Healey David, Lyons Karl
Department of Oral Sciences and Orthodontics, School of Dentistry, University of Otago, PO Box 647, Dunedin.
N Z Dent J. 2002 Jun;98(432):32-5.
The importance of evidence in teaching and in support of clinical decisions is well established in health care, including dentistry. Defence of clinical decisions increasingly requires reliable data or evidence to support the stance taken. Assistance in finding the best evidence comes from a variety of sources, including computerised databases, journals, continuing education meetings, and study clubs. The randomised controlled trial heads the hierarchy of research designs on which evaluation of evidence is based; anecdotally based evidence and individual case studies are the least preferred study designs. Evaluation of a study requires a number of questions to be asked to determine how the study was performed, and whether it applies to a clinical situation. These questions relate to how the study was carried out, whether controls were used, were the results likely to be valid, and was statistical and clinical significance present. Quackery, pressure from consumers, and legal considerations have contributed to an increase in the importance of evidence-based practice. The benefits, however, of evidence-based practice are that treatment decisions are easier to justify, especially when there is a complaint or a dento-legal issue, and the personal satisfaction that patients are being offered the best treatment.
在包括牙科在内的医疗保健领域,证据在教学及支持临床决策方面的重要性已得到充分确立。为临床决策进行辩护越来越需要可靠的数据或证据来支持所采取的立场。从各种来源可获得寻找最佳证据的帮助,包括计算机化数据库、期刊、继续教育会议和研究俱乐部。随机对照试验在作为证据评估基础的研究设计等级体系中处于首位;基于轶事的证据和个案研究是最不受青睐的研究设计。对一项研究进行评估需要提出一些问题,以确定该研究是如何开展的,以及它是否适用于临床情况。这些问题涉及研究是如何进行的、是否使用了对照、结果是否可能有效,以及是否具有统计学和临床意义。江湖医术、消费者压力和法律考量促使循证医学实践的重要性不断提高。然而,循证医学实践的好处在于,治疗决策更容易得到辩护,尤其是在出现投诉或牙医学法律问题时,以及患者因接受了最佳治疗而产生的个人满足感。