循证医学的五步骤.pptVIP

循证医学的五步骤5 Steps of Evidence-Based Medicine TO BE OR NOT TO BE ??? The 5 Steps of EBM 5A’s Example Jack is a 35 year-old adult whose medical history was unremarkable , he have been coughing and coughing up phlegm for two days. He comes to the clinic ask for help. You give him a diagnosis of Acute bronchitis . You know acute bronchitis may be caused by viruses or bacteria, antibiotics are commonly prescribed to treat this condition in most clinics, but you doubt it. Now the results of his laboratory examination are not available yet, so you want to know whether antibiotics are beneficial or not?  Jack是一位患急性支气管炎的成年男性,既往史无特殊。抗生素类药物是否应该常规使用？ Ask an answerable question P= Patient or problem（患者） I = Intervention or exposure（干预/暴露） C=Comparison（对照） O=Outcomes（结局） Example Jack是一位患急性支气管炎的成年男性,既往史无特殊。抗生素类药物是否应该常规使用？ Jack is a 35 year-old adult whose medical history was unremarkable , he have been coughing and coughing up phlegm for two days. He comes to the clinic ask for help. You give him a diagnosis of Acute bronchitis . You know acute bronchitis may be caused by viruses or bacteria, antibiotics are commonly prescribed to treat this condition in most clinics, but you doubt it. Now the results of his laboratory examination are not available yet, so you want to know whether antibiotics are beneficial or not?  Ask an answerable question P I C O Adults suffering from Acute bronchitis Antibiotics Placebo or no treatment Effects and safety Acquire the evidence 首选检索经过评估或筛选的循证医学信息资源（二次文献数据库） Clinical evidence Best Evidence Cochrane Library Up To Date SUMSearch 次选未经评估或筛选的信息资源（原始文献数据库） PubMed EMBASE CBM P I C O Adults suffering from Acute bronchitis Antibiotics Placebo or no treatment Effects and safety --Take cochrane for example 138 results Appraise the evidence 证据的分级？ The grade of evidence Source: Guide to Research Methods: The Evidence Pyramid: /ebm/2100.htm. （系统评价/Meta分析） （随机对照双盲试验） （队列研究） （病例对照研究） （病历系列报告） （个案报道） （专家意见）