问题形成-台北立万芳医院.PPT

實證醫學實務課程 -問題形成-文獻搜尋-文獻評讀-臨床應用 臺北醫學大學˙市立萬芳醫院 PBL-EBM 教學中心 吳明順醫師，郭雲鼎醫師 王慈蜂醫師，陳杰峰醫師 Mar.03, 2007 課程說明 分組教學與實地操作 運用EBM 的模式作案例分析 報告與討論 回饋時間 Cell cycle and cognitive resonance 金剛經三段論述破執法 莊嚴佛土無有住相分第十 莊嚴佛土者，即非莊嚴，是名莊嚴 Welcome to Taipei Medical University-Wan Fang Hospital Thank you!! 實證醫學實務課程 -問題形成 臺北醫學大學˙市立萬芳醫院 消化系內科 吳明順醫師 Mar.03, 2007 如何問可以回答的臨床問題? How to ask an answerable question? A clinical scenario An 80 year-old Chinese women with 20 years of type 2 DM with triopathy, dyslipidemia, and under aspirin, valsartan diamicron, metformin and atorvastatin. Recent myocardial infarction 6 months ago. Poor glycemic control, HbA1c: 10, fasting sugar usually above 200. Background questions -6W’s questions What is How to Who is indicated to Why do the patients receive When to change PEG start insulin Where is the Foreground questions-PICO Specific, less granular, directed toward more focused questions. Usually include 4 component (PICO) Population and/or specific Problem Interventions Comparison Outcomes Sumsearch / PICO-1Asking an answerable question P: An old aged Chinese female had history of type 2 DM with triopathy and poor glycemic control although taking OHA faithfully . I: OHA shifted to Insulin therapy C: Add Triglitazone to previous medication O: Satisfied glycemic control PICO-2Asking an answerable question P: An old aged Chinese female had history of type 2 DM with triopathy, old myocardial infarction and poor glycemic control . I: Intensive glycemic control with Insulin therapy alone C: Add Triglitazone to previous medication O: Prevent recurrent myocardial infarction PICO-3Asking an answerable question P: An old aged Chinese female had history of type 2 DM with triopathy and poor glycemic control although taking OHA faithfully I: Intensive life style modification with previous medications C: Insulin therapy alone O: improvement of glycemic control Clinical rationale Oral medication The efficacy of glycemic control Toxicity to the l