循证医学 Evidence-based Clinical Prac...

沈建通

目录

  • 1 基本理论与方法
    • 1.1 循证实践概述（Introduction）
      • 1.1.1 最佳证据的涵义
      • 1.1.2 证据分级的涵义
      • 1.1.3 证据分级标准
      • 1.1.4 临床经验的涵义
      • 1.1.5 患者价值观的涵义
    • 1.2 问题构建（Forming Questions ）
      • 1.2.1 问题构建技巧
      • 1.2.2 临床问题构建案例
      • 1.2.3 PICO问题构建模式
    • 1.3 证据查找（Finding the Evidence）
      • 1.3.1 各类问题的证据类型选用
      • 1.3.2 利用6S模型查找最佳证据
      • 1.3.3 证据来源选择
      • 1.3.4 PubMed数据库检索
    • 1.4 证据评价（Critical Appraisal of Evidence）
      • 1.4.1 干预性研究证据的评价与使用
      • 1.4.2 诊断试验证据的评价与使用
      • 1.4.3 危害/病因研究证据的评价与使用
      • 1.4.4 预后研究证据的评价与使用
      • 1.4.5 系统评价证据的评价与使用
    • 1.5 临床问题循证实践
      • 1.5.1 危害问题循证实践（Harm Scenario）
      • 1.5.2 诊断问题循证实践（Diagnosis Scenario）
      • 1.5.3 治疗问题循证实践 (Single Trials) Scenario
      • 1.5.4 治疗问题循证实践(Systematic Review) Scenario
      • 1.5.5 预后问题循证实践（Prognosis Scenario）
    • 1.6 证据综合：Meta分析
    • 1.7 循证实践案例（Practice Case）
      • 1.7.1 案例2
      • 1.7.2 案例3
    • 1.8 拓展学习工具与资源（EBM Library）
      • 1.8.1 教育处方
      • 1.8.2 自我评价方法
      • 1.8.3 EBM相关计算工具
      • 1.8.4 术语
  • 2 实践探索
    • 2.1 循证护理
    • 2.2 循证全科医学
    • 2.3 循证补充替代医学
    • 2.4 循证外科
    • 2.5 循证老年医学
    • 2.6 循证采购
    • 2.7 循证新生儿学
    • 2.8 循证精神卫生
    • 2.9 循证危重症
    • 2.10 发展中国家的EBM
  • 3 课程课件
    • 3.1 循证医学概述
    • 3.2 问题构建
    • 3.3 证据分类分级
    • 3.4 证据来源与检索
    • 3.5 医学研究设计概述
    • 3.6 疾病的测量与分布
    • 3.7 病因与病因推断
    • 3.8 描述性研究
    • 3.9 队列研究
    • 3.10 病例对照研究
    • 3.11 实验性研究
    • 3.12 诊断性试验
    • 3.13 诊断问题循证实践
    • 3.14 预后研究
  • 4 教学视频
    • 4.1 循证医学总论
    • 4.2 问题的构建
    • 4.3 证据的检索
    • 4.4 患者价值观与意愿
    • 4.5 病因研究证据的评价与应用
    • 4.6 诊断性证据的评价与应用
    • 4.7 防治性证据的评价与应用
    • 4.8 预后研究证据的评价与应用
    • 4.9 患者安全
循证实践概述（Introduction）

Evidence-Based Practice (EBP) is a broad concept referring to the incorporation of valid and relevant external evidence during the decision making process.

In the health sciences, such evidence is most commonly found in high-quality research studies that can be applied to the specific patient or population being considered.  

什么是循证实践? 

 The most common definition of Evidence-Based Practice (EBP) is from Dr. David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett D, 1996)EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002)

EDIM

The evidence, by itself, does not make the decision, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, and/or the etiology of disorders.

Evidence-Based Practice requires new skills of the clinician, including efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature.

循证实践模式

                   

       1992年提出的循证医学模式概念                             2014年更新后的循证医学概念

 循证实践的步骤:

ASSESS
the patient

1. Start with the patient -- a clinical problem or question arises from the care of the patient

ASK
the question

2. Construct a well built clinical question derived from the case 

ACQUIRE
the evidence

3. Select the appropriate resource(s) and conduct a search

APPRAISE
the evidence

4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)

APPLY:
talk with the patient

5. Return to the patient -- integrate that evidence with clinical expertise, patient preferences and apply it to practice

Self-evaluation

6. Evaluate your performance with this patient


拓展学习


1.循证医学在中国的起源与发展


2.循证实践重要理念的提出

3.重要检索资源

Check out these helpful HSL tutorials for tips on conducting an effective and efficient search!

4.循证实践工具箱

工具包

指南

书籍与文献

参考资讯