实证医学之经验谈.ppt

Evidence-Based Medicine (EBM)實證醫學之經驗談 顏鴻章 Institute of Emergency and Critical Care Medicine Department of Emergency Medicine Taipei-Veterans General Hospital National Yang-Ming University What is Evidence-Based Medicine (EBM) ? Evidence-based medicine (EBM) requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances. By best research evidence By clinical expertise By patient values By patient circumstances Evidence-Based Medicine (EBM) 是整合目前臨床上最好的研究結果與配合醫師專業能力，針對病患問題在各種不同的臨床環境與個人價值下， 做最適當的診治模式。 How do We Actually Practice EBM? Step 1: converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc.) into an answerable question. Step 2: tracking down the best evidence with which to answer that question. Step 3: critically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice). Step 4: integrating the critical appraisal with our clinical expertise and with our patient’s unique biology, values, and circumstances. Step 5: evaluating our effectiveness and efficiency in executing steps 1–4 and seeking ways to improve them both for next time. Incorporating EBM into Inpatient Rounds Admission rounds (after every period on call, all over the hospital, by post-call team and consultant Morning report (every day, sitting down, by entire medical service) Work rounds (every day, on one or several wards, by trainees) Consultant walking rounds (1-3 times a week, one or several wards, by trainees and consultant Incorporating EBM into Inpatient Rounds Review rounds (or “card-flip”) (every day, sitting down and at the bedside, by trainees and consultants) Social issues rounds (periodically, by trainees and a host of other professionals) Preceptor rounds (“pure education”) (1-2 times a week, by learners (often stratified) and teacher) “Down-time” or “dead space” during any rou