实证医学或循证医学

Evidence Based

Medicine

實證醫學或循證醫學

Se-Yuan Liu

Surgery

Ping-tung Christian

Hospital

實證醫學或循證醫學♦究竟是甚麼東東？

♦為什麼我該了解這個東西？

♦該怎麼做？

♦很困難嗎？

♦Evidence-based medicine (EBM) is the integration of

–best research evidence with

–clinical expertise and

–patient values

♦Evidence-based nursing (EBN)

–nurses as important, active decision-

makers

♦Clinically relevant research, often from the basic sciences of medicine

♦Especially from patient centered clinical research

♦Power of prognostic markers, and the efficacy and safety of therapeutic,

rehabilitative, and preventive regimens

♦The ability to use our clinical skills and past experience

♦To rapidly identify each patient’s unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values

and expectations

♦The unique preferences, concerns and expectations each patient has

♦Must be integrated into clinical decisions if they are to serve the patient

♦Clinicians & patients form a diagnostic and therapeutic alliance, optimizes

clinical outcomes and quality of life

法國小鎮

Why the Sudden Interest in

EBM?

♦These ideas have been around for a long time

–post-revolutionary Paris

–a much earlier origin in ancient Chinese

medicine

♦Consolidated and named EBM in 1992 by a group led by Gordon Guyatt at

McMaster University in Canada

4 Realizations

♦Daily need for valid information about Dx, prognosis, therapy and prevention ♦The inadequacy of traditional sources for this information

♦The disparity between diagnostic skills, judgment, knowledge, and performance

♦Inadequate time for study and reading

5 Developments

♦Strategies to track & appraise evidence ♦Systematic reviews and concise summaries (Cochrane Collaboration)♦Creation of evidence-based journals of secondary publication

♦Creation of information systems

♦Strategies for life-long learning

How Do We Actually Practice

EBM?

♦Asking an answerable question

♦Tracking down the best evidence

♦Critically appraising that evidence for its validity, impact, and applicability

♦Integrating appraisal, clinical expertise and patient’s values, circumstances

♦Evaluating& seeking ways to improve

Ask An Answerable Question: The PICO format

♦P: Patient or population, a 50-year old lady recently diagnosed with breast cancer, or a 2-year old boy with bronchopneumonia

♦I & C: Intervention & Compare, type of surgery, chemo or not, choice of antibiotics

♦O: Outcome, survival or quality of life,

recurrence rate, effect of treatment