循证医学eb园m的过去现在与未来.ppt

實證醫學的五個進行步驟;Asking Answerable Clinical Questions;Patient ~ Who is the patient or what is the problem being addressed? Intervention ~ What is the intervention? Comparison ~ What are the alternatives? Outcome ~ What are the outcomes?;Searching The Best Evidence尋找最佳實證資料;實證醫學資料庫查詢的優點;實證醫學主要的四個資料庫 ;本院EBM資料庫比較;實證醫學的參考書籍;;常用實證醫學網路連結;The Evidence Pyramid;Grade of Recommendation;統計數字會說話評估時以具體的數字呈現結果;Diagnosis;Calculation of OR/RR;Asking Answerable Clinical Question;Treatment Effects;Harm;Treatment of Class III-IV Lupus Nephritis;;Values of RR less than 1 indicate a reduction in risk for the outcome with the experimental treatment. Conversely, values of RR more than 1 indicate an increase in risk. The 95% CIs are a measure of variability in the precision of the RR estimate and its statistical significance. Heterogeneity of treatment effects between studies was investigated by visual examination of graphic meta-analysis plots and from the Cochran Q (heterogeneity chi-square) and I2 statistic.;;;實證醫學發展的重點;醫療資源有限，對醫療資源的合理運用，必須利用現有的證據，及使用標準化的規範及流程。 大量的醫學知識文獻，使醫療提供者(health care-provider)無法消化這些知識。因此在實驗室或臨床研究獲得的知識，與一般醫師真正日常行醫行為之應用之間產生不一致的現象。 透過各種疾病的臨床診療指引(clinical practice guideline)，使醫療不一致性減低，以提高醫療品質。 ;Resource Centers for Guidelines;Decision tree analysis;實證醫學應用之障礙; 終身學習 ~ 醫學教育增加實證醫學訓練 發現臨床問題，進而帶動研究風氣 將有限的資源運用於具有實證的醫療 臨床指引制定 (學會、健保局、及醫院)制定各種疾病的臨床診療指引及設立本土醫學資料庫，也是躋身國際舞台所不可或缺，如何整合與發揮國內學界的力量，是本世紀重要的醫學課題 ;林口長庚醫院 實證醫學中心;Interpretation of evidence is subjective: it dependents on how you view it.;;Clinical Practice Guidelines;; ;;;