林口长庚医院实证医学中心-cgmhorgtw.ppt

實 證 醫 學EBM 林口長庚醫院 實證醫學中心 余光輝醫師 Kuang-Hui Yu, M.D. Center for EBM, Chang-Gung Memorial Hospital Medical Education in the New Century 醫學人文教育 Bioinformatics Patient-centered care Problem-based learning Evidence-based medicine ※ Use of current best evidence in making decisions about the care of individual patients. ※ EBM is the integration of best research evidence with clinical expertise and patient values. 實證醫學 (EBM, Evidence-based Medicine) 以流行病學和統計學的方法，從龐大的醫學資料庫中嚴格評讀、綜合分析並找出值得信賴的部分，並將所能獲得的最佳文獻證據，應用於臨床工作中，使病人得到最佳的照顧。 Decision Making in Health Care Remember what you learned during your professional training “Do no harm” Searching bibliographic databases Browse journals Ask colleagues Textbooks Dr. Sydney Burwell, Dean of Harvard Medical School Half of what you are taught as medical students will in ten years have been shown to be wrong. And the trouble is, none of your teachers knows which half. 實證醫學沿革 1972年英國臨床流行病學者Archie Cochrane提出實證醫學的概念。 ~ 所有醫療行為都應有嚴謹研究且證實為有效的根據，才能將醫療資源做最有效的運用，並強調 Randomized controlled trials 的重要性。 1992英國國家衛生部成立實證醫學中心，並以Archie Cochrane之名命名，進而促使1993年Cochrane Collaboration的設立。(Iain Chalmers, David Sackett) 進階學習目前國外推動實證醫學著名的單位 加拿大McMaster University的HIRU（Health Information Research Unit）是Cochrane Collaboration的重鎮 http://hiru.mcmaster.ca/ 英國Oxford University的 Centre for Evidence-Based Medicine http://cemb.jr2.ox.ac.uk 美國American College of Physician（ACP），在全球資訊網出版 ACP Journal Club Online  The Evidence Pyramid The purpose of meta-analysis Employ statistical techniques in concert with a systemic qualitative review Increase statistical power for average estimate Resolve issues relating to conflicting results from studies Generate new hypothesis Glass, 1976 “the statistical analysis of a large collection of analysis results from individual studies for the purpose of integrating the findings” What Does EBM Achieve Refinement and reduction 化繁為簡 Efficiency 效率 Generalizability and consistency 可類推性及一致性 Reliability and p