文档介绍：循证医学与内科临床实践(Evidence-Based Medicine and Clinical Practice)
汪道文
华中科技大学同济医学院
附属同济医院
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循证医学的定义
Evidence-based medicine has been defined as “the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions.”
循证医学就是系统发现、评价和应用同时期研究成就作为作出临床决定的过程
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循证医学的基本概念
循证医学的基本概念--整合内外证据的基础上为你的病人作出相关的决定
内证据:(1)通过正式教育、训练所获得的知识;
(2)经日常时间积累的一般经验;
(3)医生本人和病人间的交往所获得的特殊经验
外证据:通过研究所得出的证据
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1. Transformation of the clinical problem into 3 or 4 part question
(a) relevant patient characteristics and
problems
(b) leading intervention
(c) alternative intervention
(d) clinical es or goals.
2. Additional step: answer to the question based on “internal evidence” only
steps of evidence-based decision making(1)
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steps of evidence-based decision making(2)
3. Finding “external evidence” to answer the questions External evidence: obtained from textbooks, journals, databases, experts.
The value of the external evidence will be highly variable, see step 4.
4. Critical appraisal of the external evidence. This step should answer 3 questions:
(1) Are the results valid?
(2) Are the results clinically important?
(3) Do the results apply to my patient? (or is my patient so different from those in the study that the results do not apply?)
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5. Integrating external and internal evidence
The 2 sources of information (external and internal) may be supportive, non-supportive, or conflicting. How the decision is made when non-supportive or conflicting will depend on multiple factors.
6. Evaluation of decision making process
Once the decision has been made, the process and the e are considered and opportunities for improvement are identified.
steps of evidence-based decision making(3)
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Classification of Evidence (1)
Class I Evidence and/or general agreement that a given diagnostic procedure/treatment is beneficial, useful, and effective
Class II Conflicting evidence and /or divergence of opinion about the usefu