在环境医学领域中引入循证医学的概念和方法

目的通过引进循证医学的概念和方法,促进环境医学的发展与进步.方法介绍循证医学的基本要素和实践过程.结果提出建立适合本学科发展的循证医学思维模式的理论根据和实施方法的设想.结论探讨了用循证医学的观点指导环境医学实践的必要性和重要性,指出建立循证环境医学是学科建设和发展的必然方向.     

浅谈循证医学与职业病临床

近年来随着循证医学向临床各科不断渗透和发展,已被越来越多的学者所关注和接受.该文作者通过对蹭证医学的认识和了解,从几个方面叙述了循证医学与职业病临床的关系,并且有理由相信:循证医学将会在职业病临床中大力普及并逐渐与国际接轨,循证医学最终将取代传统的经验医学.     

循证医学与信息人员

随着现代医学的发展,医学模式的转变,20世纪90年代诞生了以证据为基础的医学,即“循证医学”。循证医学要求从医人员以理论为基础加个人经验的医学模式向以科学证据为基础的模式转变。循证医学模式要求医生在临床工作中不断提出问题并通过严格的检索、挑选和评价文献来回答这些问题,加强知识更新。面对这一现状,文章略述了信息研究人员应怎样去适应。     

病案记录内涵应反映循证医学的基本思想

优秀病案记录其内涵必须充分体现循证医学的基本思想。由于循证医学(Evidence—based Medicine，EBM)的提出与推崇，一种临床医学实践新模式——EBM将会迅速被医学临床接受并推广于医疗工作的各个部门。用EBM新概念来指导临床病案工作，无疑将产生最佳的临床医疗质量，改变以往沿用已久的医疗记录模式，从而促成医疗质量、医学教学、医疗科研、医院管理、全球医疗信息、医疗服务与病案内涵的优化组合。实施EBM医疗方案及完善病案记录，不仅是个人行为，还是一个临床科室的集体行为，两者相互影响，对个人而言，医务人员须具有良好素质，拥有较高的医学理论水平与实际专业技术，有较好的协作精神与医学理论交流能力，能有效进行文献检索，从而能清楚地了解当前符合临床需要的最佳医疗信息，并从中获取有用的信息，应用于实际临床。而集体方面必须为实施EBM而提供便利的硬件设备，如计算机检索系统、计算机网络等，其高层医务临床人员，必须提高自己的决策管理能力，以便能使有关决策得以实施、统筹安排，使实验资源有效利用，其每项EBM方案的数据落实过程中达到花费最小、医疗最佳，同时也能获得一份最为满意的临床、科研、教学资料，最终使优良内涵的病案为增进人类健康，为生命科学的研究作出更大的贡献。     

从循证医学的发展看临床科研管理的改革

本文从医学信息学的角度介绍了循证医学的发展情况，并从选题和立项，查证和评价，管理和质控，后效评价和管理效流，管理理念及管理程序等浅议了循证医学对临床科研管理工作的启示。作者还结合所在医院引入循证医学，开展循证医学研究取得初步成效的实例来说明临床科研管理应重视循证医学研究。     

循证医学在国内外医疗卫生领域的研究现状

文章介绍循证医学（EBM）的研究概况,国内外学者的研究共同证明了EBM是一种值得推广的好方法,与国外相比,国内对EBM的研究广度与[深度都略显不足,若紧密联系实际加强[这方面的研究,EBM会有广泛的应用前景。     

以循证医学指导计划生育临床研究

循证医学(Evidence—Based Medicine，EBM)是近十余年发展起来的一门新兴临床科学，与传统医学相比较，其更注重查找证据，遵循证据和基于证据的临床和管理决策，其客观性、前沿性和推陈出新性引起越来越多的临床医生和卫生决策者的关注，以EBM原则指导计划生育临床研究，将极大地促进计划生育临床研究的发展和成果转化，最终将提高计划生育服务质量。     

循证医学与现代医院管理

循证医学(Evidencebasedmedicine,EBM)是近10多年来在临床医学实践中发展起来的一门新兴学科。循证医学强调医疗决策的制定应将个人的临床经验与现有的最可靠的临床研究证据、病人的期望进行完善结合,在医疗实践中起主导作用。循证医学还强调科学、规范地防治疾病,有效合理地使     

构建临床营养的循证医学平台

近年来，世界进入了一个信息急剧膨胀、知识轰炸的年代。医学新知识每年以6．7％速率递增，医学领域中的各种新理论、新知识、新技术、新方法、新药物层出不穷，日新月异。医学文献资料铺天盖地、浩如烟海，临床营养学也不例外。临床医师欲掌握了解本学科的最新进展和成果，必须坚持每天阅读大量文献，在今天这个信息通信技术（ICT）年代，方法和技术上是没有困难的。但人的精力有限，     

职业医学与临床职业病科的发展与展望

在当前职业病发病率居高不下,新的职业危害风险以及职业病不断出现的背景下,探讨职业医学与临床职业病科发展动态、趋势,对职业病防治具有非常重要的现实和理论意义。该文通过梳理职业医学与临床职业病科的发展沿革,分析职业医学与临床职业病科的区别与联系,探讨在现实背景下的临床职业病科发展趋势。     

职业卫生与职业医学的发展趋势

职业卫生与职业医学是研究劳动条件对劳动者健康的影响以及研究改善劳动条件,创造安全、卫生、高效的作业环境,提高劳动者的职业生活质量的一门预防医学学科,职业卫生与职业医学的首要任务则是识别、评价和控制不良的劳动条件,以保护劳动者的身体健康;其次是对职业性病损的受罹者进行早期检测、诊断和处理,促使其尽早康复。 我国的职业卫生工作始于新中国成立之后,在全国科技工     

Power and influence in clinical effectiveness and evidence-based medicine

BACKGROUND: The need to base clinical interventions on valid findings of research has been a dominant theme in clinical practice during the last quarter of a century. However, there is much evidence showing that research evidence reaches everyday practice slowly. Solutions to this problem include evidence-based practice and implementation by guidelines and audit. Studies of these methods have included surveys of clinicians' views, implementation projects and evaluations of educational interventions, but they have not examined their implications for the power structure of clinical organizations. This is surprising, given the emphasis placed on medical power in sociological studies of health care. METHODS: A framework derived from management theory defines and summarizes theories of power and influence under the headings: sources of power, overt methods of influence, unseen or covert methods of influence and individual response to influence. This framework is then used to analyse the power and influence possessed and exerted by general practitioners (GPs) and hospital consultants and how these are affected by evidence-based practice and guidelines and audit programmes. OUTCOMES: GPs are seen as having less expert power than consultants and to be more compliant with externally managed guidelines and audit programmes. It is pointed out that compliance with guidelines and audit programmes helps GPs to meet their contractual requirement to be involved in clinical audit activities. Evidence-based practice, which directly challenges the authority of expert opinion is seen as a threat to the power of consultants, but a potential opportunity for GPs and other clinicians whose status is traditionally lower.     

Evidence-based clinical occupational medicine: updating the ACOEM occupational medicine practice guidelines

In this article, we review the evolution and application of evidence based medicine and the results of the literature reviews and syntheses incorporated in the second edition of the guidelines. Our intent is to disseminate this information to practitioners treating injured workers and those managing and financing such care and disability management. Use of proven diagnostic, causality, testing,and treatment methods should markedly improve the quality of occupational medical care and make that care more cost effective.     

Information demands of occupational health physicians and their attitude towards evidence-based medicine

OBJECTIVES: This study assessed the extent and nature of information demands among occupational health physicians and their attitude towards the application of evidence-based medicine in occupational health. METHODS: A questionnaire survey was carried out among a random sample of 159 physicians practicing occupational medicine in The Netherlands. The questionnaire investigated the type and number of questions encountered in daily practice, the actions taken in response, the physicians' experience in using scientific databases on the Internet, and their attitude towards evidence-based medicine. RESULTS: The occupational health physicians' questions concerned medical, legal, and rehabilitation topics in particular. In pursuing answers to their questions, they generally chose to contact colleagues. Scientific databases were not consulted very often, although, in general, the attitude towards evidence-based medicine was positive. In addition to known barriers for practicing evidence-based medicine, occupational health physicians perceive a lack of scientific evidence in their field. The extensiveness of the field of knowledge in occupational health care was not regarded as an obstacle to their application of evidence-based medicine. CONCLUSIONS: Occupational health physicians have a demand for information on a broad range of topics, and, in most cases, their attitude towards evidence-based medicine is fairly positive. Besides education and training in evidence-based medicine, access to the Internet and the presence of a good knowledge infrastructure would help occupational health physicians use evidence-based medicine.     

The attitude of Flemish occupational health physicians toward evidence-based occupational health and clinical practice guidelines

Purpose  

To identify the attitude of occupational health physicians toward evidence-based occupational health (EBOH) and clinical practice guidelines (CPGs); to determine their ability to access, retrieve and appraise the health evidence and the barriers to applying evidence to practice.     

From clinical activities to didactics and research in occupational medicine

BACKGROUND: The daily practice of Occupational Physicians in the mot industrialized countries suggests that the frequency of traditional occupational diseases is progressively lowering, their gravity is decreasing, and the etiological factors are changing. This trend should be quantitatively and qualitatively verified with ad hoc studies. The information is particularly relevant for Academic Institutions where medical students and residents in occupational medicine are trained. OBJECTIVES: To analyse the trends of clinical diagnoses and health surveillance activities conducted in the last 15 years by an Italian Institute of Occupational Health, and to gain information on the most relevant topics to be taught in academic program and to be addressed with future research. METHODS: Data sources were represented by the computerised registration of a) diagnostic activities and b) health surveillance programs, conducted by the Institute of Occupational Medicine of the University of Brescia, a highly industrialized area in Northern Italy. The observation period was from 1990 to 2005. The health surveillance programs regarded workers pulled from an iron foundry, a veterinary institute, a health departments for the assistance of elderly subjects, a nursery schools and a municipal department for road maintenance. RESULTS: Diagnostic activities were conducted on 9080 subjects, who had been referred for suspected occupational disease. The diagnosis of occupational disease was confirmed for 3759 cases. Multiple diseases were diagnosed in 1554 subjects, yielding the total number of 5721 occupational diseases. The most frequent diagnoses accounted for allergic skin disease (23.4%), followed by pneumoconiosis (20.4%), chronic obstructive pulmonary disease (15.9%), noise hearing loss (7.1%), musculoskeletal disorders (6.9%), respiratory allergies (6.9%), cancer (5.9%), miscellaneous (6.4%). When limited to the last quinquennium, the analysis showed a definite increase of muskuloskeltal disorders, cancer, and, although at a lesser extent, diseases due to psychosocial factors. The analysis of the health surveillance programs regarded 1207 workers, and showed that various non occupational diseases caused limitation to individual work fitness. The most frequent conditions were musculoskeletal disorders (65%) and skin diseases (14%). CONCLUSIONS: The results from these two investigations are important not only for the didactic program run by the Institute, but also because they indicate the most relevant topics to be addressed with future research, at least at a local level.     

The process of evidence-based practice in occupational therapy: Informing clinical decisions

As we move into the 21st century, there are increasing demands placed on occupational therapists to ensure their practice is based on sound evidence. Evidence-based practice is an approach to clinical decision making that has gained considerable interest and influence during the last decade. This article describes and explains the process of evidence-based practice and its application to clinical occupational therapy practice. Directions for resources that may assist therapists' self-directed learning are also provided. As health care becomes more evidence-based, awareness of the principles, skills, and resources for evidence-based practice is of relevance to all occupational therapists.