【正文】 morbidity and treatment plications, rates of relapse, late morbidity and readmission, return to work and physical and social functioning and other measures such as quality of life, general health status. Cost to the consumer is another oute that should be considered. ? 5 Time: Over what time frame is it reasonable to expect an effect? Ref:New Zealand Guidelines Group (NZGG). Handbook for the preparation of explicit evidencebased clinical practice guidelines, 2022 p16. THE 5 PARTS TO A WELL FORMULATED CLINICAL QUESTION 教育處方 Ref:New Zealand Guidelines Group (NZGG). Handbook for the preparation of explicit evidencebased clinical practice guidelines, 2022 p46. (Tracking down the best evidence) In the long run, we39。t helped – 另謀蹊徑 Steps Up to 63% of all available RCTs may be missed by a search strategy limited to MEDLINE Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A parison of results of metaanalyses of randomized control trials and remendations of clinical experts: Treatment for myocardial infarction. JAMA. 1992。 patients’ preference)。實證醫(yī)學簡介與實務 如何改善教學技巧 臺北醫(yī)學大學九十二學年度教師發(fā)展中心研討會 Clinical Epidemiology 臨床流行病學 以流行病學及統(tǒng)計學的方法，從龐大的醫(yī)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(jù) (Evidence)，與 醫(yī)護人員的經(jīng)驗 (Experience)，及 病人期望(Expectation)的結合，以應用於臨床工作中。 Triple “E” of EBM Evidence Experience Expectation Decision Analysis update knowledge 知識更新 browsing 綜覽 problem solving 問題導向 primary journal 一級雜誌 secondary journal 二級雜誌 eg. JAMA, NEJM eg. Evidence Based Medicine, EBM reviews, 讀者文摘 initial question searchable question Search evidence Cochra ne L ibrar yBest E v idenc eAC P Jo urna l Clu bpref iltere dMed lin ePubM edunf iltere dmedical databas eGoo gl einterne t sea rch engin ese ar ch ing ev ide nc eDave Sackett Evidence Cart CEBM Centre for Evidence Based Medicine 工具篇 教學資源 Oxford Centre for EBM 實施實證醫(yī)學五大步驟 1. 整理出一個可以回答的問題 (Asking an answerable question) (Tracking down the best evidence) (Critical appraisal ) (Integrating the appraisal with clinical expertise amp。 (Auditing performance in step 14) EBM密碼 ? QSAA – Q: PECOT – S: PubMed – A: CAT – A: NNT EBM解碼 ? QSAA – Question: PECOT ? Participant ? Exposure ? Comparison ? Outes ? Time – Search: PubMed – Appraisal: CAT ? critical appraisal of topics – Apply: NNT ? Number need to treatment 洪清霖教授推薦 醫(yī)學的讀者文摘 Prefiltered DATABASES ? Cochrane Library (HINT有 ) – Cochrane Database of Systematic Reviews (CDSR)