循证治疗-2011.pptVIP

循证临床实践之——治疗篇 新疆医科大学第一附属医院 循证医学研究所 罗坤 循证临床实践(5A) 提出问题（asking question） 证据检索（acquiring evidence） 评价证据 （appraising evidence） 应用证据 （appling evidence） 后效评价 （after assessment） 证据的特点 等级之分： 对象之分：社区医生、专科医生、病人 类别之分：病因学、诊断、治疗、预后 证据等级金字塔(The Evidence Pyramid) 评价证据 （appraising evidence） 真实性 重要性 临床实用性 A RANDOMIZED, CONTROLLED TRIAL OF SURGERY FOR TEMPORAL-LOBE EPILEPSY颞叶癫痫手术的随机对照研究 The New England Journal of Medicine Background Randomized trials of surgery for epilepsy have not been conducted, because of the difficulties involved in designing and implementing feasible studies. The lack of data supporting the therapeutic usefulness of surgery precludes making strong recommendations for patients with epilepsy. We conducted a randomized, controlled trial to assess the efficacy and safety of surgery for temporal-lobe epilepsy. 癫痫的外科治疗的随机对照研究在设计和实施上很困难，对癫痫的病人是否手术无据可依，因此设计此项研究来评价手术的有效性和安全性。 Methods Eighty patients with temporal-lobe epilepsy were randomly assigned to surgery (40 patients) or treatment with antiepileptic drugs for one year (40patients). Optimal medical therapy and primary outcomes were assessed by epileptologists who were unaware of the patients’ treatment assignments. The primary outcome was freedom from seizures that impair awareness of self and surroundings. Secondary outcomes were the frequency and severity of seizures, the quality of life, disability, and death. 研究结果是否可靠 ARE THE RESULTS OF THIS INDIVIDUAL STUDY VALID?  1.?Was the assignment of patients to treatment randomized? 分组是否随机？ Until recently, it was believed that hormone replacement therapy (HRT) could decrease the risk of coronary artery disease (CAD) in post-menopausal women with a history of established CAD. This belief was based on data from several observational studies which found that women who used HRT had a decreased risk of the disease. Clinicians and patients were subsequently surprised by the results of a randomized trial of women with established