辽宁省临床医师认知和使用循证医学情况调查

为了解临床医师使用循证医学(Evidence-Based Medicine)的知晓度,获得基线资料,为卫生部门提供决策依据,课题组对辽宁省三级甲等医院的243名临床医师采用问卷调查.结果显示,临床医师受经验医学的束缚,未能将循证医学运用到医疗实践当中.为提高我国临床医学水平,在临床医师中推广循证医学非常必要.     

循证医学对目前临床医学实践的问题思考

循证医学的定义是［１］：“自觉地、准确地和公正地应用现有最好的证据来为每个病人作出治疗的选择。”循证医学实践要求全面地从每个病人身上,凭医生的临床专业知识和有关病人的最准确的证据作出判断。１　临床医师对循证医学的误解许多临床医师面对循证医学的挑战,大...     

如何正确处理循证医学与经验医学之间的关系

循证医学主张慎重和准确地应用当前所能获得的最好的研究依据。通过论述循证医学在临床实践中的重要性以及与经验医学的关系,证实循证医学是对经验医学的超越,临床医师应转变单一的经验医学,且有机地将二者结合,深刻理解指南的内容及意见,指导临床实践,达到最佳的治疗目的。     

循证医学回眸与展望

1循证医学概述与要求 1.1循证医学的概念[1-2] 循证医学(Evidence-Bsed Medicine,EBM)强调医师对患者的诊断和治疗应基于当前可得的最佳研究证据,结合医师的临床专业知识,并考虑患者的价值观,从而保证患者获得当前最好的治疗效果和生命质量(quality of life).     

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。     

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,这些征据并非完美.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.     

“比较治疗学”与“循证医学”之比较

对比较治疗学与循证医学兴起的历史背景、基本内涵的差异以及在临床决策方法方面的关系进行了较为细致的比较。循证医学与比较治疗学分属于临床决策的两个不同的阶段,比较治疗学的内涵范围要大于循证医学,同时循证医学为比较治疗学提供主要的基础性决策依据,比较治疗学的决策方法是循证医学在临床决策方法上的新发展。两者对促进临床科学决策都具有重要意义。     

"比较治疗学"与"循证医学"之比较

对比较治疗学与循证医学兴起的历史背景、基本内涵的差异以及在临床决策方法方面的关系进行了较为细致的比较.循证医学与比较治疗学分属于临床决策的两个不同的阶段,比较治疗学的内涵范围要大于循证医学,同时循证医学为比较治疗学提供主要的基础性决策依据,比较治疗学的决策方法是循证医学在临床决策方法上的新发展.两者对促进临床科学决策都具有重要意义.     

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…     

术后镇痛的实践思维

从外科医师和麻醉科医师传统临床思维方法特点分析,认为传统术后镇痛具有明显的片面性、专一性等临床诊疗的局限性。而从实践思维和循证医学理论角度分析,认为术后镇痛在围手术期“人性化”诊疗、防治全身炎症反应综合征或围手术期癌转移等方面具有的重要性与广阔前景。     

Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement

The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement.     

Connections between experience, beliefs, scientific knowledge, and self-evaluated expertise among investigators of child sexual abuse in Finland

The purpose of this study was to investigate whether clinicians investigating child sexual abuse (CSA) rely more on scientific knowledge or on clinical experience when evaluating their own expertise. Another goal was to check what kind of pre-trial beliefs the clinicians had. The connections between these different factors were investigated. A questionnaire covering items concerning demographic data, experience, knowledge about CSA, self-evaluated expertise and beliefs about CSA was given to 126 social workers, 60 child psychiatrists and 134 psychologists. The results showed that the clinicians relied more on their clinical experience than on scientific knowledge when evaluating their expertise as investigators of CSA. Furthermore, social workers possessed stronger attitudes in favor of children than the other groups, while child psychiatrists had more negative attitudes towards the criminal justice system. Male participants had less strong beliefs than did the female participants. The findings indicate that the education of CSA investigators should focus more on theoretical knowledge and decision-making processes as well as the role of pre-trial beliefs.     

GATA4在心肌肥厚中的作用

循证医学的诞生改变了几千年沿袭的医学实践模式。医学工作者通过应用循证医学的思路和方法指导医学研究和临床实践工作,进一步促进了临床决策的科学性,从而提高了医疗质量。随着循证医学的发展,其外延和内涵不断延伸。鉴于其在临床医学等领域的成功,卫生管理学者开始将循证医学的思想和方法应用于公共卫生决策和医院管理,即在卫生管理领域进行循证实践,改善公共卫生决策和医院管理水平,提高卫生资源利用效率和分配的公平性。     

Religious Knowledge and Its Use in Psychiatry

Clinicians' knowledge of and sensitivity to religious issues have been questioned. The present study measures religious knowledge and willingness to utilize such knowledge in clinical practice. We administered a 41-item questionnaire testing religious knowledge and willingness to utilize such knowledge to 28 psychiatric clinicians. The mean religious knowledge score was 61% of the total possible score. In spite of low scores, only 33% of clinicians consistently refrained from initiating discussions of religious issues. Results support a low level of religious knowledge but do not support a contention that clinicians are insensitive to religious issues.     

Evidenzbasierte Psychotherapie

Zusammenfassung Seit einiger Zeit wird auch in der Psychotherapie – so wie in anderen Bereichen der Medizin – eine intensive und kontroverse Diskussion über die wissenschaftlichen Standards und deren Praxisrelevanz geführt. Dabei nehmen Fragen der Qualitätssicherung und der Entwicklung von Leitlinien einen zunehmenden Raum ein. Von besonderer Bedeutung sind in diesem Zusammenhang die Evidence Based Medicine (EbM) und ihre methodischen Standards, in deren Mittelpunkt experimentelle Therapiestudien stehen. Im Beitrag wird das Konzept der Evidence Based Medicine im Kontext der Psychotherapie (Evidence based Psychotherapy) vorgestellt und unter methodischen und inhaltlichen Gesichtspunkten diskutiert. Eine zentrale Frage ist dabei die inhaltliche Aussagekraft und die Übertragbarkeit von wissenschaftlichen Befunden auf die klinische Praxis.      

The Impact of Depressive Symptoms and Health on Sexual Satisfaction for Older Couples: Implications for Clinicians

This study of 535 older married couples examined the relationship between depression and health and sexual satisfaction directly and when mediated by communication. The sample included 535 older couples who completed a survey questionnaire known as Project Couple Retire. Among the items in the questionnaire were measures of depression, health, perception of sexual intimacy, communication and other demographic information. Results from Structural Equation Modeling indicated that for women, health was a significant predictor of sexual satisfaction. For both genders, the results suggest that depression, when mediated by communication, is a predictor of sexual satisfaction among older couples. Implications for clinicians are discussed.     

The effects of safety knowledge and psychological factors on self-reported risky driving behaviors including group violations for e-bike riders in China

ObjectivesIt is unknown that how safety knowledge and psychological factors affect e-bike rider safety. Also, group violation behaviors, which are commonly observed in the field, have been rarely examined for e-bike riders in China. In this paper, the effects of safety knowledge and psychological factors on self-reported risky driving behaviors including group violations were examined.MethodsA questionnaire was developed to acquire information of e-bike riders in Guilin, Guangxi Province. Explanatory factor analysis was used to examine the reliability of the questionnaire and exclude redundant measurement items. Then, a Structure Equation Model was developed to examine the relationships among safety knowledge, safety attitude, risk perception and risky driving behaviors. After that, multiple regression models were fitted to examine the effect of safety knowledge on each type of risky driving behavior, as well as factors associated with group violations. At last, ANOVA tests were conducted to identify significant differences among e-bike rider groups in safety knowledge, safety attitude, and risk perception.ResultsSafety knowledge was found significantly associated with risky driving behaviors for e-bike riders in China, including aggressive driving, erroneous driving, and group violations. E-bike riders severely lack safety knowledge, especially that of traffic rules, including unmarried riders, under-educated riders, riders without driver’s license, younger riders, and riders with little riding experience. Group violations were largely found among e-bike riders, and to be associated with safety knowledge of traffic rules, risk-taking attitude, and riding experience of e-bike riders.ConclusionsThe findings could add some new safety implication and be beneficial for developing safety policies and interventions for e-bikes.     

对心血管病学若干进展的反思

心电起搏的发展经历曲折的过程,反映出以技术和设备为本的缺陷,以人为本可弥补这些缺陷;对介入新技术的过热应用反映了以技术为本的弊端;临床试验证据只反映某种情况下的患者共性,对试验证据的僵化理解和运用违背了循证医学的本义,以人为本可较好地解决这一矛盾;预防为主是以人为本的最好体现,应得到广泛的重视和实施。以人为本是医学的核心价值和出发点。     

Therapists' perception of benefits and costs of using virtual reality treatments

Research indicates that virtual reality is effective in the treatment of many psychological difficulties and is being used more frequently. However, little is known about therapists' perception of the benefits and costs related to the use of virtual therapy in treatment delivery. In the present study, 271 therapists completed an online questionnaire that assessed their perceptions about the potential benefits and costs of using virtual reality in psychotherapy. Results indicated that therapists perceived the potential benefits as outweighing the potential costs. Therapists' self-reported knowledge of virtual reality, theoretical orientation, and interest in using virtual reality were found to be associated with perceptual measures. These findings contribute to the current knowledge of the perception of virtual reality amongst psychotherapists.