临床流行病学与循证医学 绪论.pptVIP

临床流行病学与循证医学Introduction of Clinical Epidemiologyand Evidence based medicine CONTENTS 目录 Outline Features Methods Contents Task Evidence based Medicine 概述 临床流行病学的特征 研究方法 研究内容 临床流行病学任务 循证医学 医学 Medicine Basic medicine Clinical medicine Preventive medicine Epidemiology has always been a necessary part of medicine practice. 流行病学一直医学实践必不可少的部分 基础医学 临床医学 预防医学 医学之母 The mother of medicine Because, the epidemiology is from macro point of view to observe the any question. e.g. from macro point of view to study the disease and health. 因为流行病学是从宏观观察问题， 亦即从宏观研究疾病和健康 流行病学的地位和作用 疾病预防控制的应用学科 现代病因研究的方法学科 临床诊疗手段的循证学科 卫生决策产生的思维学科 一、学科形成前期-18世纪 随机对照试验 Randomization beautifully solved the problem of confounding. 随机分组以最美丽最简单的方式解决了混杂的问题 Placebo and blinding reduce selection and information bias. 安慰剂和盲法协助控制选择偏倚和信息偏倚 The scientifically most rigorous method of establishing causal relationship and forms the gold standard for evaluation of clinical effectiveness. 随机对照临床试验是在人群中建立因果关系最可靠的方式, 因而成了评估医学干预效果的金标准 20世纪80年代中期以前临床流行病学最显著的成就 Over 200,000 randomized controlled trials have been published. 累积了超过几十万个关于医学干预效果的随机对照试验 The need for review methods: introduction of meta-analysis. 系统地总结这些证据迫在眉睫: 流行病学的另一颗新星meta-分析崭露头角 META分析应运而生 Systematic, objective and quantitative method to summarize or integrate results from different studies of the same topic. 一种系统地、客观地、定量地总结或整合来自不同研究的(关于同一问题的)研究结果的综述方法, 又称系统综述 1989年一项震惊整个医学界的研究 Of 226 maneuvers in obstetrics childbirth(在产科使用的226种方法中,通过临床试验或系统综述证明) 20% were beneficial (有效: 疗效大于副作用) 30% were harmful or of doubtful value (有害或疗效可疑) 50% had no RCT evidence available (缺乏随机试验证据) 该项研究的重要启示 Experience is not reliable. Medical interventions, old or new, should all be scientifically evaluated. 经验是不可靠的. 医学干预, 不管新旧, 都应接受严格的科学评估 Ineffective therapies must be stopped and new ineffective innovations must not be allowed to start. 应停止使用无效的干预措施, 阻止新的无效措施引入医学