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。     

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，考虑患的愿望，对患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，考虑患的愿望，从而体现以患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进行处理和效果评价5个步骤。     

学习循证医学,转变临床思维

1 引言 循证医学(evidence-based medicine,EBM)是近年来国际临床医学界倡导的学科发展方向之一,也是目前医疗界的热门话题,它的出现使临床医学研究及临床实践的概念正在发生巨大转变.循证医学即遵循证据的医学,认为任何医疗决策都应基于客观的临床科学证据,即医生开处方、专家制订治疗指南、政府制订医疗卫生政策都应根据现有的最可靠的科学证据进行.许多国家已将循证医学列为医学生和医学继续教育的必修课程,学习循证医学有助于转变临床思维,使医疗实践从经验医学向循证医学转变.     

基于真实世界数据的疾病管理研究

近年来, 随着信息技术快速发展和对循证临床实践和决策的需求急剧增加, 真实世界数据在医疗健康领域的作用日益受到重视。基于真实世界数据的疾病管理研究已成为重要发展方向, 其核心是针对疾病负担、诊断、临床预防和治疗、预后管理等多个方面的疾病管理问题, 在严谨的、预先设定的设计基础上, 基于海量、多源和高质量数据开展科学的数据分析和处理, 最终将基于这些研究证据形成疾病管理的指南、路径和技术规范, 从而提高医疗质量和安全。本文系统概述了基于真实世界数据开展疾病管理研究的一些重要问题。     

更新临床思维 倡导循证医学

21世纪临床医学模式正发生着一场深刻的变革 ,经验医学逐渐向循证医学转变。在医疗卫生的各个方面循证医学正广泛地渗透 ,随之产生了诸如循证医疗、循证诊断、循证决策、循证内科、循证外科、循证儿科、循证护理等等。总之 ,一切医疗卫生领域包括临床医疗、护理、预防、卫生经济、卫生决策、医疗质量促进、医学教育等无不以研究所取得的科学证据为基础。一个以客观的临床科学依据为指导 ,进行科学治病和客观研究等各项医疗决策的全新循证医学时代已经来临。作为当代的医务工作者应该勇敢地迎接挑战 ,转变观念 ,摆脱传统的经验医学的束缚 ,以…     

循证医学与临床经济评价

循证医学是认真、慎重地应用临床研究中得到的最新、最佳证据处理临床病人的过程。临床医生在选择一项医疗措施的时候,不仅要注意临床结果,更需要注意提高患者的生活质量以及所花费的医疗成本。临床经济分析能帮助临床医生在临床诊疗过程中做出更合理的选择。应用临床经济评价的过程也是实践循证医学的过程,文章介绍了循证医学的基本概念、临床经济评价的类型和评价标准,通过临床具体的病例从确定临床问题、查询证据、评价证据的科学性和结果大小到应用证据解决患者的问题四方面阐述了循证医学在临床经济评价中的应用,拓展了循证医学在临床应用的广度和深度。     

循证医学与临床实践

应用循证医学于医疗实践,提高医疗服务质量,使病人获得最佳预后和生存质量是开展循证医学的最终目的。循证医学的证据是指以病人为中心的临床研究证据,与以往以动物实验或病理生理结果的推理为证据的临床实践不同。前者是指导临床决策的证据,而后者是指导进一步开展临床研究的证据。     

循证医学与临床实践

目前循证医学方法学已广泛应用于临床医疗实践,指导、制定临床各科疾病的治疗方案,评价药物、治疗方案的有效性、适用性,以及为政府部门制定卫生政策、新药的研究、开发评价提供证据,并已形成了许多相关学科。介绍循证医学对临床医疗、中医药发展和药学研究的影响及其临床指导作用,提倡在临床医疗实践中,充分应用循证医学的原则与方法,为临床、科研、卫生决策、医学教育提供最佳证据,并应用最佳证据指导临床决策。     

循证医学与临床经济评价

循证医学是认真、慎重地应用临床研究中得到的最新、最佳证据处理临床病人的过程。临床医生在选择一项医疗措施的时候，不仅要注意临床结果，更需要注意提高患的生活质量以及所花费的医疗成本。临床经济分析能帮助临床医生在临床诊疗过程中做出更合理的选择。应用临床经济评价的过程也是实践循证医学的过程，章介绍了循证医学的基本概念、临床经济评价的类型和评价标准，通过临床具体的病例从确定临床问题、查询证据、评价证据的科学性和结果大小到应用证据解决患的问题四方面阐述了循证医学在临床经济评价中的应用，拓展了循证医学在临床应用的广度和深度。     

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.     

医学研究生对循证医学的认知态度调查

目的了解医学研究生对循证医学认知态度和临床实践中应用循证医学的主要障碍,为进一步开展循证实践和循证医学教学提供参考。方法对2005～2008年兰州大学选修循证医学的1137名医学研究生进行问卷调查并用SPSS11．5软件处理数据。结果从2004级到2007级,医学研究生通过课堂和学术讲座获取循证医学相关知识的人数,认为循证医学可以指导临床科研、提高业务水平和为患者服务的人数,愿意参加循证医学的相关培训和继续学习、关注循证医学、认为循证医学对自己工作有帮助的人数的构成比逐年增加。循证医学应用于临床实践的障碍主要集中在对循证医学的认识不够、如何检索和评价证据、缺乏循证治病有效或有参考价值的病例和查到有效证据难以应用于临床实际问题等。结论循证医学教学已开始从普及推广学习阶段向应用提高研究阶段转化,循证医学教育应进一步加强临床循证实践的培训。     

医疗大数据时代下的Meta分析

循证医学在大数据时代迎来了绝佳的发展机遇。Meta分析作为循证医学的高级别证据,其写作方法应为临床医师熟练掌握。完成一篇高质量的Meta分析需要全面了解其方法流程,根据研究的临床问题选择合适的分析类型,从构建临床问题到数据分析撰写,皆需遵循国际通用的规范和指南要求。精准选题,严守规范,用心琢磨,方能为临床决策提供高级别的医学证据。     

A Popperian perspective of the term 'evidence-based medicine'

If the term ' evidence-based medicine ' conveys more than is conveyed by the word medicine, then there must be a way to distinguish between evidence-based medicine and non-evidence-based medicine. In particular, there must be a logically acceptable way to classify medical decisions as justified or unjustified by scientific evidence. In this essay I examine the nature of medical theories, the nature of the evidence that is produced by empirical tests of medical theories, and the relation of medical decisions to both. I conclude that attempts to classify medical decisions as justified or unjustified by scientific evidence have no foundation in logic and that the term 'evidence-based medicine' is logically indistinguishable from the term 'medicine'. The use of the term 'evidence-based medicine' calls for a new type of authoritarianism in medical practice.     

循证检验医学

在当今倡导证据指导下的医疗行为及医疗决策的时代，分析检验医学存在的问题，讨论将循证医学的理念引入检验医学的必要性及可行性，探索循证检验医学实践的途径，以使检验医学跟上临床医学的最新发展步伐，提供以病人为中心的最佳实验医学技术及实验医学服务。     

临床前医学生课外临床科研能力的启蒙与拓展——科研志愿者模式的探索

当代医学正经历由传统的"经验医学"向更为科学的"循证医学"转变和发展的过程,即临床科学研究是当代医学实践不断进步的原动力。因此,当代医学教育需重视和加强对医学生临床科研能力的培养和训练。随着对医学生科研能力要求的逐渐提高和"四早"教育(早期了解行业、早期进入临床、早期接触科研、早期开展服务)的不断深化,我们依托临床科室以学科专业为导向,构建为临床前医学生开放的科研志愿者项目平台,采用"培训–实践–评估–再培训"的螺旋递进教学模式,为临床前医学生提供循证医学和临床研究的知识和技能培训。通过志愿者积极、全方位实践,本项目获得了一定的教学成果。科研志愿者模式是为学有余力的临床前医学生提供的、可推广的、有利于提升科研素质的课外教学平台。     

Evidence-based vs. Eminence-based Medicine in der Orthop?die

Evidence-based and eminence-based medicine are terms in modern medicine which provide the rational fundamentals of medical practice and substantially contribute to the state of knowledge in a complementary way. Under scientific considerations, evidence-based medicine demands evidence and proof for medical diagnostics and therapeutics, while eminence-based medicine relies on expert opinions and experiences. However, the latter may not mandatorily correspond with the criteria of evidence-based medicine. Important tools of evidence-based medicine are the so-called levels of evidence and the grades of recommendation. Both classifications help to critically evaluate the scientific literature and to establish standards and guidelines in medicine. Finally, the patient should profit from the knowledge of evidence-based and eminence-based medicine.     

The limits of evidence-based medicine.

The importance of clinical research for the practice of clinical medicine is immense and undeniable. Yet the type of knowledge gained from clinical research, referred to here as "empirical evidence," is itself insufficient to provide for optimal clinical care. A gap exists between empirical evidence and clinical practice. Proponents of evidence-based medicine have clearly acknowledged one aspect of this gap: the part that requires the consideration of values, both patient and professional, prior to arriving at medical decisions. Not as clearly recognized, however, is the gap that exists due to the fact that empirical evidence is not directly applicable to individual patients, as the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand. Proponents of evidence-based medicine have made a conceptual error by grouping knowledge derived from clinical experience and physiologic rationale under the heading of "evidence" and then have compounded the error by developing hierarchies of "evidence" that relegate these forms of medical knowledge to the lowest rungs. Empirical evidence, when it exists, is viewed as the "best" evidence on which to make a clinical decision, superseding clinical experience and physiologic rationale. But these latter forms of medical knowledge differ in kind, not degree, from empirical evidence and do not belong on a graded hierarchy. As they differ in kind, these other forms of medical knowledge can be viewed as complementary to empirical evidence and their incorporation necessary to overcome the intrinsic gap noted above. Clinicians, then, need to incorporate knowledge from 5 distinct areas into each medical decision: (1) empirical evidence, (2) experiential evidence, (3) physiologic principles, (4) patient and professional values, and (5) system features. The relative weight given to each of these areas is not predetermined, but varies from case to case.     

Medical spirituality: defining domains and boundaries

The rapidly accumulating evidence that personal spirituality has important influences on health care outcomes is somewhat difficult to integrate into daily medical practice, in part because accepting it requires adjustments to the standard biomedical worldview, and in part because it challenges established boundaries between chaplaincy and evidence-based medicine. We propose that the recognition of medical spirituality as a distinct, interdisciplinary field of interest, with its own well-developed body of clinical evidence, clinical skill, clinical ethics, and with well-defined clinical boundaries, can help overcome much of the current confusion about how to integrate the new knowledge, and help pre-empt developing "turf" issues. The new field would contribute significantly to reframing the worldview of healing practice, consistent with the evidence-based approach.     

What goes around comes around: evidence-based management

Healthcare managers were early advocates of evidence-based medicine, given its promise of effectiveness, efficiency, and accountability in medical care. In the course of a decade, the call for evidence has swept the healthcare landscape in medicine and more recently in nursing. Somehow healthcare managers and leaders have largely escaped a call for the use of evidence in its own practice. The time has come for organizational leaders to join clinicians in using the strongest evidence available to effect change and guide decision making. This article asserts that nurse executives are in a pivotal and unique position to lead a culture shift associated with evidence-based management practice.     

Hypertension 2005: an evidence-based approach to diagnosis and treatment – an American perspective

Midway into the first decade of the 21st century, evidence-based medicine has become the predominant methodology for the education and practice of medicine. In the ascent to this pre-eminent position, evidence-based medicine has challenged several methodologies through which medicine was taught and practiced throughout the 20th century, including the clinical anecdote, the concept that medicine is an art, the notion that the physician acts as the filter through which medical knowledge is individualized for the patient, and to some extent, the application of principles of pathophysiology to guide individual patient care. Indeed, it appears that in many cases, this mechanism-based approach to disease has been replaced by a broad strokes population-based approach based on outcomes research. However, as in the law, evidence is open to interpretation, varying opinion and nuance. Perhaps nowhere is this more evident than in the field of hypertension, which arguably can be credited with developing the field of evidence-based medicine with randomized clinical trials in the early 1960s and early adaptation and promotion of outcomes-based research, beginning with the first Joint National Committee report on prevention, detection, evaluation and treatment of high blood pressure in the 1970s. The purpose of this chapter is to review the evidence in the diagnosis and treatment of essential hypertension, focusing on the following areas. First, use of ambulatory and home blood pressure monitoring as diagnostic and prognostic tools; second, recent clinical trials in the treatment of essential hypertension that form the basis of evidence-based therapeutics; and third, presentation of the key features of the Joint National Committee (JNC) 7, which forms the current basis of treatment for essential hypertension.