中山大學(xué)循證醫(yī)學(xué)evidencebasedmedicine_zsu_fs-文庫吧在線文庫
【正文】 linical Exam Prospective, blind parison to gold standard Cost Economic analysis Right methods is crucial Appraise evidences ? Measure – Objective： ? Survival ? Lab test ? Radiology – Subjective： ? Pain ? Symptoms External evidences ? Categories of Consensus In NCCN clinical guideline – Category 1: There is uniform NCCN consensus, based on highlevel evidence, that the remendation is appropriate. – Category 2: There is uniform NCCN consensus(or nonuniform NCCN consensusbut no major disagreement), based on lowerlevel evidence including clinical experience, that the remendation is appropriate. – Category 3: There is major NCCN disagreement that the remendation is appropriate. Appraise evidences ? Endpoint – alternative： ? relieve of symptom ? shrink of tumor – Gold Standard： ? cure ? prolong survival Not all the evidences are the same importance Hollingworth amp。EvidenceBased Medicine 循證醫(yī)學(xué) 楊 學(xué) 寧 Xuening Yang, MD 廣東省人民醫(yī)院 Guangdong General Hospital 廣東省肺癌研究所 Guangdong Lung Cancer Research Institute 《 循證醫(yī)學(xué) 》 雜志 Journal of Evidencebased Medicine Background ? 1997年 – 上海醫(yī)科大學(xué)中西醫(yī)結(jié)合研究所完成的“中華靈芝寶” 動物實驗 證實：該藥物具有抑瘤作用、保護免疫功能和放化療減毒增效作用。 Jarvik, Radiology 2022。 Cell or animal is equal to human Background ? Traditional practice Model – Clinicians are use convenient sources – Factors that influence decision making. ? Senior doctors ? Patient request ? Pharmaceutical representatives remendation ? Local expertbased CME Outdate! Background ? Longer life ? Chronic diseases ? More studies, more articles, much more information – 20,000 RCT’s published annually， 6000 articles enter Medline monthly – 1 study report published every 189。 – 中國科學(xué)院上海藥物研究所完成“‘中華靈芝寶’對多種培養(yǎng)人癌細胞生長的作用”。244:3138 Flowchart of costeffectiveness at each level of TA hierarchy Technical Performance Diag
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