应用循证医学的理念做好院前急救工作

循证医学(EBM)的核心思想是任何医疗决策都应建立在新近详实最佳的临床科学研究证据基础上,以保证决策的科学化.为了提高医院的院前急救质量,我们在急救工作中学习和运用循证医学的理念,自觉地、理智地利用现有最好的证据实施具体患者的急救医疗决策,采用最新最先进、最有效的证据指导院前急救工作,取得较好效果.     

循证医学在实验室设备管理中的应用

1 循证医学的概念和基本思想 循证医学是20世纪90年代引入临床医学领域的新概念,是近几年迅速兴起的一门新学科.它的出现使临床医学发生了巨大变化,逐步成为治疗疾病和医疗决策的最新思维方法和模式.不仅如此,循证医学在医疗卫生决策、医疗卫生管理等方面也得以广泛应用.循证医学的含义是指慎重、准确和明智地应用当前所能获得最好的研究依据,同时结合医生的个人专业技能和多年临床经验,考虑病人价值和愿望,将三者完美结合制定出病人治疗措施[1].循证医学要求在医疗实践中有证可循,循即是遵循、循例,证即是证据、证明;证据及其质量是循证医学的关键.     

应用循证医学的理念做好院前急救工作

循证医学（EBM）的核心思想是任何医疗决策都应建立在新近详实最佳的临床科学研究证据基础上，以保证决策的科学化。为了提高医院的院前急救质量．我们在急救工作中学习和运用循证医学的理念．自觉地、理智地利用现有最好的证据实施具体患者的急救医疗决策．采用最新最先进、最有效的证据指导院前急救工作．取得较好效果。     

树立循证理念 实践循证卫生决策

循证理念起源于中国,上世纪九十年代初国外最先应用于医学,产生循证医学,其影响迅速扩大并传入国内。循证理念在西方发达国家渗透到卫生、教育等公共管理领域,产生了良好的效果。在我国卫生管理领域循证意识淡漠、决策缺乏充足科学证据的情况下,树立循证理念、遵循循证卫生决策流程和方法进行决策,对于普及循证理念、提高卫生决策的科学化水平,实现卫生事业又好、又快地科学发展具有重要的现实意义。     

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.     

遵循循证医学理念提高医院管理绩效

循证医学的兴起,为医院管理者提供了新的思路。文章探讨了循证医学与医院管理的关系:二者相辅相成;二者的契合点在于以人为本;可持续发展是二者的最终目的。阐述了在医院管理中如何遵循循证医学的基本理念,并提出4点措施:积极开展系列培训,使医务工作者对循证医学有充分的认识和理解;加强医院基础建设,为实施循证医学创造条件;以人为本,构建学习型医院;开展临床科研,循求医学证据。     

循证医学决策模式的建立与应用

循证医学决策模式是建立在对客观的医学研究证据，长期的临床工作经验，及不同患的医疗需求进行综合分析基础上的最佳医疗方案。其建立和应用对提高医疗质量，改善医疗服务质量具有重要意义。树立循证医学决策意识，建立循证医学决策系统，实施循证医学决策管理将为军队医疗系统实现全面品质管理提供可靠依据。     

医院感染管理中循证医学的应用

目的应用循证的方法制定医院感染控制措施和规章制度,确立医院感染管理模式,科学地进行医院感染的管理. 方法充分利用科学技术的最新成果,形成可供系统的医院感染管理评价证据,采用循证的方法对医院感染控制工作中的规范、管理措施进行科学论证. 结果医院目前制定的医院感染规章制度过程一般是采取Ⅳ级方式,缺乏证据用于决策的强度;对医院感染控制工作中的干预措施,应建立在有充分的科学证据的基础之上,注重医院感染控制效果的可靠性和费用支出的合理性. 结论医院感染管理者应重视控制措施对患者的医院感染发生情况、病死率和卫生经济学指标的评价,加强医院感染的经济决策和效果、效益、效用分析,促进医院感染管理水平整体的提高.     

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     

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…     

Evidence-based health policy: context and utilisation

Evidence-based decision-making is centred on the justification of decisions. In the shift from an individual-clinical to a population-policy level, the decision-making context becomes more uncertain, variable and complex. To address this we have developed a conceptual framework for evidence-based decision-making, focusing on how context impacts on what constitutes evidence and how that evidence is utilised. We present two distinct orientations towards what constitutes evidence, representing different relationships between evidence and context. We also categorise the decision-making context based on the ways in which context impacts on evidence-based decision-making. Furthermore, we invoke the concept of axes of evidence-based decision-making to describe the relationship between evidence and context as we move from evidence-based medicine to evidence-based health policy. From this, we suggest that it may be more important how evidence is utilised than how it is defined. Based on the research and knowledge utilisation literature, we present a process model of evidence utilisation, which forms the basis for the conceptual framework for context-based evidence-based decision-making. The conceptual framework attempts to capture the role that context plays in the introduction, interpretation and application of evidence. We illustrate this framework with examples from policy development for colorectal cancer screening.     

Evidence-based medicine as Bayesian decision-making

We review two recent trends: the emergence of evidence-based medicine and the growing use of Bayesian statistics in medical applications. Evidence-based medicine requires an integrated assessment of the available evidence, and associated uncertainty, but there is also an emphasis on decision-making, for individual patients, or at other points in the health-care system. This demands consideration of the values and costs associated with potential outcomes. We argue that the natural statistical framework for evidence-based medicine is a Bayesian approach to decision-making that incorporates an integrated summary of the available evidence and associated uncertainty with assessment of utilities. We outline a practical agenda for further development.     

医院图书馆循证决策情报服务研究

医院图书馆拥有丰富的文献资源和专业的情报检索人员,可以为临床医师循证决策提供证据支持,协助医师医治患者。医院图书馆主要可从两个方面开展工作,一是建立网上咨询系统;二是开展临床馆员服务。     

Evidence-based management: from theory to practice in health care

The rise of evidence-based clinical practice in health care has caused some people to start questioning how health care managers and policymakers make decisions, and what role evidence plays in the process. Though managers and policymakers have been quick to encourage clinicians to adopt an evidence-based approach, they have been slower to apply the same ideas to their own practice. Yet, there is evidence that the same problems (of the underuse of effective interventions and the overuse of ineffective ones) are as widespread in health care management as they are in clinical practice. Because there are important differences between the culture, research base, and decision-making processes of clinicians and managers, the ideas of evidence-based practice, while relevant, need to be translated for management rather than simply transferred. The experience of the Center for Health Management Research (CHMR) is used to explore how to bring managers and researchers together and promote the use of evidence in managerial decision-making. However, health care funders, health care organizations, research funders, and academic centers need wider and more concerted action to promote the development of evidence-based managerial practice.     

Evidence-based policy: rhetoric and reality

Evidence-based policy has been hailed as the current zeitgeist in health care. Its intuitive appeal is clear but its implementation is problematic. This case study demonstrates the practical difficulties of using this approach for purchasing health care. New technologies suffer from limited knowledge about both their long-term benefits and their adverse effects. This undermines attempts to assess effectiveness and efficiency in local populations. Furthermore, the use of evidence should not be assumed to eliminate the need to apply value judgements, which has repercussions for the attainment of equity of access to health care. It is therefore unrealistic to view this approach as a panacea. Rather, evidence-based medicine should contribute to the decision-making process, in conjunction with other considerations such as equity and patient preference.     

The development of evidence-based clinical practice guidelines. Integrating medical science and practice

Practice guidelines are rapidly becoming preferred decision-making resources in medicine, as advances in technology and pharmaceutics continue to expand. An evidence-based approach to the development of practice guidelines serves to anchor healthcare policy to scientific documentation, and in conjunction with practitioner opinion can provide a powerful and practical clinical tool. Three sources of information are essential to an evidence-based approach: a) an exhaustive literature synthesis; b) meta-analysis; and c) consensus opinion. The systematic merging of evidence from these sources offers healthcare providers a scientifically supportable document that is flexible enough to deal with clinically complex problems. Evidence-based practice guidelines, in conjunction with practice standards and practice advisories, are invaluable resources for clinical decision making. The judicious use of these documents by practitioners will serve to improve the efficiency and safety of health care well.     

Beyond evidence--to ethics: a decision-making framework for health promotion, public health and health improvement

Echoing the rise of 'evidence-based medicine', the concept of evidence-based policy and practice in the inter-related fields of health promotion, public health and health improvement has attracted increasing attention over the past two decades. More recently, again with roots traceable to biomedical thinking, there has been growing interest in ethics in relation to these fields. This paper links these two topical themes in a practical way. It explores the extent to which policies and activities 'on the ground' can and should be based on evidence, and considers the relative places of evidence and ethics in decision-making. It goes on to present the 'decision-making triangle', a framework that gives primacy to a set of ethical principles--with available evidence and plausible theory being used to inform the application of these. After introducing the concept of 'ethical logic modelling', the paper concludes by suggesting an 'ethical imperative' for health promotion, public health and health improvement: to make decisions based on the explicit application of ethical principles, using available evidence and theory appropriately.     

Is evidence-based medicine useful for public health?

Evidence-based medicine is a fashionable topic although the discussions is open regarding whether it has any practical interest for daily medical practice or public health policy. One needs therefore to focus on the way evidence-based medicine can improve matters for physicians, but also on some serious challenges facing health professionals. Upon close examination, it appears that evidence-based medicine provides us with concepts and methods likely to be useful in three directions: improvement of the health care decision-making process, reinforcement of professional accountability dedicated to the promotion of human rights, implementation of fair health policy regulations taking into account the intricate relationships between participants dealing with individual or community oriented interventions. When facing these challenges, evidence-based medicine certainly deserves further attention in the field of community and public health.     

Introducing “Evidence” Into Board Decision-Making

The purpose of this article is to report on the results of a workshop that introduced evidence-based decision-making techniques to Board members of regional health authorities in Alberta.Results and conclusions: The workshop demonstrated that it is possible to design a process for the incorporation of evidence in administrative decision-making. The participants demonstrated that they were able to apply scientific evidence in administrative decision making and that the decisions taken were reasonably consistent. Also, in the absence of evidence, values took precedence in the decision-making process and the decisions taken were less consistent.