从雌激素替代治疗的历史看临床决策的影响因素

20世纪40年代,动物实验提供的致癌效应证据限制了雌激素替代治疗的应用。20世纪60年代,价值观因素极大地推动了雌激素替代治疗,以至于关于致癌效应的证据被忽视。20世纪70年代,人群研究提供的致癌效应证据使得雌激素替代治疗的应用不断减少。20世纪80年代,致癌效应的消除和观察性流行病学研究提供的心脏保护证据,将雌激素替代治疗的应用推向了顶峰。20世纪末,大规模随机对照试验提供的有害效应证据推动了雌激素替代治疗应用的大幅下降。雌激素替代治疗一波三折的历史体现了证据、价值观在不同时期对临床决策的不同影响,说明只有遵循循证医学的实践模式,基于现有最佳的科学证据,并结合医生的临床经验与患者的价值观,才可能做出科学、有效的临床治疗决策。     

非小细胞肺癌术后化疗循证医学证据引发的思考

肺癌是目前对人类生命威胁最大的恶性肿瘤之一.对非小细胞肺癌术后化疗的循证医学证据及由此引发的思考:对循证医学的局限性及认识真理的曲折性进行了阐述.     

循证医学热潮下的冷思考--循证医学误区与差异之管见

循证医学(EBM)是一门20世纪80～90年代新兴的临床医学模式.在循证医学的实施过程中,存在理论与实践方面的偏差,认知与理解方面的误区和对个体差异的忽略,这势必会影响循证医学的健康发展.为此,从三个方面对此加以阐述.     

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。     

循证医学在眼科临床实践中的应用

循证医学是在Internet蓬勃发展并极大推动社会信息化和网络化的大背景下,将临床流行病学、现代信息学与临床医学相互交叉融合的新兴边缘学科。它的出现使临床医学面临巨大的挑战,已使得行医模式由理论知识加以个人经验为指导的传统经验医学转向现代循证医学。这将是传统医学模式向循证医学模式转变的一场深刻变革,也是本世纪临床医学发展的必然趋势。     

Evidence-Based Ethical Problem Solving: An Idea Whose Time Has Come

This is an account of the evolution of ideas and the confluence of support and vision that has eventuated in the founding of the Journal of Empirical Research on Human Research Ethics (JERHRE). Many factors have contributed to the creation of this rather atypical academic journal, including a scientific and administrative culture that finally saw the need for it, modern electronic technology, individuals across the world who were committed to somehow finding common ground between researchers and those charged with ethical oversight of research, a network of helpful colleagues, and a university whose administration gave moral support to the endeavor in a time of fiscal austerity. Perhaps equally important were the decisions to make JERHRE a nonprofit undertaking, to emphasize the implications of empirical research for specific best practices, to serve the educational needs of those concerned with human research, and to seek to stimulate the interest of students in gaining an evidence-based understanding of the research contexts in which they decide to work. This article explores the ‘chemistry’ that has made it possible to develop a somewhat unorthodox journal and set of related activities.     

The practice research network: Research into practice,practice into research

The purpose of the broader project on which this report is based was to utilize a Practice Research Network, an alternative to traditional clinical studies to 1) identify demographically one practice group, namely professional counselors in the United States, 2) describe their practice patterns, and 3) identify their client population and the efficacy of their clinical work through client outcomes based on actual client reports. This article describes the development of one such nation‐wide Practice Research Network (PRN) and provides some preliminary findings for each phase of the project. Use of the PRN model can help overcome the traditional “research to practice” gap and provide research results into community practice thus integrating outcomes measures into the daily practice of mental health professionals. During the early phases of this project, a software program was developed upon which the participating practitioners could identify the data elements within the parameters of the focus on their agreed‐upon research interests, enter data following client visits over time, and by comparing their own composite profiles and effectiveness with those of other participating practitioners who had clients presenting with similar diagnoses, could alter their own service delivery patterns, therapeutic interventions, or approaches while working with the clients and thereby improve the efficacy of their service. By participating, the practitioners benefited by access to downloadable and printable reports on profiles of 1) their specific clients, 2) their service delivery patterns, and 3) the outcomes or efficacy by their clients’ direct feedback. They were also able to compare these results with the composite data from other practitioners.     

回合式教学法的有效学习：来自自闭症儿童职前教师的证据

使用异步培训技术自主学习循证教育干预方法,或可帮助自闭症儿童职前教师应对新时代自闭症儿童融合教育高质量发展带来的挑战。采用3个实验探究了自闭症儿童职前教师在3种学习材料呈现方式下对回合式教学法的自主学习效果。结果发现,学习材料呈现方式对自闭症儿童职前教师自主学习回合式教学法的效果有显著影响：“字幕+画面+声音解说”组成的视听双通道材料——真实教学视频下的学习效果最好,“文本+图像”组成的PPT材料比同属视觉单通道材料的Word文本更有优势。结果表明,无论是在知识层面的学习(实验1、2和3),还是在实操层面的忠诚度提升(实验3),学习内容以视听双通道方式呈现时,自闭症儿童职前教师的自主学习效果最好。     

Using Technology to Train and Sustain Delivery of Evidence-Based Practices

Practitioners face three challenges in delivering evidence-based practice: limitations in the evidence available to guide routine clinical decisions; limitations in clinical judgment that are hard to remedy with typical work routines; and the practical difficulties of training and sustaining the breadth of skills relevant to meet diverse patient needs in a generalist practice. We recommend designing practice environments that support development of excellent clinical judgment with use of standardized work routines that help detect relationships between clinical decisions, interventions, and patient outcomes. We describe examples illustrating how technology can support training and supervision within this framework.     

Clinical Experiences in Conducting Empirically Supported Treatments for Generalized Anxiety Disorder

Knowledge of the efficacy of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) predominantly derives from randomized controlled trials (RCTs). However, there may be unique or complex issues encountered in practice, but not necessarily in the context of a controlled clinical trial. Therefore, launching a systematic dialogue between researcher and practicing clinician can be instrumental in augmenting evidence-based therapies through identification of variables that promote and interfere with clinical effectiveness. Through an initiative sponsored by the American Psychological Association’s Divisions 12 (Society for Clinical Psychology) and 29 (Psychotherapy), this study aimed to examine clinical experiences conducting CBT for GAD. The participants were 260 psychotherapists who completed an online survey on assessment and therapeutic intervention utilization and their experience of factors that limit successful GAD treatment and symptom reduction. The majority of respondents reported 20 years or less experience using ESTs for GAD, typically treating clients in outpatient clinics, treatment centers, and private practice. Some of the most commonly used interventions address clients’ maladaptive cognitions and elevated anxiety and muscle tension typical of GAD. Approximately one half of respondents reported incorporating integrative techniques into treatment. Factors perceived as limiting effective GAD treatment included severity and chronicity of GAD, presence of comorbid conditions, stressful home and work environments, client motivation and resistance to treatment, and issues encountered when executing therapy techniques. This study provides researchers with clinically derived directions for future empirical investigation into enhancing efficacy of GAD treatment.