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1、E-DaHospital/I-ShouUniversityEvidence-BasedMedicineProcedureinEBMStep1:Formulatingthemanagementquestiontobeanswered(PICO)Step2:Searchingtheliteratureandon-linedatabasesforevidencetoanswerthequestionStep3:AppraisingtheevidenceStep4:Integratingthisappraisalwith
2、knowledgeabouttheuniqueaspectsofthepatient(includingpreferences)Step5:Evaluatingoureffectivenessandefficiencyinexecutingsteps1-4andseekwaystoimprovethem1234561234561.Clinicalscenario:2.QuestionbyPICO:P:AneightyyearsoldmalewithDMfoot.I:DietcontrolofDMfor30year
3、s.C:OHAcontrol;insulincontrolO:Bloodsugarlevels,complicationsrateofDM.Q:Is[dietcontrol]moreeffectivethan[OHAorinsulin]inoptimizing[bloodsugarlevels]andminimizing[complicationsrateinDM]patients?3.Searchstrategy:ViaPubMed:P:[80yearsoldORmaleORDMfoot]ANDI:[Dietc
4、ontrolOR30years]ANDC:[OralhypoglycemicagentsORinsulin]ANDO:[BloodsugarcontrolORcomplicationrateofDM]4.Searchoutcome:()papersfoundofwhich()werefoundtoberelevant.()paperswerediscardedaseitherirrelevantorofinsufficientqualityforinclusion.5.Citations:MathewV.,Fry
5、eRL.,LennonR.,BarsnessGW.,HolmesDRJr.Comparisonofsurvivalaftersuccessfulpercutaneouscoronaryinterventionofpatientswithdiabetesmellitusreceivinginsulinversusthosereceivingonlydietand/ororalhypoglycemicagents.AmericanJournalofCardiology.93(4):399-403,2004Feb15.
6、NicholsonAS.,SklarM.,BarnardND.,GoreS.,SullivanR.,BrowningS.TowardimprovedmanagementofNIDDM:Arandomized,controlled,pilotinterventionusingalow-fat,vegetariandiet.PreventiveMedicine.29(2):87-91,1999Aug.GutierrezM.,AkhavanM.,JovanovicL.,PetersonCM.Utilityofashor
7、t-term25%carbohydratedietonimprovingglycemiccontrolintype2diabetesmellitus.JournaloftheAmericanCollegeofNutrition.17(6):595-600,1998Dec.6.Evidenceappraisal:Citation1:Studydesign:1104DMpatientsdividedintothosetreatedwithinsulin(418patients;medianfollow-up35.5m
8、onths)vsthosetreatedwitheitheranoralagentordietalone(686patients;medianfollow-up27.9months).Studyresult:Afteradjustingfordifferencesinbaselinecharacteristics,insulintreatmentdidnotadverse
