文档介绍：循证医学证据检索与实践
王敏
******@imicams.
中国医学科学院医学信息研究所
临床上遇到问题
什么病?
怎么治?
为什么会得这种病?
会复发吗?
……
临床科研工作
如何获取高质量的文献?
系统评价文献
随机对照试验文献
指南
主要内容
循证医学概论
循证医学资源检索
循证医学实践实例
1 循证医学概论
循证医学的定义
循证医学的发展历程
循证医学实践基础
循证医学的证据特点
实施循证医学的步骤
What is EBM
The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.
The practice of evidence-based medicine requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research and our patient’s unique values and circumstances.
Source:Evidence-based Medicine: How to Practice and Teach EBM(3rd Edition),2005.
By Straus SE, Richardson WS, Paul Glasziou, Haynes RB
The integration of:
Best research evidence: valid and clinically relevant research, often from the basic sciences of medicine, but especially from patient-centered clinical research into the accuracy of diagnostic tests, the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens.
Clinical expertise: the ability to use our clinical skills and past experience to rapidly identify each patient’s unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal circumstances and expectations.
Patient values: the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient.
Patient circumstances: their individual clinical state and the clinical setting.
Evidence-based Medicine Versus Experience-based Medicine
循证医学
传统医学
证据来源
全面、系统
高质量的研究证据
医师经验、动物实验、
教科书、零散的临床研究
收集证据
系统全面
不系统全面
评价证据
重视
不重视
治疗依据
当前可得到的最佳临床
研究证据
基础研究/动物实验的推论
小样本试验
个人临床经验
医疗模式
病人为中心
疾病/医生为中心
判断疗效
病人最终结局
(终点指标)
实验室指标的改变
仪器或影像学结果(中间指标)
EBM的发展历程
1993年,成立Cochrane协作网,广泛收集RCT的研究结果,在严格的质量评价的基础上,制作和传播系统评价
1995年,David Sackett 受聘于英国牛津大学,建立英国循证医学中心(Centre