以循证医学为基础的健康体检.ppt

以循证医学为基础的健康体检 周仲华医生 陆康宁医生 海口市人民医院全科医学科 2009年4月 课程大纲 1. 周期性健康体检的概念 2.以证据为基础的医学方法 3.疾病的筛查原则 4.筛查实验的缺陷 5.符合循证医学的成人健康体检项目 案例讨论 某单位有职工20人，年龄分布从20岁至55岁。现要求为职工安排集体健康体检。你计划如何安排体检项目？ 周期性健康检查的概念 概念：针对就诊者的不同年龄、性别、职业等存在的主要卫生问题或健康危险因素进行的周期性的、终生健康检查。 对象：无症状的个体； 目标：一、二级预防； 我国缺少符合循证医学的“临床预防服务指南”。 你计划给李先生安排什么体检项目？要给他做胸部X线片吗？为什么？ Evidence Based Medicine循证医学 Patient = healthy, asymptomatic male smoker 病人=健康，无症状男性吸烟者 Intervention = lung cancer screening 干预=肺癌筛查 Comparison = no test 对比=不检查 Outcome = prolonged survival 结局=延长生存期 Focused clinical question: 临床关注的问题 In a healthy, asymptomatic, male smoker, does screening for lung cancer lead to prolonged survival, compared to no testing? 与没有进行检查的人相比，健康无症状的男性吸烟者筛查肺癌会延长寿命吗？ Ideal Screening Program: 理想的筛查项目 Sensitivity Specificty: 敏感性—特异性 Principles of Screening 筛查原则 筛查的精确性 Accuracy of the screening test 风险和利益 Risks and Benefits 循证医学方法EBM approach Strength of Recommendations A.— The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms. B.— The USPSTF recommends that clinicians provide [this service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms. C.— The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation. D.— The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits. I.— The USPSTF concludes that the evidence is insufficien