《循证医学》课件：2 循证医学的证据来源和检索
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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)）？
Eight central tasks of clinical work that generate clinical questions:
development.
EBM
Three components of EBM
Evidence
EBM
Clinician
Patient
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
2020/9/14
9
STEPS IN EBM
Evidence-based Medicine starts with a well-defined clinical problem and then seeks best evidence to solve this problem for the individual patient’s situation.
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
复习： 什么是循证医学？ Evidence-based Medicine？
2020/9/14
2
ቤተ መጻሕፍቲ ባይዱ
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’
2020/9/14
12
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?
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.）
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.
(Sackett et al. BMJ 1996).
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：将最佳证据应用于临床实践诊治病人 以便于取得最佳诊疗效果。
2020/9/14
4
EBM
The thinking behind evidence-based medicine is very soundly based on Clinical Epidemiology;
The skills being to ask the right questions, look for answers, and interpret and apply those answers for the best health outcomes.
EBM
Evidence-based medicine is a tool with many applications:
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.
and the practice will be familiar to those of you who have experience of problem-based learning.
EBM
The philosophy of evidence-based medicine is not new.
There are four main steps:
STEPS IN EBM
1. Framing Clinical Questions.
2. Searching for Evidence.
3. Appraising the Evidence.
4. Applying the Evidence.
复习： 怎么构架问题？或者都有哪些问题需要来回答 的？
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.
Eight central tasks of clinical work that generate clinical questions:
development.
EBM
Three components of EBM
Evidence
EBM
Clinician
Patient
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
2020/9/14
9
STEPS IN EBM
Evidence-based Medicine starts with a well-defined clinical problem and then seeks best evidence to solve this problem for the individual patient’s situation.
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
复习： 什么是循证医学？ Evidence-based Medicine？
2020/9/14
2
ቤተ መጻሕፍቲ ባይዱ
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’
2020/9/14
12
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?
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.）
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.
(Sackett et al. BMJ 1996).
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：将最佳证据应用于临床实践诊治病人 以便于取得最佳诊疗效果。
2020/9/14
4
EBM
The thinking behind evidence-based medicine is very soundly based on Clinical Epidemiology;
The skills being to ask the right questions, look for answers, and interpret and apply those answers for the best health outcomes.
EBM
Evidence-based medicine is a tool with many applications:
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.
and the practice will be familiar to those of you who have experience of problem-based learning.
EBM
The philosophy of evidence-based medicine is not new.
There are four main steps:
STEPS IN EBM
1. Framing Clinical Questions.
2. Searching for Evidence.
3. Appraising the Evidence.
4. Applying the Evidence.
复习： 怎么构架问题？或者都有哪些问题需要来回答 的？
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.