Montori V M, Guyatt G H
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Respir Care. 2001 Nov;46(11):1201-14.
Responding to the limitations of traditional expert recommendations as a guide to clinical practice, evidence-based medicine has presented a paradigm shift in the way clinicians learn and practice medicine. The practice of evidence-based medicine requires careful examination of the evidence, using a set of formal rules applied in an explicit manner. The clinician then judiciously applies the evidence to decision-making, with an understanding of the patient context and values. Using examples pertinent to respiratory therapists, we discuss evidence-based decision-making as a clinical problem-solving strategy, its basis on a hierarchy of evidence, and the interplay of values, preferences, expertise, and circumstances that affect its application. We briefly describe some resources available to obtain evidence reports and to learn to critically appraise and apply them.
针对传统专家建议作为临床实践指南的局限性,循证医学在临床医生学习和实践医学的方式上带来了范式转变。循证医学实践需要仔细审查证据,使用一套明确应用的正式规则。然后,临床医生在了解患者背景和价值观的基础上,明智地将证据应用于决策。通过与呼吸治疗师相关的例子,我们将循证决策作为一种临床问题解决策略进行讨论,它基于证据层次结构,以及影响其应用的价值观、偏好、专业知识和情况之间的相互作用。我们简要描述了一些可用于获取证据报告以及学习批判性评价和应用这些报告的资源。