循证临床实践00PPT.ppt

Are the results valid? Was there an independent ‘blind’ comparison with a reference standard? 独立盲法 Were patients from an appropriate spectrum for whom the test will be applied in clinical practice?疾病谱 Was the reference standard performed in all cases or did the results of the test being evaluated influence the decision to perform the reference standard? 是否全部病例均接受标准检查 Were methods of the test described in sufficient detail to permit replication? 采用的筛查方法是否详述 What are the results? What is the strength of the outcome? What were the likelihood ratios? Sen (95% CI) Spe (95% CI) Positive predictive value (95% CI) Negative predictive value (95% CI) Likelihood ratios Were the results help me in caring my patients? Will the reproducibility of the test result and its interpretation be satisfactory in my setting? 预后研究 预后：关于预测疾病可能结局及其发生的可能性大小的估计。 预后因素：与病因因素不同。 预后因素包括…… 预后研究的设计类型（表7-3） 预后研究的评价（表7-1） Prognostic factors Prognostic factors are characteristics of a patient that may be used to more accurately predict that patient’s outcome. These characteristics may be demographic（人口统计学）, disease specific（疾病相关性）, or co-morbid（并发病）. Unlike aetiological or causative factors, prognostic factors need not be causal, just strongly associated with the outcome and thus, an accurate predictor of how an individual may progress through a disease process. Prognostic factors are investigated and established via the following types of study: Cohort studies: Participants are selected according to exposure to prognostic factor. They can be studied either prospectively or retrospectively. Case-control studies: Participants are selected by outcome, with the investigator looking back to see if they have the prognostic factor, as compared to a similar control group without the outcome. Cohort Studies are preferable, as case-control studies rely on the patient or a family member reporting exposure to a prognostic factor. Case-control studies are, therefore, subject to recall bias (回忆偏倚).