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1、2017/12/16,Department of Medical Research, Chimei Medical Center,1,精品PPT课件 浏览免费 下载后可以编辑修改。http:/ of Medical Research, Chimei Medical Center,3,科學的思考方式,演譯法歸納法猜測與否證- Karl Popper 我們雖然無法證明某個假說為真，卻可以經由不斷地否證，除去錯誤的假說，如此留下來的假說比較可能趨近為真。,2017/12/16,Department of Medical Research, Chimei Medical Center,4,流行病學方法
2、論，p 11。第三版。王榮德著,2017/12/16,Department of Medical Research, Chimei Medical Center,5,流行病學方法論，p 11。第三版。王榮德著,2017/12/16,Department of Medical Research, Chimei Medical Center,6,因果關係的判定標準,必要條件時序性次要條件一致性不能用機會解釋沒有其他干擾因素合理性參考條件相關強度、相關的特定程度、劑量效應關係、生物學上的贊同性,2017/12/16,Department of Medical Research, Chimei Med
3、ical Center,7,Confounding effect,Mark Elwood. Critical Appraisal of Epidemiological Studies and Clinical Trails. 2nd Edition.,2017/12/16,Department of Medical Research, Chimei Medical Center,8,The association between O.C. use and MI - overestimation,Oral contraceptive use,Myocardial infarction,Mark
4、Elwood. Critical Appraisal of Epidemiological Studies and Clinical Trails. 2nd Edition.,2017/12/16,Department of Medical Research, Chimei Medical Center,9,The association between O.C. use and MI - underestimation,Oral contraceptive use,Myocardial infarction,Mark Elwood. Critical Appraisal of Epidemi
5、ological Studies and Clinical Trails. 2nd Edition.,2017/12/16,Department of Medical Research, Chimei Medical Center,10,常見的研究設計法,觀察性研究法Case series study世代研究法(cohort study)病例對照研究(case control study)斷代研究法(cross-sectional study)試驗性研究法社區試驗法臨床試驗法,2017/12/16,Department of Medical Research, Chimei Medical C
6、enter,11,Cohort study,Now!(concurrent cohort study),Now!(retrospective cohort study),2017/12/16,Department of Medical Research, Chimei Medical Center,12,Cohort study - advantages,適於研究rare exposure可直接觀察exposed 和non-exposed group的疾病發生率可觀察多重健康事件事件發生的時序性、先後次序Eligibility criteria和outcome assessments可以標準化
7、比RCT的行政作業簡單、便宜,2017/12/16,Department of Medical Research, Chimei Medical Center,13,Cohort Study - disadvantage,前瞻性研究，費時、昂貴不適於研究稀有或潛伏期夠長的疾病若是retrospective cohort study，需要有過去exposure status的紀錄Loss of follow up可能影響效度,2017/12/16,Department of Medical Research, Chimei Medical Center,14,RR(Relative Risk,
8、Rate Ratio),RR=(60/100) / (44/100) =1.36,RR=(a/(a+b) / (c/(c+d),2017/12/16,Department of Medical Research, Chimei Medical Center,15,01, risk factor,RR(Relative Risk, Rate Ratio),2017/12/16,Department of Medical Research, Chimei Medical Center,16,Case-control study,Recruited samples,exposed gr.,Non-e
9、xposed gr.,diseased gr.,Non-diseased gr.,Now!,2017/12/16,Department of Medical Research, Chimei Medical Center,17,Selection of study subject,Cases:一或多個醫院中就醫的所有病例整個社區或團體族群的所有病例Control:整個社區醫院其他病人病人親屬病人的同學、同事、鄰居,2017/12/16,Department of Medical Research, Chimei Medical Center,18,Case-Control Study-Adva
10、ntage,較適用於研究稀有或潛伏期長的疾病較快得到結果，較便宜保留探討多種致病因子的可能性,2017/12/16,Department of Medical Research, Chimei Medical Center,19,Matching- 控制干擾因子的一種方法,Frequency matching要有整個族群的資料Individual matching找符合條件裡頭最接近病例的人Cases是陸續收案時先考慮age, gender, race，避免overmatching,2017/12/16,Department of Medical Research, Chimei Medica
11、l Center,20,Case-Control Study-disadvantage,Exposure status需要靠過去的紀錄或回憶bias：recall bias, selection bias不容易研究多重疾病事件，且疾病事件的時序性不易建立Control group不好選Confounding effect,2017/12/16,Department of Medical Research, Chimei Medical Center,21,OR (Odds Ratio),odds1=a/b odds2=c/dOdds Ratio=odds1/odds2=ad/bc,OR=303
12、50 / 20015 =3.5,2017/12/16,Department of Medical Research, Chimei Medical Center,22,OR (Odds Ratio),01, risk factor,2017/12/16,Department of Medical Research, Chimei Medical Center,23,Cross-sectional study,2017/12/16,Department of Medical Research, Chimei Medical Center,24,Cross-Sectional Study-Adva
13、ntage,簡單便宜容易推廣到參考族群,2017/12/16,Department of Medical Research, Chimei Medical Center,25,Cross-Sectional Study- disadvantage,頂多建立相關(association),無法推論因果關係（causal-effect relationship）注意 selective survival biasConfounding effect,2017/12/16,Department of Medical Research, Chimei Medical Center,26,Clinica
14、l Trial RCT(Randomized controlled trial),Parallel designCross-Over design,2017/12/16,Department of Medical Research, Chimei Medical Center,27,RCT Parallel Design,Randomization,2017/12/16,Department of Medical Research, Chimei Medical Center,28,RCT Cross-Over Design,Recruited samples,Treatment A,Trea
15、tment B,Outcome 1,Outcome 2,Treatment B,Treatment A,Randomization,2017/12/16,Department of Medical Research, Chimei Medical Center,29,RandomizationControlledBlind-DesignIIT or PP?,2017/12/16,Department of Medical Research, Chimei Medical Center,30,Blind Design,2017/12/16,Department of Medical Research, Chimei Medical Center,31,Intention to treat,randomization,clofibraten=1065,placebon=2095,compliantn=708,compliantn=1813,Non-compliantn=882,Non-compliantn=357,Treatment accepted,Treatment allocated,
