实证医学（繁体+英文）.pptVIP

實證醫學 呂志成 高雄榮總實證醫學小組 九十五年二月 EBM - background A vast and growing volume of evidence to guide clinical decisions A rapidly increasing understanding of how to produce valid clinical research by modern computers Users become more sophisticated in their ability to distinguish credible from trivial research results More general awareness that many physicians, do not practice medicine according to the best current research evidence Changes Over Time in Doctors’ Knowledge Changes Over Time in Doctors’ Knowledge Changes in Knowledge over Time A significant inverse correlation (r = -0.3) between scores and years elapsed Knowledge declined sharply within 15 years of certification Procedure-oriented subspecialists had lower scores Information Needs in Office Practice 47 internal medicine physicians during a half day of typical “office” practice Actual information needs estimated by a brief interview after each patient visit From 409 patient visits 269 questions were raised About two questions for each 3 patients Information Needs in Office Practice For each physician an average of four questions per session were not answered immediately Of these the physician expected to find answers to a half; i.e. two-thirds of the time when information regarding patient management is required by a physician it is not forthcoming Questions were not worded in terms that would make finding the answers easy The physician is by default then practicing the “art” of medicine, rather than the “science” 何謂實證醫學 ? Conscientious(盡責), explicit(清楚), and judicious(明智而審慎) use of current best evidence in making decisions about individual patients” Archie Cochrane 1972 Integration of clinical expertise, evidence and patient’s value. Oxford Center for Evidence-based Medicine Levels of Evidence (May 2001) 來自教課書的證據 如果有參考文獻則根據它 (Original article) 如果沒有參考文獻則只是專案家意見屬於 Level 5 以上是 Bob Phillips, Oxford Center for EBM 於 June 2005 E-mail 回覆 實證醫學五步驟 提出問題 (Question formulation) 搜尋證據 (Evidence search) 明辨是非 (Cr