Schünemann Holger J, Bone Lawrence
Department of Clinical Epidemiology and Biostatistics, Health Science Centre, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
Clin Orthop Relat Res. 2003 Aug(413):117-32. doi: 10.1097/01.blo.0000080541.81794.26.
Evidence-based medicine has evolved from the need of solving clinical problems. In contrast to the traditional paradigm of clinical practice, evidence-based medicine acknowledges that intuition, clinical experience, and pathophysiologic rationale are not sufficient for making the best clinical decisions. Although evidence-based medicine recognizes the importance of clinical experience, it includes the evaluation of evidence from clinical research and the integration of patients' values, preferences, and actions for best clinical decision-making. To optimize this process, evidence-based medicine advocates that a formal set of rules must accompany training and clinicians' common sense to interpret and apply evidence from clinical research results effectively. We describe the critical appraisal of studies related to prognosis and therapy or prevention building on an example relevant for the clinical orthopaedist. Based on the example, the authors describe how clinicians can apply measures of association and of intervention effects to their practice and patient care. The authors conclude with describing the appraisal of systematic reviews, their application to the development of practice guidelines, and the process of guideline development and recommendations.
循证医学源于解决临床问题的需求。与传统临床实践模式不同，循证医学认为仅凭直觉、临床经验和病理生理原理不足以做出最佳临床决策。虽然循证医学认可临床经验的重要性，但它还包括对临床研究证据的评估以及将患者的价值观、偏好和行为纳入考量以做出最佳临床决策。为优化这一过程，循证医学主张，在培训过程中必须有一套正式的规则，并结合临床医生的常识，以便有效地解读和应用临床研究结果中的证据。我们以一个与临床骨科医生相关的例子为基础，描述对与预后、治疗或预防相关研究的批判性评价。基于该例子，作者阐述了临床医生如何将关联度量和干预效果应用于其实践和患者护理中。作者最后描述了系统评价的评估、其在实践指南制定中的应用以及指南制定和推荐的过程。
