循证医学概论知识讲稿.pptVIP

Quick Information Guidelines Explicit evidence-based Evidence-based Research-based (highly referenced) Opinion-based “expert consensus” National Guideline Clearinghouse (/) Cancer Care Ontarios Program in Evidence-Based Care (PEBC) and the Cancer Care Ontario Practice Guidelines Initiative (CCOPGI) http://www.ccopebc.ca/ Quick Information Cochrane Library- The Cochrane Collaboration Systematic reviews The current resource with the highest methodological rigor For each clinical question, all of the English literature meticulously searched for randomized trials Large systematic reviews with valid methods + collaborative effort Conclusions are based on all the evidence from valid randomized trials PDQ (Physician Data Query) /cancer_information/pdq/ Clinical Trial Database Current Controlled Trials NIH ClinicalT Evidence-Based Medicine 循证医学 Background 1997年 上海医科大学中西医结合研究所完成的“中华灵芝宝”动物实验证实：该药物具有抑瘤作用、保护免疫功能和放化疗减毒增效作用。 中国科学院上海药物研究所完成“‘中华灵芝宝’对多种培养人癌细胞生长的作用”。课题，结论证实该药物对多种白血病和人体实体癌细胞具有明显的抑制作用，并呈现较好的量效关系。 1999年 中国科学院上海生物研究所丁健研究员等实验表明，中华灵芝宝（现名：双灵固本散）能抑制拓扑异构酶I和拓扑异构酶II，造成癌细胞DNA单链或双链断裂，阻断癌细胞的无限制繁殖，导致癌细胞破裂凋亡。 2001年 上海预防医学研究院以Ames试验和骨髓微核试验作了研究，结果表明中华灵芝宝具有抗突变作用。 2002年 国家药品监督管理局（SDA）批准中华灵芝宝转为“国药准字”并更名为“双灵固本散”。 Cell or animal is equal to human Background Traditional practice Model Clinicians are use convenient sources Factors that influence decision making. Senior doctors Patient request Pharmaceutical representatives recommendation Local expert-based CME Outdate! Background Longer life Chronic diseases More studies, more articles, much more information 20,000 RCT’s published annually，6000 articles enter Medline monthly 1 study report published every ? hour More diasgnostic tools, more drugs, more treatment methods “Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, non of your teachers knows which half.” Increasing medical costs The patient knows more, and questions more! Background Too little time To