术后恶心呕吐的预防与治疗英文ppt课件.ppt

Postoperative Nausea and Vomiting:Prevention and Treatment Phillip E. Scuderi, M.D. Department of Anesthesiology Wake Forest University School of Medicine Winston-Salem, NC 27157-1009 Postoperative Nausea and Vomiting:Prevention and Treatment /anesthesia pscuderi@ Historical Perspective on PONV Quality of Clinical Trials Appearance of control treatment Blinding of randomization process Blinding of patients and observers, Sample size estimate and power analysis Confidence intervals Statistical analyses Withdrawals Side effect discussions Quality of Clinical Trials Quality of Clinical Trials Investigators Improve rigor of study protocols Improve quality of data analysis Peer Reviewers Process of randomization Power analysis Blinding Critical Evaluation of Data Quality of individual clinical trials Type and adequacy of controls used Blinding process Sample size, power analysis Appropriateness of endpoints chosen Confidence limits particularly for negative studies Statistical analysis Critical Evaluation of Data Quality of individual clinical trials Evaluation of data in aggregate Evidence Based MedicineRating Scale Level of evidence based on study design I. Large randomized, controlled trial (n100 per group) II. Systematic review III. Small randomized, controlled trial (n100 per group) IV. Nonrandomized controlled trial or case report V. Expert opinion Strength of Recommendation based on expert opinion A. Good evidence to support the recommendation B. Fair evidence to support the recommendation C. Insufficient evidence to recommend for or against Critical Evaluation of Data Quality of individual clinical trials Evaluation of data in aggregate Estimation of treatment consequences Measures of Treatment Consequences Relative Risk Reduction The reduction of adverse events achieved by a treatment, expressed as a proportion of the control rate Odds Ratio The traditional expression of the relative likelihood of an outcome expressed as P/(1 - P) where P = probabi