如何做出临床决策PPT.pptx

如何做出临床决策？How to Make Practice Decisions？田梅梅目的 Objectives罗列临床决策制定的组分 List the components of evidence-based decision making.讨论临床决策制定的步骤 Discuss the process of evidence‐based decision making.解释“投资回报”这个术语 Describe the term “return on investment”.探讨“投资回报”与循证实践项目的重要关系 Discuss the importance of ROI related to EBP projects.循证实践的步骤 EBP process临床问题Clinical Inquiry设计一个可以检索的、可以找到答案的问题Formulate a Searchable, Answerable Question (PICOT)寻找最佳证据Search for the Best Evidence快速实施证据的关键评价、评估与合并Rapid Critical Appraisal, Evaluation, and Synthesis of Evidence产生证据Generate Evidence 内部：质量改进QI外部：科学研究 Research结合临床专家意见与病人偏好整合证据Integrate the Evidence with Clinical Expertise and Patient Preference(s)评估证据应用的结果Evaluate Outcomes based on Evidence传播结果Disseminate the Outcome(s)决策 Decision对某个问题仔细考虑后的评判 The passing of judgment on an issue under consideration.得出结论或作出决定后的行动 The act of reaching a conclusion or making up ones mind.所获得的或明确的一个结论或判断，一个定论 A conclusion or judgment reached or pronounced; a verdict.不管是谁作的决策，或如何作出决策Regardless of who makes the decision, orhow the decision is made证据临床实践经验病人和家属注重的知识的正规来源Formalized Sources of Knowledge教育Education – 课堂Classroom – 临床Clinical证据 Evidence –效度Valid –信度Reliable –可行性Applicable知识Knowledge教育Education内部和外部证据Internal andExternal Evidence知识的实践来源Practical Sources of Knowledge临床经验Clinical Experience – 你个人的实践Your individual practice – 你小组的实践Your group practice –咨询同事与专家Queries to colleagues and experts病人经验Patient Experience –价值观与偏好 Values and preferences –病人与家庭 Patient and family知识Knowledge临床经验Clinical Experience病人经验Patient Experience知识和病人偏好Knowledge and Patient Preferences科研证据需要考虑到病人的关注点与偏好 Research evidence needs to be considered in light of the patient’s concerns and preferences需要评判性的判断，不仅仅是科研证据 Critical judgment is required, not only research evidence评判性决断需要两部分Critical judgment requires two components– 证据的强度 The strength of the evidence– 证据如何被应用到一个特殊的临床决策中 How the evidence is applied to a particular clinical decision应用证据Applying Evidence证据与临床实际的匹配很少是完美的The fit betwe