中山大學(xué)循證醫(yī)學(xué)evidencebasedmedicine_zsu_fs(更新版)
【正文】 risks being evidencetyrannised, for even excellent external evidence may be inapplicable or inappropriate for an individual patient. – Without the latter, practice risks being rapidly out of date, to the detriment of patients and patientcare. Definition Clinical expertise 臨床技能 Patient Values and Preferences 病人價(jià)值 外部證據(jù) External evidences The Patients ? Individualize 個(gè)體化； ? Compliance 依從性； ? Informed consent 知情同意 ? Value …… Definition Clinical expertise 臨床技能 Patient Values and Preferences 病人價(jià)值 外部證據(jù) External evidences Other factors insurance …… What EBM is Not ? EBM is not cookbook medicine – Evidence needs extrapolation to the patient’s unique biology and values – EBM requires that the best external evidence be integrated with individual clinical expertise and patientchoice in a bottomup approach. – External clinical evidence can inform, but can never replace, individual clinical expertise. ? EBM is not costcutting medicine – when efficacy for the patient is paramount, costs may rise, not fall What EBM is Not ? EBM is not restricted to randomised trials – The randomised trial and systematic review are the “gold standard” for judging whether a treatment does more good than harm. – However, some questions about therapy do not require randomised trials or cannot wait for the trials to be conducted. – Sometimes the evidence we need will e from the basic sciences such as geics or immunology. – And if no randomised trial has been carried out for our patient’s predicament, we follow the trail to the next best external evidence and work from there. 。 ? 2022年 – 上海預(yù)防醫(yī)學(xué)研究院以 Ames試驗(yàn)和骨髓微核試驗(yàn) 作了研究，結(jié)果表明中華靈芝寶具有抗突變作用。 ? 1999年 – 中國科學(xué)院上海生物研究所丁健研究員等實(shí)驗(yàn)表明，中華靈芝寶（現(xiàn)名：雙靈固本散）能抑制拓?fù)洚悩?gòu)酶 I和拓?fù)洚悩?gòu)酶 II，造成癌細(xì)胞DNA單鏈或雙鏈斷裂，阻斷癌細(xì)胞的無限制繁殖，導(dǎo)致癌細(xì)胞破裂
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