中山大學(xué)循證醫(yī)學(xué)evidencebasedmedicine_zsu_fs-資料下載頁
2025-02-21 15:24本頁面
【正文】 evidence synthesis ? Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. – Without the former, practice 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 – Without the latter, practice risks being rapidly out of date, to the detriment of patients and patientcare.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 病人價值 外部證據(jù) External evidences The Patients ? Individualize 個體化； ? 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.
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