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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳培哲(Pei-Jer Chen) | |
dc.contributor.author | Ting-Shuo Huang | en |
dc.contributor.author | 黃挺碩 | zh_TW |
dc.date.accessioned | 2021-06-16T08:27:31Z | - |
dc.date.available | 2015-02-25 | |
dc.date.copyright | 2014-02-25 | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014-01-15 | |
dc.identifier.citation | 2011 European Association of the Study of the Liver hepatitis C virus clinical practice guidelines. Liver Int, 2012. 32 Suppl 1, 2-8.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/58722 | - |
dc.description.abstract | 系統性回顧及統合分析目前扮演了兩個很重要的角色,一個是針對臨床問題整合目前可獲得的最佳證據,對臨床決策提出建議,也就是實證醫學的臨床照護。另一方面,系統性回顧及統合分析在設計新的臨床試驗時也是不可或缺的,因為它可以幫忙決定是否下一個臨床試驗是必要的,如果統合分析的結果已經有確證,那下個臨床試驗就不應該做。如果沒有確證,那系統性回顧及統合分析的結果可以提供下一個臨床試驗寶貴的資料。因此,我們把這些概念應用於三個臨床研究。第一個研究是我們利用此研究方法探討一個未解決的問題:重症病患靜脈注射硒的輔助治療是否可以改善死亡率。我們發現硒補充治療可以降低重症敗血症病患的死亡且治療時間愈長效果愈好,這個發現有機會提供重症敗血症病人的新治療方式。第二個研究是探討一直有爭議的問題:輔助性干擾素治療用於病毒性肝炎病患發生肝癌且接受根除性治療後是否會延長存活。我們的統合分析發現了干擾素是可以增進C肝病人存活的,但B肝的病人則沒有證據顯示出有療效,所以之前的統合分析不管臨床的異質性把所有收納B肝及C肝病人的隨機對照試驗和非隨機對照試驗結合起來就造成假的結果。第三個研究我們利用系統性回顧及統合分析的結果設計並執行一個臨床試驗來探討血清降鈣素原的治療指引是否可以減少腹膜炎術後抗生素的使用。我們這個研究顯示出血清降鈣素原治療指引和實證指引比較起來,顯著的降低腹膜炎術後暴露在抗生素使用的風險,且不會增加併發症的發生。因此系統性回顧及統合分析的研究方法本質是屬於執行科學的方法的一部分,可以提供臨床照護及研究者及時的實證醫學證據。 | zh_TW |
dc.description.abstract | Systematic reviews (SRs) and meta-analyses (MAs) offer more information than individual studies for benefits or harms of interventions and are of crucial important to the advance of evidence-based health care and designs of clinical trials High-quality SRs and MAs could summarize up-to-date evidence for clinical practice and provide useful information for designs of clinical trials. In addition, they could determine whether the next clinical trials are needed. Here we applied such strategies to perform three studies. First, we conducted a SR and MA to investigate parenteral selenium supplementation for critically ill patients. We were the first study to demonstrate that parenteral selenium supplementation significantly reduces all-cause mortality among critically ill patients with SIRS or sepsis, particularly those who were treated more than 7 days. Second, adjuvant interferon therapy for viral hepatitis-related hepatocellular carcinoma is controversial. We conducted a SR and MA and showed that adjuvant interferon treatment significantly improves the recurrence-free survival and overall survival among patients with hepatitis C virus-related hepatocellular carcinoma (HCC). However, there was little evidence of beneficial effects for hepatitis B virus-related HCC. Third, we used information from SRs and MAs to design and conduct a clinical trial of a procalcitonin-based algorithm to guide antibiotic use in secondary peritonitis. Our prospective study indicated that the procalcitonin-guided algorithm, compared to the standard of care, significantly reduced the hazard of antibiotic exposure among patients with secondary peritonitis following emergency surgery without increasing the risk of adverse events. Incorporating systematic reviews and meta-analyses in the research frameworks is a scientific method in context, and it could provide timely evidence for evidence-based health care and trial designs. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T08:27:31Z (GMT). No. of bitstreams: 1 ntu-103-D97421102-1.pdf: 4591878 bytes, checksum: 74c9181bd781b00b1404319c146cecc4 (MD5) Previous issue date: 2014 | en |
dc.description.tableofcontents | 口試委員會審定書………………………………………………………………….I
誌謝…………………………………………………………………………………..II 中文摘要…………………………………………………………………………….III 英文摘要…………………………………………………………………………….IV 1.緒論 1 1.1科學的方法-SMART 2 1.2 如何提出臨床問題及文獻搜索 3 1.3統合分析的理論基礎和方法 4 1.3.1固定效應或隨機效應模型 4 1.3.2異質性的來源 5 1.3.3探討異質性的方法-次群組分析及統合迴歸 6 1.3.4多重檢定及策略 6 1.3.5偏差的來源及敏感性分析 7 1.3.6確證的概念 8 1.3.7如何執行系統性回顧及統合分析方面的研究 9 1.4臨床應用 9 1.4.1重症病患靜脈注射硒的輔助治療是否可以改善死亡率 10 1.4.2輔助性干擾素治療用於病毒性肝炎病患發生肝癌且接受根除性治療後是否會延長存活 11 1.4.3血清降鈣素原的治療指引是否可以減少腹膜炎術後抗生素的使用 12 2.研究方法與材料 13 2.1重症病患靜脈注射硒的輔助治療是否可以改善死亡率 13 2.1.1搜索策略 13 2.1.2文章的收納排除條件及資料的萃取 13 2.1.3評估文章偏差風險的方法 14 2.1.4統計分析 14 2.2輔助性干擾素治療用於病毒性肝炎病患發生肝癌且接受根除性治療後是 否會延長存活 15 2.2.1搜索策略 15 2.2.2文章的收納排除條件及資料的萃取 15 2.2.3評估文章偏差風險的方法 16 2.2.4統計分析 16 2.3.血清降鈣素原的治療指引是否可以減少腹膜炎術後抗生素的使用 17 2.3.1系統性回顧及統合分析的證據 17 2.3.2臨床試驗的設計及執行 17 2.3.3收納排除條件 18 2.3.4計畫的執行 18 2.3.5臨床試驗的終點 19 2.3.6統計分析 19 3.結果 20 3.1重症病患靜脈注射硒的輔助治療是否可以改善死亡率 20 3.1.1搜尋結果及研究的特徵 20 3.1.2文章品質的評估 21 3.1.3統合分析的結果 21 3.1.4 單變項統合迴歸及次群組分析 21 3.1.5敏感性分析及發表偏差 22 3.1.6結論 22 3.2 輔助性干擾素治療用於病毒性肝炎病患發生肝癌且接受根除性治療後是否會延長存活 22 3.2.1搜尋結果及研究的特徵 22 3.2.2文章品質的評估 23 3.2.3統合分析的結果-隨機對照試驗 23 3.2.4統合分析的結果-非隨機對照試驗 24 3.2.5發表偏差 24 3.2.6結論 25 3.3血清降鈣素原的治療指引是否可以減少腹膜炎術後抗生素的使用 25 3.3.1收案結果及病患特徵 25 3.3.2血清降鈣素原在手術前後的血清值變化及Kaplan-Meier的存活分析結果 25 3.3.3 多變項迴歸分析 26 3.3.4 計劃書的順應性 26 3.3.5 微生物培養的結果及抗生素治療失敗 27 3.3.6結論 27 4.討論 27 4.1重症病患靜脈注射硒的輔助治療是否可以改善死亡率 27 4.2輔助性干擾素治療用於病毒性肝炎病患發生肝癌且接受根除性治療後是否會延長存活 29 4.3血清降鈣素原的治療指引是否可以減少腹膜炎術後抗生素的使用 30 5.展望 32 5.1 臨床應用及貢獻 32 5.2 有何限制 33 5.3 未來發展 34 6.論文英文簡述 37 7.參考文獻 68 附錄一個人在博士班修業期間所發表之相關論文清冊 87 附錄二血清降鈣素原指引在腹膜炎術後抗生素使用的先期試驗Study Protocol 88 | |
dc.language.iso | zh-TW | |
dc.title | 系統性回顧及統合分析的研究方法釐清術後干擾素治療於肝癌病患的存活及幫助執行腹膜炎術後抗生素使用的臨床試驗 | zh_TW |
dc.title | Systematic reviews and meta-analyses to clarify outcomes of adjuvant interferon therapy in hepatocellular carcinoma, and to help implement clinical trials of postoperative antibiotic use in secondary peritonitis | en |
dc.type | Thesis | |
dc.date.schoolyear | 102-1 | |
dc.description.degree | 博士 | |
dc.contributor.coadvisor | 陳祈玲(Chi-Ling Chen) | |
dc.contributor.oralexamcommittee | 高嘉宏(Jia-Horng Kao),陳志華(Chih-Hwa Chen),簡榮南(Ron-Nan Chieh) | |
dc.subject.keyword | 系統性回顧,統合分析,硒,敗血症,干擾素,肝癌,血清降鈣素原,腹膜炎, | zh_TW |
dc.subject.keyword | systematic review,meta-analysis,selenium,sepsis,interferon,hepatocellular carcinoma,procalcitonin,peritonitis, | en |
dc.relation.page | 148 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2014-01-16 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
顯示於系所單位: | 臨床醫學研究所 |
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