文档介绍：循证医学概述广东医学院胡利人 fox833@ 广东医学院胡利人 fox833@ In the years after you graduate, two things will happen: memory of what you learned in medical school will lose its freshness treatment methods will be found that they never taught you about in school because they didn't exist. If you are to remain a good doctor, or e a better one, you need to stay on top of new developments as they occur. Evidence Based Medicine provides you with the tools you need to find important new medical research quickly and easily, and to work out its implications for your practice. 广东医学院胡利人 fox833@ 广东医学院胡利人 fox833@ It is no longer It is no longer your job your job to know to know everything, even everything, even in your chosen in your chosen specialty. specialty. It is It is your job your job to be to be able to find the able to find the information as information as and when you and when you and your and your patients need it. patients need it. Journals on Aging in 1974: 28 Journals on Aging in 1994: 95 广东医学院胡利人 fox833@ 1989 年的一项震惊整个医学界的研究实例——在产科经常使用的 226 种方法中,临床试验或系统评价证明: 20% 有效或疗效大于副作用 30% 是有害或疗效可疑 50% 缺乏随机试验证据 Iain Chalmers et al. Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1989 广东医学院胡利人 fox833@ 利多卡因为心肌梗塞后各类室性心律失常的首选药。从 1960s-1990s 的9项 8745 人的 RTC(randomized controlled trial) 结果证明, 该治疗无效甚至可能是有害的。广东医学院胡利人 fox833@ ( Dr. Sydney Burwell, Dean of Harvard Medical School )(1956 年)“医学生在校期间接受的知识中,有一半在 10 年中将被证明是错误的。而糟糕的是, 没有一位教师知道哪一半是错误的” My students are dismayed when I said to them ” Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, non of your teachers knows which half ”. 广东医学院胡利人 fox833@ 启示——经验是不可靠的医学干预,不管新旧,都应接受严格的科学评估应停止使用无效的干预措施,预防新的无效措施引入医学实践所有的医学干预都应基于严格的研究证据之上广东医学院胡利人 fox833@ 循证医学的概念医学: 是一门与治疗、缓解和预防疾病以及恢复和保持健康有关的科学和技巧。证据: 证明某事物真实性的材料。证据是开端于探索,形成于积累。循证医学( evidence-based medicine,EBM ) 就是依据证据的医学。广东医学