by the National Institute of Neurological Disorders and Stroke, consisted of six multicenter clinical

    trials assessing antithrombotic therapies for preventing stroke in patients with nonvalvular atrial fibrillation.


The study 2

The Study: (研究效度)- 2

  • The trials involved 3950 participants followed for 7100 patientyears,during which 247 participants had strokes; collectively,

  • Level of Evidence: 5(屬於review 文章)


The study 3 pico t

The Study: (研究效度)- 3本篇文獻的PICO (T)


The evidence 1

The Evidence: (研究重要結果)- 1

  • Follow-up


The evidence 2

The Evidence: (研究重要結果)- 2


The evidence 3

The Evidence: (研究重要結果)- 3


The evidence 4

The Evidence: (研究重要結果)- 4


The evidence 5

The Evidence: (研究重要結果)- 5


The evidence 6

The Evidence: (研究重要結果)- 6


Comment discussion 1

Comment & Discussion: -1

  • Warfarin reduces stroke more than aspirin for all patients

    with atrial fibrillation, yet many patients do not benefit

    substantially from anticoagulation. Large benefits of

    adjusted-dose warfarin accrue to selected high-risk patients with atrial fibrillation, while low-risk patients who do not benefit importantly from anticoagulation over aspirin can be identified.

  • Stroke risk stratification to identify high-risk patients with atrial fibrillation who warrant lifelong anticoagulation has been investigated by the SPAF Investigators


Ebm style journal reading

Clinical bottom line 臨床決策底線

Stroke risk stratification to identify high-risk patients with atrial fibrillation who warrant lifelong anticoagulation has been investigated by the SPAF Investigators

回到臨床個案情境


References

References:

  • 1: Coron Artery Dis. 1998;9(4):223-Warfarin reduces silent cerebral infarction in elderly patients with atrial fibrillation.Matsuo S, Nakamura Y, Kinoshita M. First Department of Internal Medicine, Shiga University of Medical Science, Japan.

  • 2 :Neurology. 1998 Sep;51(3):674-81.Links

    Prevention of stroke in patients with nonvalvular atrial fibrillation.Hart RG, Sherman DG, Easton JD, Cairns JA.University of Texas Health Science Center, San Antonio 78284-7883


Title

結 論 (標題 Title)

Stroke risk stratification to identify high-risk patients with atrial fibrillation who warrant lifelong anticoagulation


Ebm style journal reading

敬請指教


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