中山大學(xué)循證醫(yī)學(xué)evidencebasedmedicine_zsu_fs-閱讀頁
2025-03-08 15:24本頁面
【正文】 ical 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。244:3138 Flowchart of costeffectiveness at each level of TA hierarchy Technical Performance Diagnostic Performance Diagnostic Impact Therapeutic Impact Impact on Health Source of Medical Information ? Colleagues ? Conferences ? Drug Reps ? Textbooks ? Journals ? Inter/Patients Source of Medical Information ? Primary – MEDLINE， CBM ? Secondary – Guidelines， Cochrane Lib ? Much more likely (than personal search and critical appraisal) to be true ? Saves the clinician’s time – Textbook ? Others？ – Conference – Institutional or personal experience Source of Medical Information ? Interest group or anization ? Commercial Company’s News or Brief ? Google, Yahoo! …… Open Mind and Be Very Carefully Quick Information ? Guidelines – Explicit evidencebased – Evidencebased – Researchbased (highly referenced) – Opinionbased – “expert consensus” National Guideline Clearinghouse ( Cancer Care Ontar
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