循证医学：循证医学概论.ppt

临床实践 根据工作实践情况提出要弄清的问题 系统地检索相关医学文献数据库 (Medline,Cochrane DataBase等) 用EBM方法学的原则评价证据 缺乏可靠的证据 有可靠的证据 立题并开展自己的切实可行的临床研究 即便是小样本也有意义，至少可为系统 评价提供资料（要有严格的方法学保证） 论文投稿 编辑部审稿 Cochrane 中心 直接利用 EBM与临床实践的关系 临床实践的需要 2P Personal+Practice RCT Experience Patient value RWS Real world study CER 经验医学 循证医学 循证医学+经验医学+价值医学 重点掌握的内容 循证医学的概念，英文全称，RCT、RWS、CER的全称？ 最佳证据应包括哪些特性？ 循证医学的三要素（四要素）是什么？ 实践循证医学的5步曲？ 研究证据分类与来源？ 证据等级如何分类？ 指南证据等级的ABC代表什么？ 指南推荐等级如何分类？ 传统医学与循证医学有何不同？ 随机对照研究与疗效比较研究的关系？ 循证医学与医疗实践的关系？对未来的影响？ ?    谢谢！ * * * Sackett goes on to argue that EBM is not old hat or just the same old medical practice, as evidenced by the wide variation that often occurs in clinical practice patterns. Neither is it intended to be “cookbook medicine” as EBM specifically advocates for individualized application of evidence to patient care, not forcing patient care to conform to generalized evidence. Further, EBM is not intended primarily as a savings tool – it is intended to guide practitioners to provide the best, not necessarily the cheapest, care. Lastly, EBM is not intended to be only concerned with randomized controlled trials, but with the best relevant evidence applicable to the situation in question. (A) Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isnt. BMJ. 1996 Jan 13;312(7023):71-2. PMID: 8555924 (/cgi/content/full/312/7023/71) * * Charity – EBM not mandatory (not yet) Humility – EBM is not for those who prefer an authoritarian practice of medicine Enthusiasm – have fun with the challenge, variety and change!!! * * * * 病因研究最多 干预效果研究导致了循证医学概念的产生 * * * * 由此，循证医学逐渐广为人知。 Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine(循证医学：医学实践教学新模式) * * * * This is often referred to as the evidence pyramid. It is used to illustrate the evolution of the literature. The base of the pyramid is where information usually starts with an idea or laboratory research. As the