循證醫(yī)學(xué)的五步驟

循證醫(yī)學(xué)的五步驟

5StepsofEvidence-BasedMedicineTOBEORNOTTOBE???The5StepsofEBMAskAcquireAppraiseApplyAssess5A’sExample Jackisa35year-oldadultwhosemedicalhistorywasunremarkable,hehavebeencoughingandcoughingup

phlegmfortwodays.Hecomestotheclinicaskforhelp.YougivehimadiagnosisofAcutebronchitis. Youknowacutebronchitismaybecausedbyvirusesorbacteria,antibioticsarecommonlyprescribedtotreatthisconditioninmostclinics,butyoudoubtit. Nowtheresultsofhislaboratoryexaminationarenotavailableyet,soyouwanttoknowwhetherantibioticsarebeneficialornot?

Jack是一位患急性支氣管炎的成年男性,既往史無(wú)特殊?？股仡?lèi)藥物是否應(yīng)該常規(guī)使用？AskananswerablequestionP=Patientorproblem（患者）I=Interventionorexposure（干預(yù)/暴露）C=Comparison（對(duì)照）O=Outcomes（結(jié)局）ExampleJack是一位患急性支氣管炎的成年男性,既往史無(wú)特殊?？股仡?lèi)藥物是否應(yīng)該常規(guī)使用？ Jackisa35year-oldadultwhosemedicalhistorywasunremarkable,hehavebeencoughingandcoughingupphlegmfortwodays.Hecomestotheclinicaskforhelp.YougivehimadiagnosisofAcutebronchitis. Youknowacutebronchitismaybecausedbyvirusesorbacteria,antibioticsarecommonlyprescribedtotreatthisconditioninmostclinics,butyoudoubtit. Nowtheresultsofhislaboratoryexaminationarenotavailableyet,soyouwanttoknowwhetherantibioticsarebeneficialornot?

AskananswerablequestionPICOAdultssufferingfromAcutebronchitisAntibioticsPlaceboornotreatmentEffectsandsafetyAcquiretheevidence首選檢索經(jīng)過(guò)評(píng)估或篩選的循證醫(yī)學(xué)信息資源（二次文獻(xiàn)數(shù)據(jù)庫(kù)）

Clinicalevidence BestEvidence CochraneLibrary UpToDate SUMSearch次選未經(jīng)評(píng)估或篩選的信息資源（原始文獻(xiàn)數(shù)據(jù)庫(kù)）

PubMed EMBASE CBMPICOAdultssufferingfromAcutebronchitisAntibioticsPlaceboornotreatmentEffectsandsafety--Takecochraneforexample138resultsAppraisetheevidence證據(jù)的分級(jí)？

ThegradeofevidenceSource:GuidetoResearchMethods:TheEvidencePyramid:</ebm/2100.htm>.（系統(tǒng)評(píng)價(jià)/Meta分析）（隨機(jī)對(duì)照雙盲試驗(yàn)）（隊(duì)列研究）（病例對(duì)照研究）（病歷系列報(bào)告）（個(gè)案報(bào)道）（專(zhuān)家意見(jiàn)）（動(dòng)物試驗(yàn)）（體外試驗(yàn)）--Takecochraneforexample其中有4個(gè)cochrane系統(tǒng)評(píng)價(jià)AntibioticsforacutebronchitisSusanMSmith,TomFahey,JohnSmucnyandLorneABeckerOnlinePublicationDate:March2014Applytheevidence證據(jù)的質(zhì)量證據(jù)的結(jié)論患者的意愿臨床經(jīng)驗(yàn)AssessyourownperformanceAssessour

performanceinpracticingEvidence-basedmedicineandimproveourselves.SUMMARY循證醫(yī)學(xué)的5步驟臨床問(wèn)題構(gòu)建的PICO格式Practiceafterclass

Jimisa19year-oldboysufferingfromIgAnephropathywithhypertensionandproteinuria.Wewanttoknowwhetherthedrugangiotensinconvertingenzymeinhibitor(ACEI)couldbeusedtoslowdownhisdisease.Referencebooks[1]王家良.循證醫(yī)學(xué).[M].第二版，北京：人民衛(wèi)生出版社，20