申覆
版主: 版主013
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ulcamed
- CR
- 文章: 794
- 註冊時間: 週日 8月 10, 2008 8:20 pm
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ptman
- 部長級
- 文章: 7275
- 註冊時間: 週三 5月 23, 2007 5:25 pm
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Thanatos
- 指導教授
- 文章: 9129
- 註冊時間: 週四 5月 13, 2010 9:23 am
- 來自: 烏賊帝國
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bikeman
- CR
- 文章: 505
- 註冊時間: 週二 5月 06, 2008 10:55 pm
Re: 該藥物無明確療效 這樣理由被刪 有機會申覆過嗎??
我用這招結果大都是狗吠火車ulcamed 寫:回答說⋯如果無醫療效用，請健保局及衛生署D掉這藥⋯
以前用過這招，結果過了!
春有百花秋有月，夏有涼風冬有雪
若無閑事掛心頭，便是人間好時節
若無閑事掛心頭，便是人間好時節
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apprum
- V1
- 文章: 1224
- 註冊時間: 週四 3月 19, 2009 6:19 pm
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tedwang
- V3
- 文章: 3820
- 註冊時間: 週五 2月 27, 2009 10:29 pm
Re: 該藥物無明確療效 這樣理由被刪 有機會申覆過嗎??
無明確療效apprum 寫:藥品仿單上面寫:mowball 寫:附上該藥仿單藥典
把適應症圈起來
適應症:
1.腦血管障礙及老化所引起的智力障礙可能有效
會不會審察委員看到"可能"有效 這字眼
才這樣刪的
那附仿單去申覆好像更顯得他核刪有理 這該怎麼辦呢???
叫藥商生10篇期刊論文出來
讓審查醫師讀個夠
Re: 該藥物無明確療效 這樣理由被刪 有機會申覆過嗎??
http://www.ncbi.nlm.nih.gov/pubmed/10796585
no evidence
Piracetam for dementia or cognitive impairment.
Flicker L, Grimley Evans J.
SourceDepartment of Medicine-RPH, University of Western Australia, Royal Perth Hospital Box X2213 GPO, Perth, Western Australia, Australia, 6847. leon.flicker@rph.health.wa.gov.au
Update in
Cochrane Database Syst Rev. 2001;(2):CD001011.
Abstract
OBJECTIVES: To determine the clinical efficacy of piracetam for the features of dementia or cognitive impairment, classified according to the major subtypes of dementia: vascular, Alzheimer's disease or mixed vascular and Alzheimer's disease or unclassified dementia or cognitive impairment not fulfilling the criteria for dementia.
SEARCH STRATEGY: The Cochrane Dementia and Cognitive Impairment Group Register of Clinical Trials was searched using the terms "piracetam", "nootropic" and "2-oxo-l-pyrrolidine acetamide". Electronic bibliographic databases including Medline, Embase, PychLit, Current Contents, Sociofile were searched back to 1966 with the terms piracetam, nootropics, 2-oxo-1-pyrrolidine and trials. In addition the pharmaceutical company responsible for marketing most of the piracetam worldwide, UCB Pharma, provided a comprehensive list of abstracts, which included many unpublished studies. As many of these unpublished, placebo control studies will be reviewed as possible.
SELECTION CRITERIA: All unconfounded trials specified as randomised in which treatment with piracetam was administered for more than a day and compared with placebo in patients with dementia of the Alzheimer's type, vascular dementia or mixed vascular and Alzheimer's disease or uncalssified dementia or cognitive impairment not fulfilling the criteria for dementia.
DATA COLLECTION AND ANALYSIS: Data were extracted independently by two reviewers. Each study was independently verified as fulfilling the inclusion criteria. Studies were rated for methodological quality by assessment of blinding and loss before analysis as described by Jadad et al. (1996). Studies were pooled if appropriate and possible, and the pooled odds ratios (95%CI) or the average differences (95%CI) were estimated. Where possible, intention-to-treat data were used. Sensitivity analyses were performed to determine if successive elimination of those studies performing most poorly on these quality criteria changed the effect estimate.
MAIN RESULTS: Unfortunately, many of these studies were crossover in design and data were unavailable from the first period. In many other studies data were not able to be extracted from the first period. From the data that were pooled there was only one outcome where significant amounts of evidence were available, Global Impression of Change. There was evidence of heterogeneity in the results from the individual studies, Chi squared test = 20.8 (df=5). Using a fixed effects model the odds ratio for improvement in the Piracetem group compared with the Placebo group was 3.55, [95% CI][2.45, 5.16]. If a random effects model was used the odds ratio was 3.47 [1.29, 9.30]. If one single-blind study was excluded, the fixed effects model yielded an odds ratio of 3.36 [2.29, 4.99] and if a random effects model was applied then the odds ratio was 2.89 [1.01, 8.24]. The evidence of effects on cognition and other measures, was inconclusive.
REVIEWER'S CONCLUSIONS:
At this stage the evidence available from the published literature does not support the use of Piracetem in the treatment of people with dementia or cognitive impairment because effects were found only on global impression of change but not on any of the more specific measures. There is a need for further evaluation of piracetam by : 1) Obtaining the data from these studies for an individual patient database review, 2) Performing a randomised trial of Piracetam in patients with diagnoses made by currently accepted diagnostic criteria. Piracetam should be trialled for a period of at least 6 months and preferably longer. Specific cognitive instruments which are sensitive to change, Clinician Global Impression of Change, levels of dependency and caregiver quality of life scales should also be incorporated in such a study.
no evidence
Piracetam for dementia or cognitive impairment.
Flicker L, Grimley Evans J.
SourceDepartment of Medicine-RPH, University of Western Australia, Royal Perth Hospital Box X2213 GPO, Perth, Western Australia, Australia, 6847. leon.flicker@rph.health.wa.gov.au
Update in
Cochrane Database Syst Rev. 2001;(2):CD001011.
Abstract
OBJECTIVES: To determine the clinical efficacy of piracetam for the features of dementia or cognitive impairment, classified according to the major subtypes of dementia: vascular, Alzheimer's disease or mixed vascular and Alzheimer's disease or unclassified dementia or cognitive impairment not fulfilling the criteria for dementia.
SEARCH STRATEGY: The Cochrane Dementia and Cognitive Impairment Group Register of Clinical Trials was searched using the terms "piracetam", "nootropic" and "2-oxo-l-pyrrolidine acetamide". Electronic bibliographic databases including Medline, Embase, PychLit, Current Contents, Sociofile were searched back to 1966 with the terms piracetam, nootropics, 2-oxo-1-pyrrolidine and trials. In addition the pharmaceutical company responsible for marketing most of the piracetam worldwide, UCB Pharma, provided a comprehensive list of abstracts, which included many unpublished studies. As many of these unpublished, placebo control studies will be reviewed as possible.
SELECTION CRITERIA: All unconfounded trials specified as randomised in which treatment with piracetam was administered for more than a day and compared with placebo in patients with dementia of the Alzheimer's type, vascular dementia or mixed vascular and Alzheimer's disease or uncalssified dementia or cognitive impairment not fulfilling the criteria for dementia.
DATA COLLECTION AND ANALYSIS: Data were extracted independently by two reviewers. Each study was independently verified as fulfilling the inclusion criteria. Studies were rated for methodological quality by assessment of blinding and loss before analysis as described by Jadad et al. (1996). Studies were pooled if appropriate and possible, and the pooled odds ratios (95%CI) or the average differences (95%CI) were estimated. Where possible, intention-to-treat data were used. Sensitivity analyses were performed to determine if successive elimination of those studies performing most poorly on these quality criteria changed the effect estimate.
MAIN RESULTS: Unfortunately, many of these studies were crossover in design and data were unavailable from the first period. In many other studies data were not able to be extracted from the first period. From the data that were pooled there was only one outcome where significant amounts of evidence were available, Global Impression of Change. There was evidence of heterogeneity in the results from the individual studies, Chi squared test = 20.8 (df=5). Using a fixed effects model the odds ratio for improvement in the Piracetem group compared with the Placebo group was 3.55, [95% CI][2.45, 5.16]. If a random effects model was used the odds ratio was 3.47 [1.29, 9.30]. If one single-blind study was excluded, the fixed effects model yielded an odds ratio of 3.36 [2.29, 4.99] and if a random effects model was applied then the odds ratio was 2.89 [1.01, 8.24]. The evidence of effects on cognition and other measures, was inconclusive.
REVIEWER'S CONCLUSIONS:
At this stage the evidence available from the published literature does not support the use of Piracetem in the treatment of people with dementia or cognitive impairment because effects were found only on global impression of change but not on any of the more specific measures. There is a need for further evaluation of piracetam by : 1) Obtaining the data from these studies for an individual patient database review, 2) Performing a randomised trial of Piracetam in patients with diagnoses made by currently accepted diagnostic criteria. Piracetam should be trialled for a period of at least 6 months and preferably longer. Specific cognitive instruments which are sensitive to change, Clinician Global Impression of Change, levels of dependency and caregiver quality of life scales should also be incorporated in such a study.
莫欺少年窮
猛虎未出籠
待定出頭日
血色月朦朧
猛虎未出籠
待定出頭日
血色月朦朧
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tedwang
- V3
- 文章: 3820
- 註冊時間: 週五 2月 27, 2009 10:29 pm
Re: 該藥物無明確療效 這樣理由被刪 有機會申覆過嗎??
notropil
這個藥看到養護機構臥床失智老人不知道用了多久
天天吃日日吃
都是大廟開出來的
witgen
恐怕也是如此
但因為是自費
用的不多
這個藥看到養護機構臥床失智老人不知道用了多久
天天吃日日吃
都是大廟開出來的
witgen
恐怕也是如此
但因為是自費
用的不多
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sam6840
- CR
- 文章: 649
- 註冊時間: 週日 3月 04, 2012 6:07 pm
Re: 該藥物無明確療效 這樣理由被刪 有機會申覆過嗎??
照衛生署核定的適應症用藥，應是雙方最起碼的共識。
衛生署核可的藥品適應症，健保局有意見，卻又核定了健保碼。那要健保局公告的自己的藥品使用規範，才能算數。
審核醫師代表健保局，如同法官代表法院，不能以個人意見視之。
健保局既未公告不同的使用規範，即應以官方衛生署核定的適應症為準。
衛生署核可的藥品適應症，健保局有意見，卻又核定了健保碼。那要健保局公告的自己的藥品使用規範，才能算數。
審核醫師代表健保局，如同法官代表法院，不能以個人意見視之。
健保局既未公告不同的使用規範，即應以官方衛生署核定的適應症為準。