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,考虑患者的愿望,对患者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、以患者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,临床医生应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,考虑患者的愿望,从而体现以患者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者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者进行处理和效果评价5个步骤。

Definition,development,background and practic of evidenced-based medicine

Evidence-based medicine(EBM)is the integration of best research evidence wi th clinical expertise and patient values.The best research evidence is clinicall y relevant research often from the basic sciences of medicine.The clinical exper tise is the ability to use our clinical skills and past experience to rapidly id entify each patient's unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectati ons.The patient values is the unique preferences,concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinica l decisions if they are to serve the patient. Excellent clinical doctor, best re search evidence, basic technique of clinical epidemiology and patients' cooperat ing is the base for practice of EBM. The practice of EBM includes five steps.Ste p 1 is converting the need for information into an answerable question.Step 2 is tracking down the best evidence with which to answer that question. Step 3 is c ritically appraising that evidence for its validity, impact and applicability. S tep 4 is integrating the critical appraisal with our clinical expertise and with our patient's unique biology, values and circumstances. Step 5 is evaluating ou r effectiveness and efficiency.