Margison Frank
Manchester Mental Health and Social Care NHS Trust, Manchester, UK.
J Am Acad Psychoanal Dyn Psychiatry. 2003 Spring;31(1):177-90. doi: 10.1521/jaap.31.1.177.21935.
Treatments should be based on reviews of the best available evidence. However, there are different views about the types of evidence that may be included. Evidence-based medicine (EBM) has its own clear hierarchy with systematic reviews of randomized controlled trials (RCTs) at the top level and expert and user opinion at the lowest level of evidence. Other paradigms, such as qualitative approaches, are difficult to place in such a hierarchy. This article examines some of the assumptions behind evidence-based practice, particularly when applied to complex "real life" clinical situations. A case example is used to demonstrate some of the complexity of applying evidence to practice. A complementary paradigm of practice-based evidence is described.
治疗应基于对现有最佳证据的综述。然而，对于可纳入的证据类型存在不同观点。循证医学（EBM）有其明确的等级体系，随机对照试验（RCT）的系统综述处于最高等级，而专家意见和用户意见则处于最低等级。其他范式，如定性方法，很难纳入这样的等级体系。本文探讨了循证实践背后的一些假设，尤其是在应用于复杂的“现实生活”临床情况时。通过一个案例来展示将证据应用于实践的一些复杂性。还描述了基于实践的证据这一补充范式。
