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在ebm level這個產品中，有5篇Facebook貼文，粉絲數超過9萬的網紅NEJS - the New England Journal of Stupid，也在其Facebook貼文中提到， 【EBM：拆掉金字塔吧！證據等級與證據品質的迷思～】 #金字塔蓋久了就會出問題 #證據等級是證據品質的代表 #每次學到這裡都卡關 http://jerryljw.blogspot.tw/…/misconception-of-level-of-evi… ...
　同時也有1部Youtube影片，追蹤數超過7萬的網紅Tony Jaa，也在其Youtube影片中提到，Pulse are introducing their new album Adjusting the Space which will be released worldwide on november the 6th, 2020. Their sound is a mixture of Indu...

ebm level 在 NEJS - the New England Journal of Stupid Facebook 的最佳解答

NEJS - the New England Journal of Stupid By NEJS - the New England Journal of Stupid

2017-03-01 20:00:01 有 518 人按讚
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【EBM：拆掉金字塔吧！證據等級與證據品質的迷思～】

#金字塔蓋久了就會出問題 #證據等級是證據品質的代表 #每次學到這裡都卡關

http://jerryljw.blogspot.tw/…/misconception-of-level-of-evi…

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NEJS - the New England Journal of Stupid

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Q 為什麼叫做NEJS呢？ A 因為NEJS (New England Journal of Medicine) 太難了！所以我們推出的是連笨蛋都看得懂的版本～當然看的人就不會是笨蛋囉～ Q NEJS的內容有哪些？ A 我們的服務項目是臨床藥學、臨床/重症醫學、實證醫學 (evidence-based medicine) 等等～用最易懂、能懂、可懂的方式幫你充電～ Q NEJS是一個人嗎？ A 是，他是一個人，只有一個人，真的只有一個人
這裡是NEJS的粉專，NEJS是New England Journal of Stupid的縮寫，我們關注醫療、健康
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ebm level 在 加護病房查房日誌 Facebook 的最佳解答

加護病房查房日誌 By 加護病房查房日誌

2014-07-09 12:37:10 有 79 人按讚
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加護病房查房日誌20140709
各位同學，希望大家對於昨天的EBM影音分享有所收穫，老師已經把相關的檔案分別放在youtube(https://www.youtube.com/watch?v=0-4IYUR5GaQ)和slideshare(http://www.slideshare.net/ymkbaz60/ebm-36731109)中，有興趣的同學可以直接下載。
今天早上有個病人的digoxin level=2.17,稍微偏高，我們也都知道現在Af的病人建議不用抽血中濃度，只要follow HR，此外CHF的病人，digoxin level 最好是在0.8-1.2之間，在高死亡率反而會增加。
這個病人其實是年輕人，從青春期就被診斷是Becker muscular dystrophy，而且伴隨心臟肌肉病變，所以有Af和CHF，使用digoxin 0.25 mg qd po已經約3-4年的時間了，濃度一直控制在1.1-2之間，這次入院稍微偏高，但臨床上並無特別的毒性出現。
甚麼是becker muscular dystrophy?
病人會缺乏dystrophin蛋白，dystrophin蛋白在骨骼肌肉的細胞膜上含量很多，跟肌肉細胞的完整性有相當密切的關係。缺乏dystrophin蛋白的患者骨骼肌肉細胞會壞死。通常是小孩子(7-26歲)就會發生，x-linked recessive(male affected, female carriers)。併發症主要是呼吸衰竭和心肌病變，心衰竭。抽血你會發現CK會上升，ALT/AST也會上升。
治療的話主要是以症狀控制為主，改善生活品質，建議多活動，可做物理治療。藥物的部分，可補中creatine，evidence level 2(cochrane review: Cochrane Database Syst Rev. 2013 Jun 5;6:CD004760.)。
病人大部分到成年後就不能再行走，因為下肢無力，約一半的病人可以活到50歲。
不知道大家有沒有遇過這樣的病人呢?

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這是一個分享加護病房中查房心得，醫藥新知的地方。以簡單的方式呈現給大家，希望對大家有所幫助。
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ebm level 在 加護病房查房日誌 Facebook 的最讚貼文

加護病房查房日誌 By 加護病房查房日誌

2014-06-27 13:31:17 有 137 人按讚
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加護病房查房日誌20140627
今天早上藥局的學妹報告痛風藥物的治療，提到一個大家應該慢慢會越來越熟悉的藥物: febuxostat。我們這樣講好了，大家應該知道allopurinol吧，和她一樣都是屬於xanthine oxidase inhibitor，但是非嘌呤類。兩個比較可以參考圖片(這是從慈濟藥訊中節錄下來的)
最近老師EBM上身，我們來比較一下febuxostat和allopurinol的效果和安全性還有經濟評估吧。
PICO:
P: gout with hyperuricemia
I: febuxostat
C: allopurinol
O: 降尿酸效果, side effects
Evidence: UpToDate (因為時間不夠)
Key word: gout AND febuxostat AND allopurinol
裡面有一篇: prevention of recurrent gout，其中舉了一個second phase III的6個月研究，比較febuxastat (80 mg or 120 mg or 240 mg qd) vs. allopurinol 300 mg 和placebo。
3個月將uric acid降至6 mg/dl以下，febuxastat 80 mg(48%)，120 mg(65%)，240 mg(69%)，allopurinol (22%)，p<0.05。兩組的副作用差不多，但是在febuxastat 250 mg那組的拉肚子和頭暈比較多。兩組退出試驗的原因差不多，但在febuxastat發生gout flares的比例較高。
Ref: Arthritis Rheum. 2008;59(11):1540.
基本上呢，這樣的文獻證據等級對我來講是不夠的，應該是要繼續到pubmed or cochrane繼續找看有沒有meta analysis。我們再去cochrane找找看好了，沒想到只用gout的Meshterm找，就找到一篇不錯的2012年的meta analysis，收入4個RCT，和2個open label trials，共3978位病人，裡面比較febuxastat和allopurinol，為期24-52周。
1. 兩組出現gout flares的比例類似，febuxastat 40 mg並沒有比較好也沒有比較多副作用。
2. 但80 mg達到尿酸低於6是allopurinol的1.8倍(95% CI 1.6-2.2)。
3. 總退出率在80 mg or 120 mg febuxastat都比較高，因副作用停用的比例兩組都差不多，在80 mg 的總副作用比率較allopurinol來的低，RR 0.93; 95% CI 0.87-0.99。
文獻評讀的部分: 因為篇幅的關係，怕大家睡著就省略。簡單跟大家summary看到的資料，基本上febuxastat用於降尿酸的效果比allopurinol好，但是副作用兩者都差不多，不過要小心在使用初期febuxastat的gout flares可能較高，但長期來講是還好。
應用到病人身上: 病人可能得到的好處: 80 mg febuxastat vs. allopurinol: RR 1.8 (1.6-2.2)，NNTB約3人，副作用是差不多。
經濟效益，你想想febuxastat一顆健保價25.9元，allopurinol 一顆2元，假設每天吃，一星期是181元比上14元，一個月是734 vs. 56元。看起來似乎allopurinol比較便宜喔，就算有調劑量我想也還是allopurinol比較便宜啦。
病人本身的價值觀和期待: 這就要看病人本身了。
最後是以病人聽得懂的話回答: 以目前的證據來看，用febuxastat治療3人可以有一個人的尿酸降得比allopurinol好，副作用差不多，但是價錢比較高。(心理OS: 就是比較貴啦)
證據強度Level 2 (因為研究品質差，降一階，from CEBM)

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這是一個分享加護病房中查房心得，醫藥新知的地方。以簡單的方式呈現給大家，希望對大家有所幫助。
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ebm level 在 Tony Jaa Youtube 的最佳解答

Tony Jaa By Tony Jaa

2020-10-11 08:00:00 有 208 人看過 有 32 人喜歡
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Pulse are introducing their new album Adjusting the Space which will be released worldwide on november the 6th, 2020. Their sound is a mixture of Industrial Metal, blended with cyberpunk and EBM.

Listen and find out more here:

https://nrt-records.com/info/pulse/ad...

Adjusting The Space from Pulse tells the story of an extraterrestial high advanced and hostile species, which brings us a dark fate. Pulse suits for fans of Science Fiction, but also music acts Rammstein, Lindemann, KMFDM, Nine Inch Nails, Suicide Commando and more. Formed by Astaroth Mastermind Nemesis, Pulse released their debut Extinction Level Event in 2014. Now the intergalactic soundwave warlords switched mothership and release their upcoming album via NRT-Records on november the 6th. On october the 31st, you will be able to listen to the album for free on the link above

find out more about the dark electronic cyber metal act pulse at:

https://www.pulse-galaxy.com
https://nrt-records.com/info/pulse/ad...
https://www.facebook.com/pulseaustria/
https://open.spotify.com/artist/3JbBg...
https://www.instagram.com/pulseaustria/

To promote your channel or upload your videos on this channel, please place your order on “Fiverr”.
https://www.fiverr.com/share/qb6egZ
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**FAIR USE**
Copyright Disclaimer under section 107 of the Copyright Act 1976, allowance is made for “fair use” for purposes such as criticism, comment, news reporting, teaching, scholarship, education and research.

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#67. Levels of Evidence - Evidence Based Health Care

OCEBM Levels of Evidence. The Oxford Centre for Evidence-Based Medicine uses a 5-Step (Level) grid system to rank studies. Download the ...

#68. Levels of Evidence in Research: Examples, Hierachies ...

Medicine and allied health have adapted evidence-based practice, aptly named evidence-based medicine (EBM), which is an approach to the practice that optimizes ...

#69. 文獻搜尋與評析

http://www.medlib.ncku.edu.tw/ebm/index.html#summaries ... Appraise: Level of Evidence by Oxford ... The 2011 Oxford CEBM evidence levels of.

#70. Grading levels of evidence - CIAP Clinical Information Access ...

Another way of ranking the evidence is to assign a level of evidence to grade the ... (NHMRC) and The Centre for Evidence-Based Medicine (CEBM) in Oxford.

#71. Evidence-Based Medicine Subject Guide: EBM Pyramid

Note: Evidence in these resources may vary from expert opinion to high levels of evidence. Medscape. Physician authors and editors contribute to ...

#72. NHMRC levels of evidence and grades for recommendations ...

developers received by the NHMRC indicated that the levels of evidence used by the NHMRC ... and evidence based medicine are also available – see ...

#73. Evidence Based Medicine: Levels of Evidence & Question Types

Evidence Based Medicine : Levels of Evidence & Question Types ... There are a variety of "Question Types" that apply to the EBM process.

#74. The Evidence-Based Medicine Pyramid!

The Evidence-Based Medicine Pyramid is simply a diagram that was created to help us understand how to weigh different levels of evidence in ...

#75. Breast Cancer Research to Support Evidence-Based ...

Evidence-based medicine (EBM) entails using the results... ... There is a need to increase EBM levels in breast cancer research to address ...

#76. Orthopaedic Evidence-Based Medicine - OrthoInfo - AAOS

To develop a guideline, a panel of experts meticulously reviews the medical literature and scientific evidence to determine the highest level of evidence ...

#77. levels-of-evidence-based-medicine-in-mass-gathering-public ...

Pubrica promotes Levels of evidence-based medicine in large public health and emergency data collection, which is required to summarise the ...

#78. EBM - Evidence-based Medicine - Harvard Library Guides

Tutorials on the EBM process, EBM based information resources ... and arranged by relevance and categorized by type and level of evidence.

#79. Evidence-based radiology - EIBIR

EBM needs to be the integration of: i) research evidence, ii) clinical expertise, ... the top-down way [10]) implies a higher level of knowledge of medical ...

#80. Evidence-based medicine: reviews and meta-analysis

Therefore, review articles are works of considerable importance at various levels and, consequently, the quality must be carefully evaluated ...

#81. Evidence Grading & Reporting - Evidence Based Medicine

The OHAT Risk of Bias Rating Tool can be used for human and animal studies. The CEBM Levels of Evidence framework sets out one approach to ...

#82. EBM文獻評讀演練 - 國立臺北護理健康大學

未經嚴謹評估的意見，或者基礎生理學、一般實驗室研究及必要原. 則。 42. Page 43. 隨機控制試驗Randomized controlled trial (level 1b).

#83. Evidence-Based Medicine: History, Review, Criticisms, and ...

Systematic reviews of RCTs and robust RCTs still serve as the necessary foundations for EBM. The five levels of evidence are: (i) level I ...

#84. What Is Evidence-Based Medicine and Why Should I Care?

The highest evidence level is an “n-of-1” random- ized, controlled trial, in which a patient undergoes pairs of treatment periods in which he or she receives a ...

#85. Level 1 Evidence-Based Medicine - AJNR Blog

Editor's Choice Does Embolization with Larger Coils Lead to Better Treatment of Aneurysms (DELTA) was an investigator-initiated multicenter prospective, ...

#86. 認識實證醫學 - 聖保祿醫院

所謂實證醫學(Evidence-Based Medicine, EBM)，又稱循證醫學，是一種從龐大的醫學資料庫中， ... Evidence-Based Medicine a Framework for Clinical Practice, 1998.

#87. Evidence-based medicine among physicians working in ...

Background: Evidence-Based Medicine (EBM) is the process of systematically locating, ... sample size, Zα/2 (1.96): significance level at α =0.05, P:.

#88. APPRAISE the Evidence - Evidence-Based Medicine (EBM)

EBM classic text - Studying a Study & Testing a Test was first published ... GRADE is used to rate the body of evidence at the outcome level ...

#89. Evidence-based management—recognizing your own ...

Find out everything about Evidence Based Management: What is EBM ✓ The four key ... At the management level and below, existing processes are constantly ...

#90. Evidence-based medicine - EUPATI Toolbox

Patients can have an active role to play at all levels of evidence. Assessing evidence for evidence-based medicine. To assess the quality of evidence, the ...

#91. Evidence based medicine editorial - RACGP

Parodies of EmBM abound, including the formation of levels and grades of EmBM promulgated by the Utopian College of Emergency Medicine (UCEM). 3 Other flawed ...

#92. 實證醫學研究之系統性回顧方法評論- -療效研究之品質評估

的大作「Evidence-Based Medicine:How to Prac- tice and Teach EBM」中指出:實證醫學的概念 ... 藉此建立實證醫學研究證據的強度等級(level of.

#93. 5S Pyramid of Evidence Resources - Guides

Evidence-Based Medicine Resources: 5S Pyramid of Evidence Resources ... evidence varies from expert opinion to high levels of evidence.

#94. GreenIntelligence – The next level of Green | ebm-papst

At ebm -papst, energy-efficient fans and drives become intelligently networked complete solutions. Stefan Brandl, CEO of ebm -papst, ...

#95. Finding the Best Evidence - Evidence Based Medicine

... types" filter on the left to select the type of study that offers the highest level of evidence given your specific clinical question.

#96. Evidence-Based Medicine

AAPM&R supports evidence-based medicine principles. ... Levels of Evidence & Grades of Recommendation: This tool is utilized by the Evidence Committee to ...