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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 賴美淑 | |
dc.contributor.author | Chia-Huei Chu | en |
dc.contributor.author | 褚嘉慧 | zh_TW |
dc.date.accessioned | 2021-06-15T01:15:33Z | - |
dc.date.available | 2010-09-16 | |
dc.date.copyright | 2009-09-16 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-07-28 | |
dc.identifier.citation | 1. Rovers, M.M., et al., Otitis media. Lancet, 2004. 363(9407): p. 465-73.
2. Cherry, D.K. and D.A. Woodwell, National Ambulatory Medical Care Survey: 2000 summary. Adv Data, 2002(328): p. 1-32. 3. Diagnosis and management of acute otitis media. Pediatrics, 2004. 113(5): p. 1451-65. 4. Faden, H., L. Duffy, and M. Boeve, Otitis media: back to basics. Pediatr Infect Dis J, 1998. 17(12): p. 1105-12; quiz 1112-3. 5. 洪敬賢, 中耳炎的流行病學. 台耳醫誌, 2004. 6. Revai, K., et al., Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics, 2007. 119(6): p. e1408-12. 7. Alho, O.P., et al., The occurrence of acute otitis media in infants. A life-table analysis. Int J Pediatr Otorhinolaryngol, 1991. 21(1): p. 7-14. 8. Lanphear, B.P., et al., Increasing prevalence of recurrent otitis media among children in the United States. Pediatrics, 1997. 99(3): p. E1. 9. Paradise, J.L., Otitis media in infants and children. Pediatrics, 1980. 65(5): p. 917-43. 10. Uhari, M., K. Mantysaari, and M. Niemela, A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis, 1996. 22(6): p. 1079-83. 11. Yamanaka, N., et al., Immunological deficiency in 'otitis-prone' children. Ann N Y Acad Sci, 1997. 830: p. 70-81. 12. Veenhoven, R., et al., Immunoglobulins in otitis-prone children. Pediatr Res, 2004. 55(1): p. 159-62. 13. Adair-Bischoff, C.E. and R.S. Sauve, Environmental tobacco smoke and middle ear disease in preschool-age children. Arch Pediatr Adolesc Med, 1998. 152(2): p. 127-33. 14. Shurin, P.A., et al., Persistence of middle-ear effusion after acute otitis media in children. N Engl J Med, 1979. 300(20): p. 1121-3. 15. Damoiseaux, R.A., et al., Long-term prognosis of acute otitis media in infancy: determinants of recurrent acute otitis media and persistent middle ear effusion. Fam Pract, 2006. 23(1): p. 40-5. 16. Mandel, E.M., et al., Efficacy of 20- versus 10-day antimicrobial treatment for acute otitis media. Pediatrics, 1995. 96(1 Pt 1): p. 5-13. 17. Sipila, M., et al., The Bayesian approach to the evaluation of risk factors in acute and recurrent acute otitis media. Acta Otolaryngol, 1988. 106(1-2): p. 94-101. 18. Rovers, M.M., et al., Prognostic factors for persistent otitis media with effusion in infants. Arch Otolaryngol Head Neck Surg, 1999. 125(11): p. 1203-7. 19. Iino, Y., et al., Prognostic factors for persistent middle ear effusion after acute otitis media in children. Acta Otolaryngol, 1993. 113(6): p. 761-5. 20. Hendley, J.O., Clinical practice. Otitis media. N Engl J Med, 2002. 347(15): p. 1169-74. 21. Leibovitz, E., Acute otitis media in pediatric medicine: current issues in epidemiology, diagnosis, and management. Paediatr Drugs, 2003. 5 Suppl 1: p. 1-12. 22. Jacobs, M.R., et al., The Alexander Project 1998-2000: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J Antimicrob Chemother, 2003. 52(2): p. 229-46. 23. Jacobs, M.R., et al., Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 oral antimicrobial agents based on pharmacodynamic parameters: 1997 U.S. Surveillance study. Antimicrob Agents Chemother, 1999. 43(8): p. 1901-8. 24. Dowell, S.F., et al., Acute otitis media: management and surveillance in an era of pneumococcal resistance--a report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group. Pediatr Infect Dis J, 1999. 18(1): p. 1-9. 25. Whitney, C.G., et al., Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med, 2000. 343(26): p. 1917-24. 26. Casey, J.R. and M.E. Pichichero, Changes in frequency and pathogens causing acute otitis media in 1995-2003. Pediatr Infect Dis J, 2004. 23(9): p. 824-8. 27. Wald, E.R., Acute otitis media: more trouble with the evidence. Pediatr Infect Dis J, 2003. 22(2): p. 103-4. 28. 龐一鳴, 從健保申報資料探討中耳炎抗生素療程之合理性. 台灣衛誌, 2004. 29. 劉品均, 抗生素處方型態與臨床指引之相關研究. 國立台灣大學衛生政策與管理研究所碩士論文, 2006. 30. 微免感學會, 台灣URI使用抗生素指引. 微免感雜誌, 2002. 31. Quach, C., J.P. Collet, and J. LeLorier, Acute otitis media in children: a retrospective analysis of physician prescribing patterns. British Journal of Clinical Pharmacology, 2004. 57(4): p. 500-5. 32. Solis, G., C. Ochoa, and C. Perez Mendez, The variability and appropriateness of the antibiotic prescription of acute otitis media in childhood. The Spanish Study Group for Antibiotic Treatments. International Journal of Pediatric Otorhinolaryngology, 2000. 56(3): p. 175-84. 33. Akkerman, A.E., et al., Analysis of under- and overprescribing of antibiotics in acute otitis media in general practice. Journal of Antimicrobial Chemotherapy, 2005. 56(3): p. 569-74. 34. Reuveni, H., et al., Adherence to therapeutic guidelines for acute otitis media in children younger than 2 years. International Journal of Pediatric Otorhinolaryngology, 2006. 70(2): p. 267-73. 35. Garbutt, J., D.B. Jeffe, and P. Shackelford, Diagnosis and treatment of acute otitis media: an assessment. Pediatrics, 2003. 112(1 Pt 1): p. 143-9. 36. Dowell, S.F., B. Schwartz, and W.R. Phillips, Appropriate use of antibiotics for URIs in children: Part I. Otitis media and acute sinusitis. The Pediatric URI Consensus Team. Am Fam Physician, 1998. 58(5): p. 1113-8, 1123. 37. Vernacchio, L., R.M. Vezina, and A.A. Mitchell, Knowledge and practices relating to the 2004 acute otitis media clinical practice guideline: a survey of practicing physicians. Pediatr Infect Dis J, 2006. 25(5): p. 385-9. 38. Rosenfeld, R.M., et al., Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr, 1994. 124(3): p. 355-67. 39. Easton, J., S. Noble, and C.M. Perry, Amoxicillin/clavulanic acid: a review of its use in the management of paediatric patients with acute otitis media. Drugs, 2003. 63(3): p. 311-40. 40. Pichichero, M.E. and J.R. Casey, Acute otitis media: making sense of recent guidelines on antimicrobial treatment. J Fam Pract, 2005. 54(4): p. 313-22. 41. Jean, S.S., et al., Nationwide surveillance of antimicrobial resistance among Haemophilus influenzae and Streptococcus pneumoniae in intensive care units in Taiwan. Eur J Clin Microbiol Infect Dis, 2009. 42. Guillemot, D., et al., Low dosage and long treatment duration of beta-lactam: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. JAMA, 1998. 279(5): p. 365-70. 43. Schrag, S.J., et al., Effect of short-course, high-dose amoxicillin therapy on resistant pneumococcal carriage: a randomized trial. JAMA, 2001. 286(1): p. 49-56. 44. Garrison, G.D., et al., High-dose versus standard-dose amoxicillin for acute otitis media. Ann Pharmacother, 2004. 38(1): p. 15-9. 45. Garbutt, J., et al., Developing community-specific recommendations for first-line treatment of acute otitis media: is high-dose amoxicillin necessary? Pediatrics, 2004. 114(2): p. 342-7. 46. Dowell, S.F., et al., Otitis Media---Principles of Judicious Use of Antimicrobial Agents. Pediatrics, 1998. 101(1): p. 165-171. 47. Veenhoven, R., et al., Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study. Lancet, 2003. 361(9376): p. 2189-95. 48. Jansen, A.G., et al., Pneumococcal conjugate vaccines for preventing otitis media. Cochrane Database Syst Rev, 2009(2): p. CD001480. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/42528 | - |
dc.description.abstract | 前言及目的:
急性中耳炎 (AOM,Acute otitis media)是兒童罹患急性上呼吸道感染常見的併發症,也是醫師開立抗生素予兒童最常見的原因之一。美國小兒科醫學會、家庭醫學科醫學會和耳鼻喉頭頸外科醫學會,於2004年組成委員會,共同發表急性中耳炎臨床診療指引,提供醫師治療兩個月到十二歲兒童非複雜型(Uncomplicated acute otitis media)急性中耳炎之初步處理方法及藥物使用建議。本研究欲探討急性中耳炎患者之抗生素處方型態及其影響因子,並探討抗生素處方型態遵從度和急性中耳炎預後之相關性。 研究方法: 本研究資料來源為台北榮民總醫院耳鼻喉科2005年~2008年,年齡2個月~12歲大,主診斷碼為急性中耳炎之兒童病患。以病歷回溯的方式,紀錄病患基本資料 (年齡、性別、體重)、醫師開立抗生素處方 (包括品項、劑量、天數)、就診日期及病程以評估短期預後及中期預後。以該臨床診療指引為判斷抗生素處方型態遵從度之依歸,評估抗生素處方遵從度與分析急性中耳炎預後之相關性。以統計軟體SPSS 14.0版進行整體描述性統計和相關分析。 研究結果: 共收集207名急性中耳炎患者,年齡以2~6歲最多(占60.4%);春、秋季就診人數較多(占58.5%)。醫師處方抗生素處方遵從度(包括品項、劑量、給藥天數)為8.2%。其中處方品項皆為指引建議品項,遵從度100%;其中92.7%醫師處方抗生素品項為「Amoxicillin類」類藥物。抗生素劑量遵從度極低,僅11.6%,絕大多數為劑量不足(占85%)。給藥天數遵從度為50.7%。專科醫師年資超過20年者,處方遵從度較低(p=0.006);處方抗生素品項為「非Amoxicillin類」者,處方遵從度較高(p=0.006)。 總體來說,處方遵從度與急性中耳炎患者短期預後、中期預後皆無關。將處方品項、劑量、給藥天數分開檢視,抗生素「劑量」遵從度和急性中耳炎短期預後顯著相關(p=0.047);劑量符合指引建議者,短期控制失敗的勝算比較低。就「Amoxicillin類」類抗生素而言,「劑量」遵從度和急性中耳炎預後之相關性在體重低於20Kg且雙側患病的孩童具顯著意義,藥物劑量不足者,短期控制失敗的勝算比較高(p=0.045)。「給藥天數」遵從度與短期預後無關,與中期預後顯著相關(p=0.42)。 | zh_TW |
dc.description.abstract | Background and Objectives:
AOM (Acute otitis media) is one of the most common childhood infections, especially after acute upper respiratory tract infections. It is also the leading cause of clinic’s visits by children, and the most frequent reason doctors prescribe antibiotics. The American Academy of Pediatrics, American Academy of Family Physicians and American Academy of Otorhinolaryngology Head-and-Neck surgery develop a clinical practice guideline for AOM. This evidence-based guideline provides recommendations to clinicians for the management of children from 2 months through 12 years of age with uncomplicated AOM. Our goal is to assess the variability and appropriateness of antibiotics prescribing patterns and also to evaluate the relationships between guideline adherence and prognosis of AOM. Methods: Data source of this study was based on outpatient clinic of Otolaryngology Head-and-Neck surgery department in Taipei Veterans General Hospital from 2005 to 2008. Medical records of children from 2 months through 12 years of age with ICD-9 CM diagnosis code of AOM were reviewed. The adherence of doctors’ prescribing patterns focusing on antibiotics was considered appropriate when in accord with clinical practice guideline for AOM. The study also examines the relationships between guideline adherence and primary control (defined as the eardrum condition at the evaluation point closest to 1~14 days after therapy of antibiotics finished), secondary control (defined was the eardrum condition at the evaluation point closest to 30 days after first visit owing to this episode) of AOM. Results: Complete medical record review was conducted in a total of 207 children, aged mostly from 2 to 6 years old (60.4%). Numbers of the visits were higher in Spring and Autumn (58.5%). Amoxicillin with or without β‐lactamase inhibitor was prescribed to majority of the patients (92.7%). The overall adherence of antibiotics prescription was only 8.2%. Among them, all of the antibiotics “items” fulfill the recommendations of guideline, while the “dosage” was under in 85%. The “duration” of prescribing antibiotics was adherent to guideline in 50.7%. Specialists who had been practicing for more than 20 years have poorer adherence to the guideline (p=0.006). The overall adherence was associated neither with primary nor secondary control of AOM. Better adherence of “dosage” was found to be significantly related to better primary control (p=0.047). As to the prescription containing amoxicillin, the relationship was stronger in children below 20Kg with bilateral AOM (p=0.045). Better adherence of “duration of prescribing antibiotics” was related to better secondary control (p=0.42). | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T01:15:33Z (GMT). No. of bitstreams: 1 ntu-98-R96846009-1.pdf: 1029032 bytes, checksum: 5fe1ce887abb479208a22cecaae6f66d (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | 口試委員會審定書
中文摘要 1 英文摘要 3 第一章 前言 5 第一節 研究背景與動機 5 第二節 研究目的 7 第二章 文獻回顧 8 第一節 急性中耳炎發生之影響因子和預後因子 8 第二節 急性中耳炎之致病細菌與抗生素治療 12 第三節 美國急性中耳炎臨床診療指引 14 第四節 以臨床診療指引評估抗生素處方型態之相關研究 17 第三章 研究設計與方法 25 第一節 研究類型 25 第二節 資料來源 25 第三節 研究對象 25 第四節 資料處理流程 26 第五節 研究變項定義 29 第六節 假設與統計分析 34 第四章 研究結果 36 第一節 急性中耳炎個案之基本資料分析 36 第二節 抗生素處方型態分析 38 第三節 抗生素處方遵從度及其影響因子 41 第四節 急性中耳炎預後 47 第五節 抗生素處方遵從度與急性中耳炎預後之相關性 50 第五章 結論與討論 63 第一節 抗生素處方型態 63 第二節 抗生素處方遵從度與預後 63 品項遵從度與預後 66 劑量遵從度與預後 68 天數遵從度與預後 74 第三節 本研究之優點 76 第四節 本研究之限制與未來展望 76 參考文獻 78 附錄:急性中耳炎臨床診療指引原文 82 | |
dc.language.iso | zh-TW | |
dc.title | 急性中耳炎患者抗生素處方遵從度與預後之相關研究-以某醫學中心耳鼻喉科為例 | zh_TW |
dc.title | Adherence to the Clinical Practice Guidelines for Acute Otitis Media and It’s Relationship to Outcomes | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 蕭安穗,季瑋珠,蕭朱杏,方啟泰 | |
dc.subject.keyword | 臨床診療指引,急性中耳炎,抗生素,遵從度, | zh_TW |
dc.subject.keyword | Acute otitis media,Clinical practice guideline,Adherence,Antibiotics, | en |
dc.relation.page | 82 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2009-07-28 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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