循证医学与个体化治疗的共存和矛盾

从人体个体差异的绝对性出发,论述了个体化治疗与循证医学共存的必然性及两者之间的矛盾。循证医学的结论可通过对大量个体化治疗病例的循证研究而不断刷新,从而更好地指导个体化治疗,这是解决两者矛盾的途径。     

循证医学与个体化治疗的共存和矛盾

从人体个体差异的绝对性出发,论述了个体化治疗与循证医学共存的必然性及两者之间的矛盾.循证医学的结论可通过对大量个体化治疗病例的循证研究而不断刷新,从而更好地指导个体化治疗,这是解决两者矛盾的途径.     

肺癌多学科综合诊疗模式的探讨

肺癌是最常见的恶性肿瘤,发病率和病死率居所有肿瘤之首。多学科综合诊疗(multi-disciplinary team,MDT)是肺癌最佳治疗模式。有利于肺癌及时准确的诊断,并根据治疗指南和循证医学证据提出个体化治疗方案。但目前MDT模式在肺癌的诊治过程中存在不足之处,改进并推广肺癌MDT有助于提高肺癌诊治水平,从而提高患者生存质量,延长生存期。     

肺癌治疗中辨证论治与循证医学的矛盾与统一

肺癌的个体化治疗是依托于循证医学和飞速发展的分子生物学技术开启的西医治疗的新篇章,但同时也面临着很多困境。而中医辨证论治思想在朴素哲学思想的启领下,早已体现了个体化治疗的灵魂。笔者融合辨证论治思想,现代循证医学证据,提出了肺癌中西医治疗新的概念,从个体差异的绝对性出发,论述了辨证思想与循证医学共存的必然性及两者之间的矛盾。循证医学的结论可通过对大量个体化辨证治疗的研究而不断更新,从而更好地指导辨证治疗,这是未来中西医临床肺癌诊疗的必经之路。     

非小细胞肺癌分子靶向治疗中的循证医学和个体化治疗

肺癌是我国发病率和病死率最高的恶性肿瘤,分子靶向治疗是晚期非小细胞肺癌新的有前景的治疗方法。本文通过介绍以表皮生长因子受体酪氨酸激酶抑制剂为代表的非小细胞肺癌的分子靶向治疗历程,说明了循证医学和个体化治疗在临床肿瘤治疗中的相辅相成,只有将循证医学和个体化治疗结合起来才能不断地提高临床肿瘤治疗水平。     

国内循证医学文献计量学研究

循证医学 (evidence -basedmedicine ,EBM )是近十余年来在临床医学实践中发展起来的一门新兴临床学科 ,引起了医学界很大的兴趣 ,由此出现了许多循证学科 ,如 :循证外科、循证护理、循证检验医学、循证口腔医学、循证精神卫生、循证管理等。循证医学的核心思想是 :任何临床医疗决策的制定都应基于客观的科学研究依据 ,临床医生在疾病诊治过程中 ,应将个人的临床经验与现有的最好临床科学证据结合起来进行综合考虑 ,为每个病员做出最佳诊治决策[1] 。为了解循证医学在国内的发展情况 ,本文从文献计量学的角度对国内循证医学文献进行调查研…     

非小细胞肺癌分子靶向治疗中的循证医学和个体化治疗

肺癌是我国发病率和病死率最高的恶性肿瘤,分子靶向治疗是晚期非小细胞肺癌新的有前景的治疗方法.本文通过介绍以表皮生长因子受体酪氨酸激酶抑制剂为代表的非小细胞肺癌的分子靶向治疗历程,说明了循证医学和个体化治疗在临床肿瘤治疗中的相辅相成,只有将循证医学和个体化治疗结合起来才能不断地提高临床肿瘤治疗水平.     

选择最佳证据 加强多学科协作

循证医学给医学带来了一次变革,极大地促进了医学的发展,使医生在对患者的诊治过程中有证可循,大大提高了临床诊治的准确性,也使各种诊治方法趋于规范化。循证医学首先强调的是应用当前所能获得的最好的研究证据,那么什么是最好的研究证据？如何获得最好的研究证据？又如何通过运用循证医学使患者得到最佳的治疗效果呢？本期“临床决策研究”栏目中陈懿等撰写的文章“循证医学与实事求是”对此进行了深入的探讨和评论。     

脊柱转移瘤个体化综合治疗中的临床决策

脊柱转移是恶性肿瘤最重要的并发症,其个体化综合治疗应遵循循证医学原则,根据患者机体状况、肿瘤病理类型、临床分期和发展趋势等,优化多学科综合治疗手段,努力做到临床决策的科学性,以期最大幅度地提高患者临床疗效及改善患者生活质量。     

选择最佳证据加强多学科协作

循证医学给医学带来了一次变革,极大地促进了医学的发展,使医生在对患者的诊治过程中有证可循,大大提高了临床诊治的准确性,也使各种诊治方法趋于规范化.循证医学首先强调的是应用当前所能获得的最好的研究证据,那么什么是最好的研究证据?如何获得最好的研究证据?又如何通过运用循证医学使患者得到最佳的治疗效果呢?本期"临床决策研究"栏目中陈懿等撰写的文章"循证医学与实事求是"对此进行了深入的探讨和评论.     

转化医学在肺癌诊治中的应用

促进基础医学研究向临床应用的转化,同时根据临床医学的需求提出前瞻性的应用基础研究方向,是转化医学的核心思想。肺癌的诊治经过百年的发展,已经取得了一系列阶段性成果。在后基因组时代,如何将实验室发现的有意义结果转化为能提供临床实际应用的手段,真正实现肺癌的个体化治疗,是我们亟需解决的问题。     

循证医学证据的哲学蕴义

循证医学的核心理念是开发利用最佳证据用以指导临床医疗实践。从认识论的角度看,其证据的本质仍然是通过以病人为研究对象的临床医学研究所获得的知识信息,但却是经过分层滤过、系统综合和翻译转化的知识信息,是可以用于提高临床诊断、治疗水平和服务质量的,即可以直接转化为“现实生产力”的可运用的知识信息。     

Long‐Term Effects of the Family Check‐Up in Early Adolescence on Risk of Suicide in Early Adulthood

The impact of the Family Check‐Up (FCU), a school‐based prevention program, as delivered in public secondary schools on suicide risk across adolescence, was examined. Students were randomly assigned to a family‐centered intervention (N = 998) in the sixth grade and offered a multilevel intervention that included (1) a universal classroom‐based intervention, (2) the FCU (Dishion, Stormshak, & Kavanagh, 2011), and (3) family management treatment. Engagement with the FCU predicted significant reductions in suicide risk across adolescence and early adulthood.     

循证烧伤医学与烧伤医学的发展

循证医学是以证据为基础的医学,其在烧伤医学的应用即为循证烧伤医学。循证医学主要实施策略是发现和提出问题;寻求烧伤医疗实践中或者文献中的有价值证据;进行实验或方法学的评价;应用于临床检验的实践中;评价实践结果。循证烧伤医学和循证医学对烧伤医学的学科发展和临床工作的开展具有重要的意义,烧伤医学今后的发展方向是循证烧伤医学。     

解读《恶性肿瘤骨转移及骨相关疾病临床诊疗专家共识》

肿瘤专业工作者不仅要关注患者的抗癌治疗,同时也要关注他们的康复与姑息治疗,骨转移是肿瘤患者的常见转移病灶。《恶性肿瘤骨转移及骨相关疾病临床诊疗专家共识》（2007年版）适时地对恶性肿瘤骨转移及骨相关疾病提出了指导性意见,体现了肿瘤的综合治疗原则,其特点为：（1）多学科合作的结晶;（2）以高级别循证医学证据为基础;（3）突出了实践性和可操作性。和一切“诊断规范”一样,《共识》一方面对指导肿瘤科及其他相关科室医师们的临床实践发挥积极作用,同时又需要在实践中继续得到检验。     

法医学鉴定循证实践的局限性及其对策

循证法医学实践尚处于起步阶段,存在循证意识薄弱、循证素养有待提高、证据资源匮乏、专业信息共享平台缺乏等局限性.要用发展的眼光看待循证法医学,知其优劣,寻找对策,将其理论辩证地应用于法医学实践中.     

Recognizing Racit Knowledge in Medical Epistemology

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine.An erratum to this article can be found at     

On the effectiveness of and preference for punishment and extinction components of function-based interventions

The current study describes an assessment sequence that may be used to identify individualized, effective, and preferred interventions for severe problem behavior in lieu of relying on a restricted set of treatment options that are assumed to be in the best interest of consumers. The relative effectiveness of functional communication training (FCT) with and without a punishment component was evaluated with 2 children for whom functional analyses demonstrated behavioral maintenance via social positive reinforcement. The results showed that FCT plus punishment was more effective than FCT in reducing problem behavior. Subsequently, participants' relative preference for each treatment was evaluated in a concurrent-chains arrangement, and both participants demonstrated a dear preference for FCT with punishment. These findings suggest that the treatment-selection process may be guided by person-centered and evidence-based values.     

The Virtues of Evidence

Evidence-based medicine has been defined as the conscientious and judicious use of current best evidence in making clinical decisions. This paper will attempt to explicate the terms "conscientious" and "judicious" within the evidence-based medicine definition. It will be argued that "conscientious" and "judicious" represent virtue terms derived from virtue ethics and virtue epistemology. The identification of explicit virtue components in the definition and therefore conception of evidence-based medicine presents an important starting point in the connection between virtue theories and medicine itself. In addition, a unification of virtue theories and evidence-based medicine will illustrate the need for future research in order to combine the fields of virtue-based approaches and clinical practice.