走出循证医学的误区——关于证据的反思

循证医学在临床实践中起着越来越重要的作用,证据的可靠性是循证医学赖以生存的基石。循证医学遵循的证据来自随机对照试验,这些证据并非完美。临床医师在采纳这些证据时须注意以下几个方面的问题证据的适用人群,干预措施是否存在均一性,对照是否存在片面性,试验的研究终点是否与临床脱节,证据的时效性,以及随机试验提供的证据不足等。只有结合医生的专业技能和临床经验,考虑病人的价值和愿望,对证据进行正确评估和采纳,才能使证据发挥最大的效能,促进循证医学的发展。

Avoiding Misunderstanding of Evidence-based Medicine:correct thought before adopting evidence

Evidence-based medicine (EBM) plays a more and more important role in clinical practice. The reliability of evidence is the foundation stone for EMB to exist. The evidences of EBM are provided by random controlled trial (RCT), and it is not perfect for clinical use. Clinician should pay much attention to the problems they may encounter when they decide to adapt these evidences. These problems may be: the applicable population of evidence, the uniform of intervention treatment of RCT, the one-sidedness of control, the endpoint of trials losing contact with clinical practice, the chrono-effect of evidence, and insufficiency of evidence etc. The evidence will not bring into full play only when it is evaluated and adopted in a correct way,and when the specialized skill and clinical experience of clinician combined together with the value and desire of patients, and so the EBM will be promoted.