第2讲 循证医学的证据来源和检索(1)

Evidence-based Medicine starts with a welldefined clinical problem and then seeks best evidence to solve this problem for the individual patient’s situation.
(Sackett et al. BMJ 1996).
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EBM，循证医学（Evidence based Medicine）：
是临床医生经过认真尽责地、正确判断地且很明确 地做出决定8/14
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EBM
The thinking behind evidence-based medicine is very soundly based on Clinical Epidemiology;
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复习： 怎么构架问题？或者都有哪些问题需要来回答 的？
2020/8/14
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Step 1 - Framing Clinical Questions
询证医学的第一步是问正确的临床问题：这些有 关患者保健问题都是医生每天所要面对的。
如何解释这些临床结果? 哪些诊断试验有助于诊断和管理病人? 哪些治疗将会带来最大的“风险与获益”比? 预后是怎样的?
to complement clinical expertise in providing best care for patients;
to make best, rational, use of limited resources; as an aid to continuing education and
professional development.
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EBM
Three components of EBM
Evidence
EBM
Clinician
Patient
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四大因素的有机结合 临床流行病学方法学基础
最佳 研究 成果
素质 良好 医师
患者的参与
循证医学
2020/8/14
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STEPS IN EBM
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Step 1 - Framing Clinical Questions
Eight central tasks of clinical work that generate clinical questions:
1. 临床结果（Clinical findings）: 怎样恰当地采集 病史，并根据病史和身体检查来解释临床结果 。 （how to properly gather and interpret findings from the history and physical examination.）
and the practice will be familiar to those of you who have experience of problem-based learning.
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EBM
The philosophy of evidence-based medicine is not new.
张啸飞 浙医二院 临床流行病和生物统计中心
xfzhang63@
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复习： 什么是循证医学？ Evidence-based Medicine ？
2020/8/14
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Evidence-based medicine (EBM) is the name given to the ‘the conscientious, judicious and explicit use of current best evidence in making decisions about the care of the individual patient’
What is new is the enormous and growing capacity to access knowledge in an efficient manner.
Evidence-based medicine exploits the information explosion that might otherwise overwhelm us.
The skills being to ask the right questions, look for answers, and interpret and apply those answers for the best health outcomes.
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EBM
Evidence-based medicine is a tool with many applications:
2. 病因学（Etiology）: 怎样来识别或鉴定病因 （how to identify causes for disease (including its iatrogenic forms， 医源性的)）？
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Eight central tasks of clinical work that generate clinical questions:
3. Differential diagnosis （鉴别诊断）: when considering the possible causes of a patient’s clinical problem, how to rank them by likelihood, seriousness and treatability.
There are four main steps:
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STEPS IN EBM
1. Framing Clinical Questions. 2. Searching for Evidence. 3. Appraising the Evidence. 4. Applying the Evidence.
4. Diagnostic test （诊断检查）: how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety etc.