实证医学简介与实务

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1、實證醫學簡介與實務-如何改善教學技巧-臺北醫學大學九十二學年度教師發展中心研討會http://www.wanfang.gov.tw/ebmclifchen@ms1.hinet.netClinicalEpidemiology-臨床流行病學以流行病學及統計學的方法，從龐大的醫學資料中過濾出值得信賴的部份，嚴格評讀、綜合分析、將所能獲得的最佳文獻、證據(Evidence)，與醫護人員的經驗(Experience)，及病人期望(Expectation)的結合，以應用於臨床工作中。什麼是實證醫學Triple“E”ofE

2、BMEvidenceExperienceExpectationDecisionAnalysisSearchevidenceDaveSackettEvidenceCart-CEBM-CentreforEvidenceBasedMedicine工具篇教學資源OxfordCentreforEBMhttp://www.cebm.net實施實證醫學五大步驟1.整理出一個可以回答的問題(Askingananswerablequestion)2.尋找文獻證據(Trackingdownthebestevidence)3.嚴格

3、評讀文獻(Criticalappraisal)4.應用於病人身上(Integratingtheappraisalwithclinicalexpertise&patients’preference)。5.對過程進行稽核(Auditingperformanceinstep1-4)EBM密碼QSAAQ:PECOTS:PubMedA:CATA:NNTEBM解碼QSAAQuestion:PECOTParticipantExposureComparisonOutcomesTimeSearch:PubMedApprais

4、al:CATcriticalappraisaloftopicsApply:NNTNumberneedtotreatment洪清霖教授推薦醫學的讀者文摘PrefilteredDATABASESCochraneLibrary(HINT有)CochraneDatabaseofSystematicReviews(CDSR)CochraneControlledTrialsRegister(CCTR)DatabaseofReviewsofEffectiveness(DARE)NHSEconomicEvaluationDa

5、tabaseHealthTechnologyAssessmentDatabaseCochraneLibraryhttp://www.updatesoftware.com/cochrane/abstract.htmEMBASE操作操作"pre-filtered"EBMresourceToanswerfocusedclinicalquestions,themostefficientapproachistobeginwitha"pre-filtered"evidence-basedmedicineresources

6、uchasBestEvidence,theCochraneLibrary,orClinicalEvidenceNationalGuidelineClearinghouseBooleanOperators(AND,OR,NOT,*,(aorb)andc)http://www.guideline.govScreeningforbreastcancer:recommendationsandrationale,2002filterhttp://www.guideline.gov/search/detailedsear

7、ch.aspx操作SearchevidenceUnfilteredDATABASESMEDLINECINAHLPsycINFOERIC(EducationResourcesInformationCenter)SearchingKeyWords:搜尋策略topdownRCTCase-ControlCaseReportsOpinionsCanhyperbaricoxygenationacceleratesthehealingrateofnonischemicchronicdiabeticfootulcers?PE

8、COTP:nonischemicchronicdiabeticfootulcersE:HyperbaricoxygenationacceleratesC:woundcareO:thehealingrateT:onemonthText+GraphVPN(VirtualPrivateNetwork)MEDLINEIfasearchofUpToDate,BestEvidence,andtheCochran