循证医学王绿化PPT.ppt

提出临床问题( Asking Answerable Clinical Questions) 正确反应—Positive Response 应用循证医学方法寻找答案 二、如何检索证据How to find current best evidence 继续教育的必要性 My students are dismayed when I said to them”Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, non of your teachers knows which half”. ( Dr. Sydney Burwell, Dean of Harvard Medical School ) 如何检索证据How to find current best evidence 证据来源-教科书 Burn your ( traditional ) textbook 具备下列条件的教科书 每年修订一次 参考文献全面 证据清晰可靠 如何检索证据How to find current best evidence 证据来源－Evidence Databases Clinical Evidence, first published in 1999 by BMJ Publishing Group (/index.html ) (www.clinical evidence. org) full text online Pubmed in MEDLINE Cochrane Library (/cochrane/cdsr.htm) 如何检索证据How to find current best evidence 证据来源-数据库 Embase－欧洲制作，3500余种期刊，以药物方面为优，有偿。 EBMR(Evidence-based Medicine Reviews) 为 Cochrane + Best Evidence, 有偿 CRDD ( Center for Reviews and Dissemination Database ) 如何检索证据How to find current best evidence 证据来源-数据库 TRIPDatabase (Turning Research Into Practice Database ) 英国，可以在线查询 中国生物医学光盘检索系统 1980－ 近千种 中国循证医学/Cochrane 中心数据库 如何检索证据How to find current best evidence 证据来源-期刊 EBM (Evidence Based Medicine) ACP Journal Club htt///fldguide/acpddb.htm Evidence Based Nursing Evidence Based Health Care 如何检索证据How to find current best evidence 证据来源-指南 NGC （National Guideline Clearinghouse) 是循证临床实践指南数据库 Guidelines 如何检索证据How to find current best evidence 检索证据的评价及再检索 真实性 ( Validity ) 可靠性 ( Reliability ) 实用性 ( Applicability ) 如评价结果不理想，选择第二数据库进行检索: Medline Cochrane Library EBMR 等 如何评价证据Assessing the Validity of Medical Information 研究结果是否可信？ A. 研究目的能否代表所研究的问题 B. 研究结果是否由别的因素所致 (Chance; Bias; Confounders ) C. 研究结果是否与该领域相关知识相符 与其它文献报道是否一致 生物学上的合理性 如何评价证据Assessing the Validity of Medical Information 2.研究结果的临床价值 3.研究结果对你所治疗的具体病人是否有帮助 文献中介绍的情况与你的病人情况是否相似 文献中描述的预测因素是否恰当,能否用于你