医学图书馆与循证医学实践

循证医学是20世纪国际临床领域出现的一门新兴学科,在我国临床医院,循证医学的概念正在由实践探索逐步向推广普及发展,文中论述了循证医学的概念、意义及医学图书馆在循证医学实践中所发挥的作用。     

医学图书馆为循证医学实践服务的思考

本文提出了21世纪新的临床医学模式－循证医学模式，并指出循证医学实践就是如何将现有的，客观的研究证据应用到临床实践的过程。医院图书馆必须拓宽服务职能，在更新服务手段，完善服务设施，优化服务资源，变革服务模式，提高馆员素质等方面为循证医学服务。     

循证医学与病理学实践

循证医学 (ｅｖｉｄｅｎｃｅ ｂａｓｅｄｍｅｄｉｃｉｎｅ ,ＥＢＭ)即遵循证据的医学 ,强调医学工作者应该注意并且慎重和准确地应用临床研究中得到的最新、最有力的科学证据 ,结合医师个人的临床经验 ,考虑患者的愿望来诊治疾病[1] 。目前 ,ＥＢＭ已广泛地应用于医疗卫生各个领域 ,包括临床药物治疗、疾病预防和预后研究、生命质量评价、卫生决策分析等 ,产生了诸如循证内科学、循证护理学、循证卫生决策等分支学科。循证病理学也已初现端倪[2 ,3] 。一、病理学中实施循证医学的必要性1.临床外科病理学中实施ＥＢＭ的必要性 :病理诊断属于…     

论医学图书馆在循证医学实践中的作用

对循证医学的定义、核心思想及医学图书馆在循证医学实践中的作用进行了论述，并就如何发挥医学图书馆的作用提出了建议。     

循证医学与医学图书馆的发展和建设

1 循证医学。循证医学是20世纪80年代以来出现的医学临床实践新模式，在这十几年里完成基础理论，实践方法，到实践目标一整套完整的模式，转变着21世纪的临床医疗实践，涉及到21世纪的医疗教育，科研及卫生管理机构的管理方法和决策等，涉及面非常深广。它的诞生，主要是现代科学技术的进展，包括电子信息技术、临床流行病学和临床医学是其主要依靠背景。因此要在本国、本地区、本单位实行、推广、应用循证医学模式，也必须从这三方面切实加强工作，否则就会成为无本之木。     

循证医学实践中的伦理学思辩

循证医学在产生后的十几年内，通过系统收集、严格评价产生出临床医学的最佳证据并将其和病人的意愿及选择有机整合到医生的传统技能和经验中，广泛被应用于临床决策。从医学伦理学的角度看，循证医学的产生和发展有着鲜明、深刻的道德特征，反映了当代医学道德进步，符合21世纪临床医学及伦理学的发展。下面笔者就有关问题的思考与谫陋认识，与同道交流探索。     

循证医学与医学信息服务

循证医学是20世纪90年代在国际上迅速兴起的一种新的临床医学模式，筛选证据来源和检索证据是医学实践的关键。这对医学信息提出了更高的要求，同时也促进了医学图书馆信息服务的发展。     

循证医学数据库DynaMed简介

循证医学是对个体患者进行治疗决策时,负责、清楚而明智地使用当前的最佳证据。快速有效地检索和应用最佳研究证据是循证实践的核心。然而,临床医生想要在海量文献中快速查找到自己需要的证据将面临重重困难,如何为临床医生提供经加工总结的易懂易用的循证资源,帮助他们充分利用证据,既是循证医学未来的发展方向,也是确保循证实践的必然。     

创面负压治疗技术对体表创面治疗效果的Meta分析

背景：创面负压治疗技术已被人们广泛应用,目前发表的文献其实际学术价值有限,缺乏科学的、客观的量化指标证明创面负压治疗技术对于创面治疗的有效性。 目的：通过系统评价创面负压治疗技术的临床效果,为临床应用提供更高等级的证据支持,并指导临床科研的研究方向。 方法：通过检索不同的数据库,检获符合纳入条件的文献共15篇。分别由两名研究者负责提取数据并评估研究质量,采用Cochrane协作网提供的RevMan5.0软件进行统计分析。 结果与结论：最终有15个随机对照试验纳入分析,其中10个随机对照试验为B级中度偏倚风险,5个为C级高度偏倚风险;10个试验为研究创面负压治疗技术在慢性创面中的疗效,另5项试验为研究其在急性创面的疗效。创面负压治疗技术与传统治疗在多数主要结果评判指标中存在显著差异。慢性创面患者中创面负压治疗技术与传统治疗在“术前准备时间”、“创面缩小与肉芽组织增长的速度”、“截肢率”存在显著性差异,在“疼痛强度”、“并发症数量”没有显著性差异。急性创面中创面负压治疗技术与传统治疗在“术前准备时间”、“肉芽增长速度”、“伤口感染率”、“材料费用”上存在显著性差异,在“创面自行愈合数量”、“住院时间”差异无显著性意义。说明创面负压治疗技术不论在慢性创面或者急性创面的治疗中都显示出有效性,缩短了术前准备时间、加快肉芽组织生长速度、减少截肢率及伤口感染率。文章为临床推广应用提供了最高质量的证据。但是这些纳入研究分析的试验尚存在方法学上的缺陷,有必要设计更严谨的研究方案,开展更高质量的随机对照研究来支持这一结论。     

循证医学与医学信息服务的几个问题

循证医学是近10余年在临床医学实践中发展起来的一门新兴交叉学科，已引起医学界的极大关注。本文就循证医学的起源与发展，与医学信息的服务的关系，给医学信息工作带来的机遇及以循证医学为中心，做好医学信息服务等问题作一简述。     

Evidence-based medicine and general practice.

Evidence-based medicine (EBM) aids clinical decision making in all fields of medicine, including primary care. General practice is characterized by particular emphasis on the doctor-patient relationship and on biomedical, personal and contextual perspectives in diagnosis. Most evidence available to general practitioners (GPs) addresses only the bio-medical perspective and is often not directly applicable to primary care, as it derives from secondary or tertiary care. Emphasis on the biomedical domain and the randomized controlled trial (RCT) alone reflects a reductionist approach that fails to do justice to the philosophy of general practice. The art of medicine is founded on context, anecdote, patient stories of illness and personal experience, and we should continue to blend this with good quality and appropriate research findings in patient care.     

利用循证医学原理指导骨科临床实践与教学

循证医学是一种实证医学与求证医学。将循证医学与现代骨科学相结合便产生了循证骨科学。随着世界范围内循证研究的广泛开展和国际权威骨科杂志（JBJS）循证骨科学栏目的开辟,临床骨科医学研究和临床骨科实践发生了巨大的变化。临床骨科学正在由传统的经验医学模式不断向循证的模式实施着转变。伴随着临床医疗模式的改革,将循证医学理念适时的引入当临床教学中是迫切而必要的。     

Evidence-based medicine, medical decision analysis, and pathology

Recent advances in molecular pathology and other technologies such as proteomics present pathologists with the challenge of integrating the new information generated with high-throughput methods with current diagnostic models based mostly on histopathology and clinicopathologic correlations. Parallel developments in the field of medical informatics and bioinformatics provide the technical and mathematical methods to approach these problems in a rational manner. However, it remains unclear whether pathologists or other medical specialists will become primarily responsible for the development and maintenance of these multivariate and multidisciplinary diagnostic and prognostic models that are hoped to provide more accurate, individualized patient-based information. Evidence-based medicine (EBM) and medical decision analysis (MDA) are relatively new disciplines that use quantitative methods to assess the value of information, differentiate fact from myth, and integrate so-called best evidence into multivariate models for the assessment of prognosis, response to therapy, selection of laboratory tests, and other complex problems that influence individual patient care. We review from an epistemological viewpoint the current approach to information in pathology and describe some of the concepts developed by the practitioners of EBM and MDA.     

Evidence-based medicine and tort law

Recent statutes and legal decisions have been aimed at bettering the quality of tort-law decisions by substantively improving "expert" testimony. However, in analogy to the experience of physicians attempting to upgrade medical practice using the principles of evidence-based medicine, lawyers and the courts have found it much easier to describe ideal science than to actualize it. This is particularly so in a system (the Law) that has traditionally not been very discerning about scientific rigor, and which has established procedural priorities that are often incompatible with strict scientific standards. This overview will examine the American tort system from an evidence-based perspective. We include a discussion of standards that could be used for "outcomes analysis" in the Law; recognition and classification of errors made by the courts themselves; the relationship between medical errors, "negligence," and standard of care; and the problem of reconciling the rights of plaintiffs with medical-scientific facts. We also consider selected impediments to developing a legal system that is capable of consistently reaching evidence-based decisions concerning complex scientific information, including pathologic interpretation of tissue specimens.     

试述转化医学的发展与实践

转化医学是连接基础研究与临床应用的创新研究模式,发展转化医学,促进成果转化,可为临床疾病的防、 诊、治提供先进的理念和方法。本文围绕转化医学的发展和实践进行综述。     

Evidence-based medicine in pathology: an introduction

Evidence-based medicine (EBM) is a school of thought that has spread rapidly through medicine in the past 2 decades and is eliciting an increasing interest in Anatomic Pathology and Laboratory Medicine. It has been defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." The environmental factors that created a need for EBM and basic concepts of this discipline are reviewed. Methods for the accrual and critical appraisal of the validity of available evidence and its impact, applicability and usefulness in pathology practice are discussed. Basic concepts of bayesian data analysis with an emphasis on concepts such as prior and posterior probability and the use of "holdout" or "test" data are introduced. The future of EBM in pathology is discussed and potential applications of these concepts to pathology practice and research are proposed.     

Platelet-activating factor (PAF-acether): Historical background and definition

The platelet-activating factor (PAF-acether) was first described as released from sensitized basophils. It is now recognized as a mediator of inflammation, since it is released from most stimulated pro-inflammatory cells. It has a unique phospholipid structure and, as yet, is the most potent platelet-activating agent acting at the 1×10^–12 to 1×10^–10 M level. It also degranulates and attracts neutrophils. Its release from alveolar macrophages might play a role in the onset of bronchoconstriction in experimental animals and in man. Thus, PAF-acether is gaining increasing importance as a major intermediate of inflammatory reactions.     

循证医学与临床医学图书馆员

本文阐述了临床医学图书馆员参与循证医学的重要作用、工作方式以及应具备的业务素质，同时还介绍了当今国内外一些主要的循证医学证据检索工具，如有关的医学期刊与数据库。