循证医学理念在肝脏外科临床教学中的应用

循证医学是整合最佳研究证据、临床经验和病人价值观,为临床问题决策提供明智的答案和研究证据的一门学科。将循证医学理念应用于肝脏外科临床教学是一种科学的符合当今医学发展形势的临床医学教育模式。该文通过研究认为,循证医学理念应用于临床教学,有利于培养学生的循证思维能力,增加学生的学习兴趣,提高学生解决临床实际问题的综合能力。     

河北省医院图书馆提供循证医学证据服务的可行件研容

对河北省医院图书馆提供循证医学证据服务的需求特点以及供给能力进行分析.结果 显示,临床读者对图书情报人员开展循证医学信息服务工作有一定客观需求,但半数图书馆员的循证医学临床证据服务意识欠缺,缺乏馆藏循证医学文献资源,馆员专业素质参差不齐,医学专业知识不足,普遍缺少专门循证医学临床证据检索技能培训.但是,在检索能力和时间两方面具备一定优势.指出河北省医院图书馆暂不具备开展全方位循证医学证据检索和评价服务的条件,需要在馆藏资源建设和馆员素质教育等方面努力,以循证医学思想为出发点,深化现有文献服务工作.     

大力开发临床科学证据积极促进我国循证医学实践

文章对循证医学实践和临床科学证据进行了综述.重点阐述了循证医学临床实践所面临的问题,分析了其原因.对如何开发临床科学证据、促进我国循证医学实践的开展提出了具体建议.     

第十八讲循证医学的概念与系统综述方法

循证医学 (evidence basedmedicine)是指遵循证据的医学 ,所谓证据即指当前医学研究的可靠结果或其综合。循证医学并不为各类临床决策提供直接答案或指令 ,而仅为临床决策提供参考性证据。临床医师应根据个人经验、患者意愿和病情 ,结合这些证据作出科学的决策 ,处理患者 ,以提高医疗水平。循证医学的基本原理是通过全面、系统地收集质量可靠的客观证据 ,合并起来进行meta分析 ,得出简明的综合结论 ,以电子出版物或其他形式发表交流 ,给临床医师提供便于查阅的资料。一、循证医学的发展与现状在临床医疗实践的过程中 ,临床医师面对数以万计…     

绵阳市5家三级综合医院临床护士循证护理能力现状及影响因素

目的了解绵阳市三级综合医院临床护士循证护理能力现状并分析其影响因素,为制定提升临床护士循证护理能力相关规定提供参考。方法采用一般资料问卷、循证护理能力量表、循证护理实践自我效能量表,对绵阳市5所三级综合医院827名临床护士进行调查。结果 827名临床护士循证护理能力总均分为48.21±4.53,其中证据形成能力得分为13.07±2.22,证据整合能力得分为10.12±1.97,证据传播与评估能力得分为6.16±1.15,证据应用能力得分为18.85±2.57。循证护理实践自我效能总分为115.38±12.32,与循证护理能力呈正相关(r=0.751)。多元回归分析显示,是否参加循证护理培训、职业态度、现任职务、工龄、职称、学历、循证护理实践自我效能是临床护士循证护理能力的主要影响因素。结论三级综合医院临床护士循证护理能力欠佳,有待进一步提升。循证护理实践自我效能、是否参加循证护理培训、职业态度、现任职务、工龄、职称、学历与临床护士循证护理能力有关,管理者应着重关注,以全面提升临床护理工作者循证护理能力,从而提升临床护理质量。     

循证决策模拟案例分析

循证医学是有意识地、明确地、审慎地利用现有最好的证据制定关于个体病人的诊治方案。循证医学强调临床决策必须根据当前最佳临床研究证据、结合医生的经验,并尊重患者的意愿。用循证医学的思想处理和解决群体的医疗卫生问题,就是循证公共卫生决策,比如依据证据制定医疗卫生政     

应用循证护理持续改善护理质量

循证护理是护理学科发展的必然趋势。采用知识-应用循环圈模型指导循证护理临床实践,依托循证转化组构建循证护理组织架构,创新运行模式和培训模式,达成证据总结和证据应用双重目标,推进了循证护理临床应用,改善了患者结局指标,创造了良好经济效益和社会效益。     

临床循证实践面临的困难与对策

近20年来,循证医学获得长足进展,然而临床循证实践与循证医学两者之间还存在巨大的鸿沟,医师临床循证实践的开展情况仍受到各种因素的制约.文章从科学证据、医护人员、患者、组织和卫生系统等五个方面对科学证据转化为循证实践面临的困难进行了系统回顾,并从循证临床实践指南开发、医学教育、信息化建设、医疗机构管理和加强卫生系统的作用等角度提出了促进循证实践开展的建议.     

从循证医学到循证营养

循证医学被定义为“有意识地、明确地、审慎地利用现有最好的证据制定临床决策”。在临床领域,使用循证临床实践指南来进行临床决策,已经成为过去十年里该领域最大的改变之一。循证营养被定义为:“系统收集来的现有最佳证据在制定营养政策和营养实践中的应用”。循证营养的重要     

循证医学在病案质量管理中的应用

本文介绍了循证医学的概念及对临床的实践指导作用,要求按照循证实践的要求书写病案,提出问题,检索证据,列出各证据的结果,评价证据的真实性,结合临床经验与最好证据对患者进行处理,并对效果进行评价,要以循证实践的观点强化病案质量,提高人员素质,坚持动态病案质量管理,完善对临床实践路径的管理。     

Towards evidence-based general practice in rural and remote Australia: an overview of key issues and a model for practice

There is an extensive global move towards evidence-based practice intended to increase the quality and effectiveness of health care. However there are barriers and issues when rural general practitioners attempt to incorporate evidence-based medicine in their practice. Key issues affecting the uptake of evidence-based medicine by rural general practitioners include the gaps in the scientific evidence relevant to general practice, time limitations, and the cost of Internet access, geographical isolation from centres of evidence-based practice and limited training opportunities. General practitioner consultations may involve multiple, ill-defined problems and the patients' views about their treatment may conflict with an evidence-based treatment approach. Rural general practitioners may require additional supports to access information from research through Internet-based resources, accessible summaries of evidence or clinical practice guidelines. In addition a model to assist rural general practitioners use evidence-based medicine is suggested. This model may enable the clinical decision-making process to integrate clinical experience, patient preferences and an understanding of the rural context of practice with the best available evidence, to in turn produce best practice.     

循证医学在促进中医药学发展中的作用

讨论了中药疗效评价存在的问题,提出将循证医学应用于中药学是中药现代化和国际化的需要,在实践中可为药品遴选和临床治疗决策提供科学依据.论述了应用循证医学进行药物遴选的程序：①编制检索策略;②对证据分级;③进行Meta分析并总结成文.最后,讨论了目前将循证医学引入中药学存在的困难：缺乏高质量的临床试验、中药的标准化有待完善、复合型人才匮乏,以及存在发表性偏倚.     

推进实施性研究在中国公共卫生领域的应用

随着医学实践的迅速发展,循证医学将最佳证据、临床经验和患者价值有机地结合,循证公共卫生在公共卫生领域的作用也日益突显。然而,仅有约50%的循证医学证据能够真正转化成常规的卫生保健服务,且转化过程耗时长。为了弥合从最佳证据到临床或公共卫生应用之间的鸿沟,实施性研究作为一门新兴学科应运而生。本文介绍了实施性研究的产生背景、发展、理论和方法,并讨论其在中国公共卫生领域的应用及面临的挑战。     

全麻下行丘脑底核脑深部电刺激术治疗帕金森病的研究进展

随着脑科学、手术方法和磁共振成像技术的不断发展,大量临床循证医学证据的逐渐完善,脑深部电刺激术在帕金森病的治疗上逐渐受到国内外的认可。帕金森病(PD)的深部脑刺激(DBS)传统上是在清醒患者中进行的。一些患者在传统的DBS植入过程中无法忍受清醒手术或长时间停药以允许进行神经生理学测试,这在以前限制了这些患者的手术选择。故近年来,越来越多医生尝试在全麻状态下进行手术。对全麻下手术的治疗效果、手术并发症及未来的发展等方面来进行综述,为临床应用提供科学依据。     

循证思想在医院管理中的应用

随着循证医学的迅猛发展,循证思想已逐渐渗透至医学的各个相关领域,其在医院管理中也具应用价值.作者通过比较临床决策与管理决策在文化、研究基础及决策过程三方面的循证特点,提出推动循证医院管理,要营造新的文化氛围、提供充分的实用性强的证据来源、纠正循证的证据内涵以及针对证据进行广泛的沟通,以实现科学决策、合理配置卫生资源的目标.     

Evaluation of scientific evidence in law, adjudication and policy: when occupational health takes the witness chair

Health and medical knowledge are essential to the resolution of disputes in law and administrative applications (such as workers' compensation) and provide essential input into public policy decisions. There are no socially agreed-upon rules for the application of this knowledge except in the law. On a practical level, the legal system lacks the capacity to evaluate the validity of knowledge as evidence and therefore relies heavily on expert opinion. Over the last 30 years, an approach called "critical appraisal" and "evidence-based medicine" addressed a similar problem in medical practice and established norms for the acceptance of evidence in clinical medicine. A similar evidence-based framework may be possible for applying knowledge of health and medicine to dispute resolution in the law. One critical issue is how to apply scientific evidence when the standard is "more likely than not" rather than scientific certainty. Another is how the generalizations drawn from epidemiology and population-based sciences are interpreted and individualized, as they must be, for the case at hand. A related issue is how risk is interpreted for an individual after the fact, when conventional probability treats risk before the fact and conventional biostatistics applies primarily to a population. This emerging approach is called "evidence-based medical dispute resolution".     

Dissemination 2.0: closing the gap between knowledge and practice with new media and marketing

Despite substantial investments in public health and clinical research at the national level, and significant advancements in these areas of science, few evidence-based programs and services are rapidly implemented in health care or public health practice as a result of failures of dissemination. A significant gap in current processes to disseminate and implement effective programs relates to the lack of systems and infrastructure to facilitate distribution of scientific research products to potential end users, including clinicians and other practitioners. In this article, the authors assert that Web 2.0 technologies can be leveraged to enhance dissemination efforts and increase the implementation of evidence-based programs and services in everyday practice. The authors describe the research-to-practice delivery process and highlight gaps in the supply chain necessary to translate research findings into evidence-based practice. The authors critically evaluate the 4 most prominent strategies currently used to promote dissemination and implementation of research evidence in practice, and they detail how each can be improved by leveraging Web 2.0 technologies to enhance dissemination of research evidence. Last, the authors provide examples and suggestions for capitalizing on Web 2.0 technologies to enhance dissemination efforts and ensure that evidence-based research products reach intended end users and are implemented in clinical practice.     

Validity and reliability of guidelines for neck pain treatment in primary health care. A nationwide empirical analysis in Spain.

OBJECTIVES: To assess the reliability and validity of existing clinical guidelines on neck-pain physiotherapy treatment and follow-up in Spain. DESIGN: We identified existing guidelines through a nationwide census and listed their recommendations, grouped according to the main steps of the process flow-chart. To assess reliability we analysed the variability of statements. To analyse validity we assessed the type of scientific evidence supporting the recommendations, and we compared them with a list of evidence-based recommendations that was elaborated for this study. SETTING AND PARTICIPANTS: Primary health care centres (n = 24) with guidelines for neck-pain treatment and follow-up. MAIN OUTCOME MEASURES: We quantified the number of recommendations, the proportion of valid statements, the frequencies of non-evidence-based recommendations, and the absence of the evidence-based recommendations we had identified. RESULTS: The 34 identified guidelines contained 325 recommendations, with great variation between guidelines with respect to the number, type (for up to 26 different clinical decisions), and content of the recommendations they provided. Direct assessment of the scientific evidence was not possible because no specific reference was given to support any recommendation. When compared with our list, only 20.9% of the recommendations could be considered evidence-based. No guideline contained all the eight evidence-based recommendations we identified. CONCLUSIONS: The results question the guidelines' reliability and validity, and their usefulness in ensuring quality. We conclude that guidelines should be reviewed and re-designed with greater scientific rigour.     

Health policy issues and applications for evidence-based medicine and clinical practice guidelines

Evidence-based medicine and clinical practice guidelines have become increasingly salient to the international health care community in the 1990s. Key issues in health policy in this period can be categorised as costs and access to care, quality of and satisfaction with care, accountability for value in health care, and public health and education. This paper presents a brief overview of evidence-based medicine and clinical practice guidelines and describes how they are likely to influence health policy. Evidence-based medicine focuses on the use of the best available clinical (efficacy) evidence to inform decisions about patient care; guidelines are statements systematically developed from efficacy and effectiveness research and clinical consensus for practitioners and patients to use in making decisions about appropriate care under different clinical circumstances. Both fields have developed methods for evaluating and synthesising available evidence about the outcomes of alternative health care interventions. They have clear implications for health policy analysts: greater reliance should be placed on scientific evidence, policy decisions should be derived systematically, and health care decisionmaking must allow for the active participation of health care providers, policy makers, and patients or their advocates. The methods and information generated from evidence-based guidelines efforts are critical inputs into health policy analysis and decision-making.