循证医学的临床应用知识讲稿.ppt

Step 3 Critically-appraising the evidence Measure Objective：Lab test，Radiology Subjective：pain，symptoms Endpoint alternative：relieve of symptom, shrink of tumor Gold Standard：prolong survival Step 3 Critically-appraising the evidence Conclusion Based on the data? New? Updated? Compare with other study And, What next? Step 3 Critically-appraising the evidence Attention! Don’t trust it just because it is from a big boss, meta-analysis, RCT, or guideline. Evidence should be in consistence with known medical science ( physiology, pathology, pharmacology, etc ） Usage of scientific language is not necessarily mean scientific based Scientific methods credit Not all the evidences are the same importance Hollingworth Jarvik, Radiology 2007;244:31-38 Flowchart of cost-effectiveness at each level of TA hierarchy Technical Performance Diagnostic Performance Diagnostic Impact Therapeutic Impact Impact on Health Step 4 Application Integrating the evidence with our expertise and our patient’s unique biology and values Your question Your patient Your expertise Your hospital How to…… Step 5 Evaluating our performance Follow-up Evaluate The patients benefit……? Next…… ……Or again another 5 steps Collect data and write an article EBP Models Traditional practice Model (×) Model 1: Use the highest quality information to guide clinical decisions Model 2: Search, evaluate, and make available specialty specific best available evidence Model 3: Create original research or systematic reviews Selective EBP May not need to carry out all 5 steps 1. Asking Answerable Clinical Questions. X 2. Searching for the best current evidence. X 3. Critically-appraising the evidence. 4. Application: Integrating the evidence with our expertise and our patient’s unique biology and values 5. Evaluating our performance Selective EBP 3 different modes of EBP Searching appraising provides E-B care, but is expensive in time and resources Searching only much, quicker, and if carried out among E-B resources, can