在产科临床实践中应用循证医学的体会

1 引言 循证医学是遵循证据的医学,其核心思想是"任何临床医疗决策的制定,都需要基于科学研究的依据".它要求医生"在为患者提供医疗照顾、作临床决策时,诚心诚意地、明确地和审慎地运用现有的最佳证据" ,具体是指医生在制定治疗方案、医疗专家制定预防疾病指引、政府制定医疗卫生政策时,都应依照现有最可靠的证据进行.     

循证医学与临床实践

循证医学实际上是临床医生诊断、治疗患者的一个实践过程。它需要许多的证据、方法和荟萃分析，最终决定患者的治疗方案，促进临床医生的医疗水平不断提高。     

论循证医学临床实践的常见问题

为提高对循证医学认识的全面性和准确性，本对循征医学临床实践方面常见的5个问题进行了评论。这些问题包括：1、循证医学只强调证据而否定临床经验吗？2、循证医学的证据只有随机对照试验和系统评价／Meta－分析吗？3、怎样看待证据的质量？4、研究证据不适用于个体病人的特异性治疗决策吗？5、多数临床问题尚无相应证据，循证医学没有意义吗？     

循证医学对临床实践和医学教育的影响

随着人类疾病谱的逐渐改变，慢性病的防治消耗了大量的医疗资源，而有限的资源要求成本最小化而效益最大化，经济发展也要求减少医疗费用增长的压力。另一方面，新型药品、新诊疗技术层出不穷，网络信息平台迅速发展，传统参考文献相对滞后，先进的临床科研方法逐步兴起。现代临床医学发展至此，循证医学的产生与发展势在必行。     

在计划生育医疗服务中实践循证医学

循证医学在妇产科方面的研究为计划生育医生提供了较好的证据以指导临床工作.本文结合现有的临床研究实例,探讨计划生育服务中的循证医学实践方法.     

应用循证医学,推动妇产科临床工作更科学地发展

循证医学是一门在医学实践中寻找、评价和使用最佳临床证据的新兴学科,循证医学的理念与方法为临床医生和科研人员从事临床研究和医疗实践提供了新的思路与方法.循证医学不仅适用于内、外、妇、儿、护理、保健、诊断、预防等临床医学下属学科,同时也可应用于卫生经济、卫生决策、医疗质量促进、医疗保险及医学教育等医疗卫生领域.     

循证医学在检验医学中的应用

循证医学（evidence—based medicine,EBM）是以证据为基础的医学,循证医学在检验医学的应用即为循证检验医学（evidence—based laboratory medicine,EBLM）。EBLM就是遵循EBM的核心思想,在应用大量可靠的临床资料和经验的基础上,研究检验项目临床应用的价值,为临床诊断、疗效观察、病情转归提供最有效、最实用、最经济的检验项目及检验组合,并最终获得可靠的检验信息资料,为医疗决策提供循证。     

循证医学教育在儿科见习中的体会

循证医学是一种新的医学实践模式.改进目前的医学教育模式,引入循证医学教育,培养循证思维与临床思维能力,尤其是在临床医学生由学生向医生转变的关键阶段-见习阶段,引入循证医学的临床实践教学,对建立临床思维及服务模式有着至关重要的意义.在现代教学模式中,通过使医学生养成利用现代知识载体,坚持自我教育的习惯,同时严格强化临床基本技能训练,坚持"一切为了病人"的原则,为临床医学生顺利转型奠定了良好的基础.     

循证医学在美国的应用与实践

中国循证医学中心代表团对美国循证医学的现状与发展进行了考察,寻找我国与国际上存在的差距,为进一步促进和规划我国循证医学的发展提供借鉴.     

Evidence-Based Medicine and Clinical Trials in Pain Practice and Orthopedics

Abstract:   Medical practices should be based on scientific findings pursuant to the rules of evidence-based medicine. Quality standards for interventional pain therapy and orthopedic clinical studies have been lacking. As a result, the efficacy of many forms of therapy is insufficiently documented, making the level of evidence low.
This article identifies common deficiencies in the conduct of clinical trials, as well as limitations in conducting randomized controlled studies. Recommendations for improvement are provided. The discussion provides the clinically active physician with interpretation aids for the evaluation of meta-analyses, supports personal evidence-based decisions, and reviews the most important principles for planning and conducting of experimental clinical studies. Current examples in the literature verify the implementation of these principles and present current findings in accordance with evidence-based medicine (EBM) criteria.
In spite of an increasing emergence of EBM-based studies, we conclude that the number of well-designed, high quality, controlled studies conducted in accordance with the guidelines of Good Clinical Practice examining interventional pain therapy and orthopedic clinical studies remains unacceptably low.     

Complementary Medicine and Evidence-Based Practice

Healthcare is changing as evidence-based medicine (EBM) is incorporated into education and practice. This article considers the hierarchy of evidence, the validation of evidence for decision making and the extent to which this includes aspects of cultural and social constructs of health. We review the influence and the methodology of EBM as it is applied to complementary and alternative medicine (CAM), and suggest that there is an uneasy relationship as the two approaches to health have divergent understandings of health and evidence. There are fundamental philosophical and epistemological differences between orthodox and complementary medicine and we suggest that EBM is limited in how it can be applied to CAM. We question how the two approaches to healthcare can work together to create optimal outcomes in practice. The movement towards evidence-based practice underscores the division between biomedicine and CAM. Historically, there has been little scientific research into CAM, largely because of its place as a ‘fringe’ profession. Most research is funded by private sector interests who might see the economic benefit of a certain procedure or product. The research culture that has developed has been one that emphasises an evidence-based approach to establishing the efficacy of single herbs and nutrients, which overlooks the way that complementary therapists use these substances. The review concludes with a concern that the relationship between EBM and complementary medicine may become unbalanced, and the proponents of one system ignore or dismiss the values of the other. This lack of cross-paradigmatic respect is the wellspring for division and suspicion that is currently permeating the arranged marriage between CAM and EBM.     

循证医学理念在长学制临床医学教学质量管理中的应用

目的 探讨循证医学理念在长学制临床医学教学质量管理中的应用效果.方法引入循证临床教学质量管理体系的概念,初步构建以<基于网络环境的教学质量实时监控系统>为核心的临床教学质量管理体系.采用专门的评估量表由学生对教师的教学效果进行评估,并用SPSS 10.0软件和u检验的方法对评估结果进行统计分析.结果 2001～2003年该系统获得数据共853 280条.在被评估的285个课题中,有96.4%(275/285)的课题的评估成绩在85分以上;有无出国经历和年龄是否＞45岁对教师授课质量无影响(P＞0.05);有无博士学历对教师授课质量的影响有统计学差异(P＜0.05).结论在长学制临床医学教学质量管理工作中,只有本着循证的思想,采取科学的手段寻求最客观的依据,实施有效的措施,才能保证长学制临床医学教学质量的稳步提高.     

PBL在循证医学教学中的应用研究

目的探讨PBL在循证医学教学中的应用效果。方法将2005级临床医学专业1．8班随机分为PBL教学组（PBL组）和传统教学组（LBL组）,每组各4个班。利用考试成绩、问卷调查和座谈会相结合的方法进行教学效果评估。用SPSS11．5软件处理所有数据。结果两组50％以上的同学认为PBL教学可以调动学习积极性,激发学习兴趣,提高参与意识、综合分析能力和自学能力等,在提高综合分析能力和学习效率,更好消化课堂所学内容,加强师生沟通及是否继续实施PBL教学方面的差异有统计学意义（P〈0．05）。PBL组考试成绩与LBL组相比,多项选择题、判断题、名词解释、简答题、论述题得分和总成绩差异有统计学意义（P〈0．05）。结论PBL教学模式能很好地训练本科生的临床思维,培养其构建问题、综合分析、文献检索、语言表达和探索创新等方面的能力,全面提高循证医学课教学质量。