由實證藥學(xué)導(dǎo)入藥師持續(xù)教育談起課件

1、由 實 證 藥 學(xué) 導(dǎo) 入藥 師 持 續(xù) 教 育 談 起臺北醫(yī)學(xué)大學(xué) 萬芳醫(yī)院藥劑部 住院調(diào)劑組黃麗華 組長為何要推動 實證藥學(xué)?來自病人的問題 藥師，我有糖尿病血油高，鄰居 介紹我吃魚油可以嗎?From CCIS: 0 篇From Medline: 246篇 (Reviews 38篇) From MD consult: 57篇 From Cochrane SR: 4篇來自藥師的問題 學(xué)姊，脊椎損傷的病人， 急性期為什麼要給高劑量的 Methylprednisolone?From CCIS: 8 篇From Medline: 244篇 (Reviews 35篇) From MD consult

2、: 93篇; Reference books: 7 From Cochrane SR: 2篇 From ACP Journal Club SR: 1篇來自醫(yī)師的問題一新陳代謝科討論會，臨床藥師 被詢問PPI及H2A ，何者治療 胃食道逆流癥效果較好? From CCIS: 24 篇From Medline: 85篇 (Reviews 51篇) From MD consult: 61篇 From Cochrane SR: 0篇 From Bandolier SR: 1篇 來自醫(yī)師的問題二 病房迴診時,主治醫(yī)師詢問臨床藥師,是否有新的降血脂肪準則? From CCIS: 0 篇From Medli

3、ne: 213篇 (Reviews 71篇) From MD consult: 69篇; Practice guideline: 5 From Cochrane SR: 0篇 From National Guideline Clearinghouse: 2篇 From PSAP: 1篇實證醫(yī)學(xué)的五大步驟整理出一個可以回答的問題 (Asking an answerable question)尋找文獻證據(jù) (Tracking down the best evidence)嚴格評讀文獻 (Critical appraisal )應(yīng)用於病人身上 (Integrating the appraisal w

4、ith clinical expertise & patients preference)對過程進行稽核 (Auditing performance in step 1-4)導(dǎo)入實證藥學(xué)前之評估導(dǎo)入實證藥學(xué)前之準備實證醫(yī)學(xué)導(dǎo)讀課程網(wǎng)路系統(tǒng)建構(gòu)教導(dǎo)不熟悉電腦的藥師實證網(wǎng)站搜尋及期刊介紹實證分級介紹實證藥學(xué)導(dǎo)入持續(xù)教育以本院現(xiàn)有實證期刊進行導(dǎo)讀各?？婆R床藥師以實證為基礎(chǔ), 進行個案報告或?qū)ｎ}討論Pharmacotherapy Self - Assessment Program (PSAP)以問題為導(dǎo)向之網(wǎng)路搜尋討論會網(wǎng)路化之EBP - PBL討論區(qū)藥劑部持續(xù)教育內(nèi)容 (91.1 - 91.6)實證

5、藥學(xué)推動計劃甘梯圖導(dǎo)入實證藥學(xué)困難面需充實軟硬體設(shè)備需花費大量時間及人力需不斷尋找適合於藥學(xué)使用之網(wǎng)站研究報告的準確性實證分級的評斷不易臨床應(yīng)用時與醫(yī)療人員之衝突與挫折感健保制度適用的可行性人員輪調(diào)及排班實證醫(yī)學(xué)考量因素ABCD醫(yī)療資源Resources醫(yī)療價值Values臨床實證EvidenceA+D機會成本(opportunity cost)B+D成本效益(cost-effectiveness)C+D醫(yī)療價值未來發(fā)展請詳見附圖一與院外醫(yī)療人員交流與臺北醫(yī)學(xué)大學(xué)合作朝向本土化之實證藥學(xué)研究及論文發(fā)表 附 圖 一經(jīng)營管理教學(xué)藥品管理健保核刪總額預(yù)算臨床路徑處方集制定新藥評估藥師持續(xù)教育藥物資訊

6、副作用通報實習生教學(xué)自我學(xué)習藥事照顧演講終生學(xué)習藥師網(wǎng)路化病人醫(yī)護人員檢驗科醫(yī)師護理人員藥事照顧用藥指導(dǎo)EBP - PBL討論區(qū)實證藥學(xué)與實證藥學(xué)有關(guān)之期刊Clinical Evidence :每半年更新一次季刊: Evidence-Based Cardiovascular medicine Evidence-Based Health Care Evidence-Based Obstetrics & Gynecology Evidence-Based Oncology Evidence-Based Mental Health Primary Care case Reviews月刊: Bando

7、lierBest Practice與實證藥學(xué)有關(guān)網(wǎng)站Abstracts of Cochrane Reviews http:/cochrane/revabstr/mainindex.htmCentre for Evidence - Based Medicine http:/cebm.jr2.ox.ac.ukNational Guideline Clearinghousehttp:/index.aspACP - ASIM http:/journals/ebm/ebmmenu.htmBandolier http:/www.jr2.ox.ac.uk/bandolier/band50/b50-8.htm

8、l與實證藥學(xué)有關(guān)網(wǎng)站 (續(xù))PubMed - National Library of Medicine http:/PubMed/clinical.htmlThe CATbank /cats/allcats.htmlNCI CancerNet Database Main Index http:/www.meb.uni-onn.de/cancernet/cancernet.html醫(yī)藥衛(wèi)生研究資訊網(wǎng) http:/.tw/resource.htmMedline plus Health Information http:/medlineplus與實證藥學(xué)有關(guān)網(wǎng)站 (續(xù))Virtual Hospital http:/Emergency Medicine http:/emerg/index.shtmlThe Home Page of Emergency Medicine http:/University of Rochester Medical Center http:/medicine/res/CATS/index.htmlAlternative Health News Onli