实证医学简介

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1、實證醫學簡介高雄榮民總醫院實證醫學小組徐圭璋實證醫學！？♦♦Conscientious,explicit,andjudiciousConscientious,explicit,andjudicioususeofcurrentbestevidenceinmakinguseofcurrentbestevidenceinmakingdecisionsaboutindividualpatientsdecisionsaboutindividualpatients””ArchieCochrane1972♦♦Int

2、egrationofclinicalexpertise,Integrationofclinicalexpertise,evidenceandpatientevidenceandpatient’’svalue.svalue.DavidSackett,1996為為什什麼要提倡實證醫學麼要提倡實證醫學??♦♦終生學習終生學習♦♦臨臨床決策床決策(知識爆炸即時學習)♦♦醫醫療療品質品質♦♦臨臨床研究床研究♦♦同儕溝通同儕溝通♦♦成本效益成本效益♦♦醫醫療療糾紛糾紛實證醫學五步驟♦提出問題(Questionfo

3、rmulation)♦搜尋證據(Evidencesearch)♦嚴格判讀(Criticalappraisal)♦恰當運用(Evidenceapplication)♦評估結果(Outcomeevaluation)實證醫學五步驟♦提出問題(Questionformulation)♦搜尋證據(Evidencesearch)♦嚴格判讀(Criticalappraisal)♦恰當運用(Evidenceapplication)♦評估結果(Outcomeevaluation)提問之重要性♦檢視現況♦重點分析♦決定搜

4、尋♦影響決策GATEFrame:5PECOTcomponents4.Outcomes+-2.ExposureGp1.Participants3.Comparison5.TimeGATEageneralappraisaltoolforepidemiologyhttp://www.health.auckland.ac.nz/comhealth/epiq/epiq.htm問題之結構♦P:Participant♦I:Intervention(E:Exposure)♦C:Comparison♦O:Outcome

5、♦T:TimeRelevantwellformulatedquestionforaninterventionstudy(RCT)♦P-inpostmenopausalwomenwithCHD♦I-doesHRT♦C-comparedwithnoHRT♦O-reducetheriskoffurtherCHDevents♦T-overthenext5-10years錯誤示範♦問題:戒菸門診病人一年戒菸成功率與性別有無差異♦P(Paticipants):戒菸病人♦I(Intervention):門診戒菸治療

6、♦C(Comparison):電話追蹤♦O(Outcome):男性與女性之一年戒菸成功率差異正確之提問♦P門診之戒菸病人♦I男性(或女性)♦C女性(或男性)♦O戒菸成功率♦T(time)一年示範二♦問題:接受全人工膝關節置換術擺不擺引流管有無差別♦P:接受全人工膝關節置換術病人♦I:沒有置放引流管病人♦C:有置放引流管病人♦O:術後結果實證醫學五步驟♦提出問題(Questionformulation)♦搜尋證據(Evidencesearch)♦嚴格判讀(Criticalappraisal)♦恰當運用(

7、Evidenceapplication)♦評估結果(Outcomeevaluation)實證醫學資料庫♦http://ebm.bmjjournals.com/免費全文實證醫學期刊牛津實證醫學中心♦http://www.cebm.net實證醫學基本概念♦http://www.jr2.ox.ac.uk/bandolier/♦http://www.uptodate.com很棒像一本一切都有實證的臨床教科書♦http://www.york.ac.uk/inst/crd/centreforreviewsandd

8、issemination♦http://www.clinicalevidence.com/ceweb/conditions/index.jspBMJ出版的一本期刊♦http://www.pubmed.org美國國家醫學圖書館免費提供包含Medline♦http://www.cochrane.org英國創辦全世界許多分支全球響應♦http://www.bestreatments.org♦http://www.nice.org.uk/♦http://www.