实证医学简介与实务.pptxVIP

實證醫學簡介與實務;Clinical Epidemiology - 臨床流行病學; 以流行病學及統計學的方法，從龐大的醫學資料中過濾出值得信賴的部份，嚴格評讀、綜合分析、將所能獲得的最佳文獻、證據(Evidence)，與醫護人員的經驗(Experience)，及病人期望(Expectation)的結合，以應用於臨床工作中。;Triple “E” of EBM;Search evidence;Dave Sackett;;;工具篇;Oxford Centre for EBM;實施實證醫學五大步驟 ;EBM密碼;EBM解碼;;;Prefiltered DATABASES;pre-filtered EBM resource;National Guideline Clearinghouse ;Search evidence;Unfiltered DATABASES;Searching ;Can hyperbaric oxygenation accelerates the healing rate of nonischemic chronic diabetic foot ulcers?;PECOT;;;;;;;MEDLINE;Steps;Problem 5: The search gives no articles, or too few 絕處逢生 Problem 6: You don‘t know where to start searching 無從下手 Problem 7: Limiting a set loses important  articles but does not exclude those  of low methodological quality 點石成金 Problem 8: Medline hasnt helped 另謀蹊徑;Up to 63% of all availableRCTs may be missed by a search strategy limited to MEDLINE ;Other Searching Strategy;PubMed;Search evidence;Textbooks and the Internet;e-book;;;;原文哪裡找;Try Google .tw/ 甲、+ pdf 乙、+ doc Recommend “Reference Manager” internet search;The extent to which beliefs are based on evidence is very much less than believers suppose.;教學流程篇;How to get start….;Evidence-Based Medicine;1.整理出一個可以回答的問題  (Asking An Answerable Question); 1st step; THE 5 PARTS TO A WELL FORMULATED CLINICAL QUESTION;4 Outcome: What is really important to the patient/consumer? What does this exposure affect? Which outcomes should be considered? - intermediate or short term measures (eg lowering in cholesterol levels), mortality, morbidity and treatment complications, rates of relapse, late morbidity and readmission, return to work and physical and social functioning and other measures such as quality of life, general health status. Cost to the consumer is another outcome that should be considered. 5 Time: Over what time frame is it reasonable to expect an effect? ;;;2.尋找文獻證據 (Tracking down the best evidence); 2nd step;3.嚴格評讀文獻 (Critical Appraisal