Doherty Steven
Emergency Department, Tamworth Base Hospital, Tamworth, New South Wales, Australia.
Emerg Med Australas. 2005 Aug;17(4):307-13. doi: 10.1111/j.1742-6723.2005.00753.x.
In this article I will discuss the various definitions of evidence-based medicine (EBM), and summarize the application, criticisms and limitations of EBM. The spectrum of evidence, from pathophysiological inference to randomized controlled trials, will be presented as a mechanism for filtering bias with more rigorous evidence being required when bias is more likely. Although randomized controlled trials and meta-analyses are at the top of the evidence hierarchy, they are not always necessary, might not be the most appropriate forms of evidence for some clinical questions, and have their own limitation that need to be understood. Best available evidence, applied to individual patients, is the corner stone of EBM. Although there are valid criticisms and limitations of EBM, if these are understood then the practice of EBM can provide guidance to the clinician and enhance patient care.
在本文中，我将讨论循证医学（EBM）的各种定义，并总结循证医学的应用、批评意见和局限性。将呈现从病理生理推断到随机对照试验的证据范围，作为一种过滤偏倚的机制，当偏倚可能性更大时，需要更严格的证据。尽管随机对照试验和荟萃分析处于证据等级的顶端，但它们并非总是必要的，可能不是某些临床问题最适当的证据形式，且有其自身需要理解的局限性。应用于个体患者的最佳可得证据是循证医学的基石。尽管对循证医学存在合理的批评意见和局限性，但如果能理解这些，那么循证医学实践可为临床医生提供指导并改善患者护理。
