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1、Selecting Resources to Inform Evidence-based Healthcare PracticesJoseph Lau (刘子江刘子江), MD Professor Emeritus Center for Evidence-based Medicine Brown University School of Public Health Providence, Rhode Island, USA1Aim of this lecture To encourage you to seek out and use best available evidence to in
2、form your medical practice decisions, and to provide some guidance on selecting the most appropriate resource among many that are now availableTo achieve this aim Review some of the reasons leading to the development of EBM Discuss the types of evidence available, and their strengths and limitations
3、 by using an example Provide some guidance on when to use specific types of evidenceA very brief history of EBM The phrase “evidence-based medicine (EBM)” was created by researchers at McMaster University in Canada, it first appeared in the medical literature in 1992, this idea is now 24 years old E
4、BM concepts and its main tools (systematic review and meta- analysis) have withstood the test of time and they have evolved and improved These methods are now well established and widely accepted in many (developed as well as developing) countries as well as by WHO to inform healthcare decisions and
5、 policiesEvidence-based health care is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of he
6、alth care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors.Early EBM definition Sackett et al. BMJ 1996 6Sources of medical information all can be considered as evidence Medical literature Personal experience
7、 Colleagues Experts Patients own experience Industry (pharmaceutical representatives) Internet / mediaRange of evidence-based resources Primary research studies: risks, treatments, diagnostic tests, database analyses, patient preferences, etc. Syntheses of primary research: systematic reviews, meta-
8、 analyses (do not make recommendations) Incorporation of benefits and harms in explicit model: decision analyses / cost-effectiveness analyses / pharmaco-economic analyses Integration of above by an expert body and makes recommendations: Clinical Practice Guidelines Summary of above to provide point
9、-of-care information: clinical decision support tool8How to Read a Clinical JournalThis chapter has been prepared for those clinicians who are behind in their clinical reading. As nearly as we can tell from several informal polls, this includes all of us. And well it should. To keep up with the 10 l
10、eading journals in internal medicine a clinician must read 200 articles and 70 editorials per month. When this chapter was written, there were over 20,000 active biomedical journals (up from 14,000 ten years earlier), and to “read up” on viral hepatitis required selection from among 16,000 citations
11、 published on this single topic in the previous 10 years in English alone. To put it in an even more depressing way, if you were all caught up now, and read one article every day from the subsequently published medical journals, by this time next year you would be 55 centuries behind in your reading
12、.As if that was not bad enough, the biomedical literature is expanding at a compound rate of 6% to 7% per year. Thus, from the time you start medical school until you are established in practice 10 to 12 years later, the biomedical literature will have doubled! During your professional career it may
13、 increase tenfold! How can anyone keep up?Sackett DL, Haynes B, Tugwell P. Chapter 12. How to read a clinical journal. In: Clinical Epidemiology. A basic science for clinical medicine. Little, Brown and Company, Boston, 1985.Information ExplosionRough estimates of different types of publications to
14、inform clinical decisions RCTs 1 million Observational studies 1 million Systematic reviews / meta-analyses 100,000 Evidence reports / technology assessments commissioned by governments 10,000 Decision analyses / CEA 10,000 Clinical Practice Guidelines 15,000 Evidence-based CPGs 5,000 Clinical decis
15、ion support resources dozens10What does the medical literature offer? Lots of journals and articles Medline indexes over 5,600 journals from around the world Since 1966, it has indexed over 26 million articlesFigure 2. The number of published trials, 1950 to 2007. Bastian H, et al. Seventy-Five Tria
16、ls and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med 2010.Figure 3. The number of systematic reviews in health care, 1990 to 2007. INAHTA is International Network of Agencies for Health Technology Assessment. Bastian H, et al. PLOS Med 2010.Problems of having many articles Too many, No clinician in able to follow this much literature Many may
