循证医学的定义、发展、基础及实践

循证医学是结合医生的个人专业技能和临床经验，考虑患的愿望，对患作出医疗决策而发展起来的新兴临床学科。高质量的证据是指尽可能保证结果真实性的、以患为中心的临床研究数据。证据及其质量是循证医学的关键。研究人员应该尽量提供高质量的证据，临床医生尽可能使用现有的最佳证据。循证医学在进行诊断和治疗决策时，考虑患的愿望，从而体现以患为中心的医疗服务宗旨。高素质的临床医生、最佳的研究证据、临床流行病学的基本方法和知识及患的参与是循证医学的基础。循证医学实践包括提出问题，检索证据，评价证据，结合临床经验与最好证据对患进行处理和效果评价5个步骤。     

掌握国际循证医学数据库是向SCI期刊投稿的第一步

1.循证医学的定义？ 循证医学是指慎重、准确和明智地应用现有的最好研究证据,同时结合临床医生的个人专业技能和多年临床经验,考虑患者的权利、价值和愿望,将三者完美地结合,对患者作出医疗决策。2.循证医学的要素？     

网络上的循证医学信息资源

循证医学(evidence—based medicine，EBM)即遵循证据的医学。循证医学的创始人之一David Sackett教授将循证医学定义为“慎重、准确和明智地应用现有的最佳研究依据，同时结合临床医生的个人专业技能和多年临床经验，考虑患者的权利、价值和期望，将三者完美地结合以制定出患者的治疗措施”。其核心思想是，在临床医疗实践中，对患者的医疗决策都应尽量以客观的科学研究结果为证据。循证医学的基石来自于临床研究的证据，循证医学的实践过程离不开科学研究证据的搜集和评价。     

循证医学在内分泌及代谢病临床教学实践中的应用与思考

循证医学(Evidence-based medicine,EBM)是指遵循科学依据的科学,国外学者将其定义为:明确和明智地应用当前所能获得的最好研究证据,同时结合医生的个人专业技能和临床经验,考虑患者的价值和愿望,对患者做出医疗决策[1]。最佳研究证据是循证医学的核心问题。自20世纪80年代初循证医学概念引入我国后,在临床实践、医学继续教     

证据的来源与检索

循证医学是指认真、明确和明智地应用现有的最好证据,同时结合医生的个人专业技能和临床经验,考虑病人的愿望,对患者做出医疗决策.因此证据及其质量是循证医学的关键.本文旨在系统介绍证据的来源和如何检索证据,为卫生健康工作者的循证医学实践提供服务和帮助.     

证据的来源与检索

循证医学是指认真、明确和明智地应用现有的最好证据，同时结合医生的个人专业技能和临床经验，考虑病人的愿望，对患做出医疗决策。因此证据及其质量是循证医学的关键。本旨在系统介绍证据的来源和如何检索证据，为卫生健康工作的循证医学实践提供服务和帮助。     

康复医学的循证治疗决策

循证治疗决策是指根据患者的具体情况,康复医生利用自己的临床经验、专业知识,结合当前最好的研究证据,再考虑患者的愿望,制定出最适宜的治疗方案,将有效、安全、经济的治疗措施用于自己的患者。循证治疗决策分为4个步骤:提出临床治疗问题并转化成可以回答的问题;找出最恰当的相关临床研究文献;评价研究结果的真实性及临床和统计学意义;结合患者的具体情况,考虑患者的需求,将研究结果用于自己的患者。     

浅谈循证医学在医院感染管理中的应用

加拿大David sackett教授在2000年<怎样实践和讲授循证医学>中将循证医学定义为:"慎重、准确和明智地应用当前所能获得的最佳研究证据,同时结合临床医生的个人专业技能和多年临床经验,考虑病人的价值和愿望,将三者完美地结合,制定出病人治疗措施".即"以证据为基础"的概念和模式.医院感染管理中循证医学应用的目的,就是把最新的医院感染研究成果与临床实践相结合,"是应用最多的信息(最佳证据),通过谨慎、明确和明智的确认和评估,作出医学方面决策的实践活动"[1].其最终目的就是加强医院感染的管理,减少感染的发生.针对目前医院感染控制中普遍存在的几个问题,应用循证医学的方法对其进行剖析.     

浅谈循证医学在医院感染管理中的应用

加拿大Davidsackett教授在2000年《怎样实践和讲授循证医学》中将循证医学定义为：“慎重、准确和明智地应用当前所能获得的最佳研究证据，同时结合临床医生的个人专业技能和多年临床经验，考虑病人的价值和愿望，将三者完美地结合，制定出病人治疗措施”。即“以证据为基础”的概念和模式：医院感染管理中循证医学应用的目的，就是把最新的医院感染研究成果与临床实践相结合，“是应用最多的信息（最佳证据），通过谨慎、明确和明智的确认和评估，作出医学方面决策的实践活动”。其最终目的就是加强医院感染的管理，减少感染的发生。针对目前医院感染控制中普遍存在的几个问题，应用循证医学的方法对其进行剖析。     

临床药理学教学需要循证思维

循证医学(evidence-based medicine,EBM)源于上世纪80年代,即遵循证据的医学。1996年循证医学的创始人之一David Sackett教授将循证医学明确定义为"慎重、准确和明智地应用现有的最佳研究依据,同时结合临床医生的个人专业技能和多年临床经验,考虑患者的权益、价值和期望,将三者完美地结合以制定出患者     

Evidence-based medicine: specific skills necessary for developing expertise in critical appraisal

The concept of evidence-based medicine (EBM), defined as the integration of best research evidence with clinical expertise and patient values, is essential to the review, understanding, and application of clinical principles into the practice of medicine. Critical appraisal includes recognizing and evaluating various study designs and their ranking in order of priority, judging relevance to the question at hand, identifying potential sources of bias, and determining whether the data presentation, statistical analysis, and conclusions are appropriate. The focus of this article is on the quality of the evidence and how each step in critical appraisal is important to the overall concept and application of EBM.     

Evidence-based medicine et Recommandations : traduire les résultats de la recherche clinique dans leur contexte d’utilisation

The goal of evidence-based medicine (EBM) and clinical practice guidelines is to integrate the most relevant research results with clinical expertise and patient values. Translating evidence into guidelines is influenced by the organisational and cultural context in which the evidence will be interpreted and implemented. Confronted with the ever-increasing quantity of research results, clinical practice guidelines provide a resource for busy clinicians and a basis for the development of patient informational material.     

Evidence-based practice of transfusion medicine: is it possible and what do the words mean?

Evidence-based medicine (EBM) optimizes clinical decision making by dictating that clinical decisions be based on the best available research evidence and by integrating best research evidence with clinical expertise and patient values. Several rankings of the strength of the evidence generated from different types of clinical research designs have been presented, and, in addressing a particular problem, clinicians can base their decision making on the types of clinical reports that have been published, along with an assessment of the strengths and weaknesses of each study. At a policy level, the concept of EBM would dictate that policy decisions also be made based on the best available research evidence. In transfusion medicine, however, decisions are based on a broader range of inputs, and the criteria for evaluating the efficacy and/or cost-effectiveness of proposed interventions differ from those used in other areas. Reasons why policy decisions are often based on considerations other than the best research evidence include public expectations about transfusion safety and proposals for applying the precautionary principle to transfusion medicine. Using the debate over the appropriateness of introducing universal white-cell reduction as an example, this review describes 2 perspectives for assessing evidence and/or making clinical or policy decisions: the evidence-based approach and the precautionary-principle approach; and also considers whether decisions in transfusion medicine can be truly evidence based.     

临床流行病学和循证医学的学科建设

临床流行病学是在临床医学领域内引入现代流行病学和统计学方法，从患病个体诊治扩大到患病群体研究，以探讨疾病病因、预防、诊断、治疗、预后等规律的临床基础学科。循证医学的核心思想是通过检索、评价和应用证据，结合医生技术经验和患者的具体情况，经医患共同决策作出符合患者需求的利大于弊的诊疗决定。加拿大McMaster大学的David Sackett及其学生Gorden Guyatt先后对临床流行病学这门学科的建立、完善和传播，对循证医学概念的提出、发展和推动，起到了里程碑式的作用。20世纪80年代初，我国第一批追随David Sackett的医生方法学家引入了临床流行病学的核心思想，即临床研究的设计、测量和评价，90年代又引入了循证医学的理念。30年来，临床流行病学和循证医学在我国生根、发芽、开花、结果，对我国现代医学的发展起到了巨大推动作用。在全面建设“健康中国”的新时代，加强临床流行病学和循证医学的学科建设刻不容缓。     

Evidence-based laboratory medicine

Evidence-based medicine (EBM) is a method for solving problems concerning the assessment of laboratory testing in patient care. Practising EBM involves the use of the available evidence to make health care decisions. The best way to practice EBM is the development, validation and implementation of guidelines. Guidelines are considered as the process by which healthcare research and experience are translated into improved patient care. In laboratory diagnostics EBM can be best demonstrated in high-prevalence conditions. Because of the number of patients encountered, high-prevalence conditions have a greater impact on patient morbidity and health care expenditure. In evidence-based laboratory medicine the best evidence comes from systematic reviewing studies of diagnostic tests. The reviewing of diagnostic trials and the development of good practice guidelines on the basis of these studies must be an important task of the scientific associations of clinical chemistry and laboratory medicine.     

The principles of evidence-based medicine

Evidence-based medicine (EBM) integrates individual clinical expertise with the best available external evidence in the care of individual patients. By enabling clinicians to directly appraise and apply current clinical research, EBM deals with the problems of deterioration in clinical performance, information overload, and lag in application of research findings to clinical practice. Thus, EBM is a useful tool to address the problems faced by clinicians attempting to provide optimum, current care for their patients. The rationale for EBM, its principles and application, as well as some limitations, are described here.     

Evidence-based medicine: revisiting the pyramid of priorities

Evidence-based medicine (EBM) is beset with numerous problems. In addition to the fact that varied audiences have each customarily sought differing types of evidence, EBM traditionally incorporated a hierarchy of clinical research designs, placing systematic reviews and meta-analyses at the pinnacle. Yet the canonical pyramid of EBM excludes numerous sources of research information, such as basic research, epidemiology, and health services research. Models of EBM commonly used by third party payers have ignored clinical judgment and patient values and expectations, which together form a tripartite and more realistic guideline to effective clinical care. Added to this is the problem in which enhanced placebo treatments in experimentation may obscure verum effects seen commonly in practice. Compounding the issue is that poor systematic reviews which comprise a significant portion of EBM are prone to subjective bias in their inclusion criteria and methodological scoring, shown to skew outcomes. Finally, the blinding concept of randomized controlled trials is particularly problematic in applications of physical medicine. Examples from the research literature in physical medicine highlight conclusions which are open to debate. More progressive components of EBM are recommended, together with greater recognition of the varying audiences employing EBM.     

Application of the principles of evidence-based medicine to patient care

Evidence-based medicine (EBM) is the conscientious and judicious use of the best evidence available collected from clinical trials, guidelines, and consensus statements. This article provides simple ways to practice EBM using five steps (assess the patient, ask a clearly focused clinical question, acquire the best evidence available from the medical literature, appraise the evidence, and apply the evidence to patient care) and how to execute each step properly, multiple examples of how to apply EBM to patient care, and examples of how to apply the PICO mnemonic (patient, intervention, comparison, and outcome) to the process of EBM.     

What is evidence-based medicine and why should I care?

The principles of evidence-based medicine provide the tools to incorporate the best evidence into everyday practice. Evidence-based medicine is the integration of individual clinical expertise with the best available research evidence from systematic research and the patient's values and expectations. A hierarchy of evidence can be used to assess the strength of evidence upon which clinical decisions are made, with randomized studies at the top of the hierarchy. The efficient approach to finding the best evidence is to identify a systematic review or evidence-based clinical practice guidelines. Calculated metrics, such as sensitivity, specificity, receiver-operating-characteristic curves, and likelihood ratios, can be used to examine the evidence for a diagnostic test. High-level studies of a therapy are prospective, randomized, blinded, placebo-controlled, have a concealed allocation, have a parallel design, and assess patient-important outcomes. Metrics used to assess the evidence for a therapy include event rate, relative risk, relative risk reduction, absolute risk reduction, number needed to treat, and odds ratio. Although not all tenets of evidence-based medicine are universally accepted, the principles of evidence-based medicine nonetheless provide a valuable approach to respiratory care practice.