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edge base. – Bordley, Clinicians ? The basic for EBM P r o v i d e r U s e r C o n s t r u c t c l i n i c a l q u e s t i o n + + + + + + T a s k P r o v i d e e v i d e n c e C o r r e c t a p p l y o f e v i d e n c e C l i n i c a l p r a c t i c e + + + + + + C l i n i c a l e p i d e m i o l o g y ( D M E ) + + + + Me d i c a l s t a t i s t i c s ++ + M e d i c a l e c o n o m i c s ++ + S o c i a l m e d i c i n e ++ + M e d i c a l i n f o r m a t i c s ++ + G r o u p I n d i v i d u a l Definition Clinical expertise 臨床技能 外部證據(jù) External evidences Patient Values and Preferences 病人價值 External evidences ? Best available external clinical evidence: – clinically relevant research ? basic sciences of medicine ? patientcentred research – External clinical evidence has a short doublingtime, and both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer External evidences ? Is All Evidence Created Equal? ? Oxford Centre for Evidencebased Medicine Levels of Evidence The Evidence Pyramid Hierarchy of evidence: arranges study designs by their susceptibility to bias Primary Research Experimental observational Secondary Research ?For quantitative studies ?For qualitative studies No consensus about the relative rigour of different methods Systematic review 雙靈固本散 Appraise evidences Type of Question Suggested best type of Study Therapy RCTcohort case control case series Diagnosis Prospective, blind parison to a gold standard Etiology/Harm RCT cohort case control case series Prognosis Cohort study case control case series Prevention RCTcohort study case control case series Clin