循证医学的证据来源和检索.pptx

循证医学研究证据的来源与检索复习： 什么是循证医学？ Evidence-based Medicine？Evidence-based medicine (EBM)Evidence-based medicine (EBM) is the name given to the ‘the conscientious, judicious and explicit use of current best evidence in making decisions about the care of the individual patient’ (Sackett et al. BMJ 1996). EBM，循证医学（Evidence based Medicine）： 是临床医生经过认真尽责地、正确判断地且很明确地做出决定：将最佳证据应用于临床实践诊治病人以便于取得最佳诊疗效果。 EBMThe thinking behind evidence-based medicine is very soundly based on Clinical Epidemiology; and the practice will be familiar to those of you who have experience of problem-based learning.EBMThe philosophy of evidence-based medicine is not new. What is new is the enormous and growing capacity to access knowledge in an efficient manner. Evidence-based medicine exploits the information explosion that might otherwise overwhelm us. The skills being to ask the right questions, look for answers, and interpret and apply those answers for the best health outcomes.EBMEvidence-based medicine is a tool with many applications:to complement clinical expertise in providing best care for patients;to make best, rational, use of limited resources;as an aid to continuing education and professional development.EBM 四大因素的有机结合临床流行病学方法学基础素质良好医师最佳研究成果患者的参与循证医学STEPS IN EBMEvidence-based Medicine starts with a well-defined clinical problem and then seeks best evidence to solve this problem for the individual patient’s situation. There are four main steps:STEPS IN EBMFraming Clinical Questions.Searching for Evidence.Appraising the Evidence.Applying the Evidence.复习： 怎么构架问题？或者都有哪些问题需要来回答的？Step 1 - Framing Clinical Questions询证医学的第一步是问正确的临床问题：这些有关患者保健问题都是医生每天所要面对的。如何解释这些临床结果?哪些诊断试验有助于诊断和管理病人?哪些治疗将会带来最大的“风险与获益”比?预后是怎样的?Step 1 - Framing Clinical QuestionsEight central tasks of clinical work that generate clinical questions:临床结果（Clinical findings）: 怎样恰当地采集病史，并根据病史和身体检查来解释临床结果 。（how to properly gather and interpret findings from the history and physical examination.）病因学（Etiology）: 怎样来识别或鉴定病因 （how to identify causes