循证医学ebm的过去现在与未来.ppt

Values of RR less than 1 indicate a reduction in risk for the outcome with the experimental treatment. Conversely, values of RR more than 1 indicate an increase in risk. The 95% CIs are a measure of variability in the precision of the RR estimate and its statistical significance. Heterogeneity of treatment effects between studies was investigated by visual examination of graphic meta-analysis plots and from the Cochran Q (heterogeneity chi-square) and I2 statistic. This is a forest plot, with a vertical line at 1.0 representing equivalence in risk for an outcome with experimental and control treatment (null hypothesis). The RR for each outcome and its 95% CI are indicated by a solid square and a line. The size of the solid square represents the contribution (weight) of the trial to the analysis. Diamond-shaped symbols represent the summary estimator of overall effect pooling the weighted effect of individual RCTs. 實 證 醫 學EBM過去、現在與未來 林口長庚醫院 實證醫學中心 余光輝醫師 Medical Education in the New Century 醫學人文教育 Bioinformatics Patient-centered care Problem-based learning Evidence-based medicine 實證醫學 (EBM, Evidence-based Medicine) 以流行病學和統計學的方法，從龐大的醫學資料庫中嚴格評讀、綜合分析並找出值得信賴的部分，並將所能獲得的最佳文獻證據，應用於臨床工作中，使病人得到最佳的照顧。 實證醫學沿革 1972年英國臨床流行病學者Archie Cochrane提出實證醫學的概念。 ~ 所有醫療行為都應有嚴謹研究且證實為有效的根據，才能將醫療資源做最有效的運用，並強調 Randomized controlled trials 的重要性。 1992英國國家衛生部成立實證醫學中心，並以Archie Cochrane之名命名，進而促使1993年Cochrane Collaboration的設立。(Iain Chalmers, David Sackett) Lancet 曾把Cochrane Collaboration比作臨床醫學的人類基因組計劃 基因：是具有遗传效应的DNA片段。 Dr. Sydney Burwell, Dean of Harvard Medical School Half of what you are taught as medical students will in ten years have been shown to be wrong. And the trouble is, none of your teachers knows which half. ※ Use of current best evidence in making decisions about the care of individual patients ※ Not only a skill but also an attitude change ※ Conscientious, explicit, and judicious use of current best evidence in making decisions about individual patien