Evidence-Based Medicine(EBM)
〔實證醫學〕〔證據醫學〕〔驗證醫學〕


What is EBM?

 

1

Sackett, et al. :
Evidence-Based Medicine (EBM) is “the integration of best research evidence with clinical expertise and patient values. (Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1)

   

by best evidence
by clinical expertise
by clinical expe
ctation
    (http://ktclearinghouse.ca/cebm/intro/whatisebm)

 
 
 

2

The EBM Working Group
EBM is nothing more than a process of life-long, self-directed learning in which caring for patients creates the need for clinically important information about diagnosis, prognosis, therapy, and other clinical and health care issues
( http://researchguides.uic.edu/ebm)

 

 

3

Doherty, Steve. "Evidence-based medicine: Arguments for and Against."  Emergency Medicine Australasia 2005; 17: 307-13.
EBM is… an evolutionary progression of knowledge based on the basic and clinical sciences and facilitated by the age of information technology.
(http://researchguides.uic.edu/ebm)

 

4

Wikipedia, the free encyclopedia :
Evidence-based medicine (EBM) (sometimes called evidence-based health care or EBHC to broaden its application to allied health care professionals) has been defined as "the conscientious, explicit an judicious use of current best evidence in making decisions about the care of individual patients."[1][2] Trisha Greenhalgh and
Anna Donald define it more specifically as "the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation or management of individual patients."[3] ...More (http://en.wikipedia.org/wiki/Evidence-based_medicine)
(1)Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (January 1996). "Evidence based medicine: what it is and what it
    isn't"
BMJ 312 (7023): 71–2.
(2)
Timmermans S, Mauck A (2005). "The promises and pitfalls of evidence-based medicine". Health Aff (Millwood) 24 (1): 18–28.
(3)
Greenhalgh, Trisha. How To Read a Paper: The Basics of Evidence-Based Medicine. Wiley-Blackwell, fourth edition, 2010, p. 1.

   

The Five Steps of EBM   (www.cebm.net)
實證醫學的5步驟 (Sackett, 2000)

 

1

Asking Focused Questions: translation of uncertainty to an answerable question PICO (PICO Flowchart)
整理出可以回答的問題 → 以PICO的方式提出問題
Patient、Invention、Comparison、Outcome (Answering Clinical questions)
(Sackett DL, Richardson WS, Rosenberg W, Haynes RB (1997). Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingston)

   

Defining a clinical question in terms of the specific patient problem aids the searcher in finding clinically relevant evidence in the literature. ( http://researchguides.uic.edu/ebm )

PICO. Model

P

I

C

O

Population/patient

Intervention/indicator

Comparator/control

Outcome

The population or problem you are       interested in (client group, problem)
The intervention that you are interested in
The comparison or alternative intervention (if relevant)

 

The outcome or reason for using the intervention
 (Amy Baker & Melissa Edwards, University of  South Australia)
 

2

Finding the Evidence: systematic retrieval of best evidence available → 3 steps
找尋最佳證據 有3個步驟
Identify terms to fit your PICO question
Look for secondary sources
Guidelines、CATs、Evidence-Based Summaries、Structured Abstracts、Systematic Reviews
Search for Primary Sources〔PubMED〕

 

3

Critical Appraisal: testing evidence for validity, clinical relevance, and applicability
嚴格評讀證據
證據等級
Levels of EBM 2011  、2009(www.cebm.net)

 

 

4

Making a Decision: application of results in practice
整合文獻證據,應用於病人身上
Define the population and intervention
Search for and understand the biases 
Interpret the findings and apply them to your patient

 

 

5

Evaluating Performance:auditing evidence-based decisions
針對上述四點進行評估

 


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