Ventegodt Søren, Orr Gary, Merrick Joav
Quailty of Life Research Center, Copenhagen, Denmark.
Int J Adolesc Med Health. 2011 Nov 4;24(2):113-9. doi: 10.1515/ijamh.2012.017.
Evidence-based medicine (EBM) is defined as "the integration of best research evidence with clinical expertise and patient values." EBM is based on three equally important key factors: i) the best available scientific evidence; ii) the physician's experience and intuition; and, iii) the preferences and values of the patient. EBM uses a hierarchy of evidence and critical appraisal of the sources, which makes it possible to balance high quality evidence with documented effectiveness. A treatment that is more safe and effective, but less well documented may very well be the treatment of choice. Ethics (not putting the patient at risk of harm with a treatment if this can be avoided at all) is an important part of EBM. Many pharmaceutical drugs have a number needed to treat (NNT) of approximately 20 [NNT=20, confidence interval CI (5-50)] and the number needed to harm is less well understood and documented. The adverse effect profile of pharmacological agents can be more harmful than non-drug medicine. Most EBM-treatments are likely to be non-drug treatments in the future. There are six steps to the practice of EBM: i) the patients and the physician must work together to define the problem; ii) the patients and the physician must explore the patient's values and preferences; iii) the information about the possible alternative medical interventions must be discussed and critically appraised; iv) the best, relevant evidence must be applied to the patient as a treatment or cure; v) together, the patient and the physician must evaluate how useful the intervention was; and vi) if the intervention did not help sufficiently, the process must begin again. In this review, we explain, in our opinion, how non-drug EBM should be practiced.
循证医学（EBM）的定义是“将最佳研究证据与临床专业知识及患者价值观相结合”。循证医学基于三个同等重要的关键因素：i）可获得的最佳科学证据；ii）医生的经验和直觉；iii）患者的偏好和价值观。循证医学使用证据等级体系并对证据来源进行批判性评价，这使得在高质量证据与已证实的有效性之间取得平衡成为可能。一种更安全有效但记录较少的治疗方法很可能就是首选治疗方法。伦理学（如果可以避免，就不让患者因某种治疗而面临伤害风险）是循证医学的重要组成部分。许多药物的需治疗人数（NNT）约为20 [NNT = 20，置信区间CI（5 - 50）]，而伤害所需人数则了解和记录得较少。药物制剂的不良反应可能比非药物治疗更有害。未来，大多数循证医学治疗可能会是非药物治疗。循证医学实践有六个步骤：i）患者和医生必须共同确定问题；ii）患者和医生必须探讨患者的价值观和偏好；iii）必须讨论并批判性评价关于可能的替代医疗干预措施的信息；iv）必须将最佳的相关证据应用于患者作为治疗或治愈方法；v）患者和医生必须共同评估干预措施的有用程度；vi）如果干预措施帮助不够充分，必须重新开始这个过程。在本综述中，我们将阐述我们认为非药物循证医学应如何实践。
