University of Florida, Gainesville, FL, USA.
Asian J Psychiatr. 2011 Dec;4(4):304-8. doi: 10.1016/j.ajp.2011.11.002. Epub 2011 Dec 6.
Practicing evidence-based medicine (EBM) requires the ability to evaluate relevant evidence for the purpose of making an evidence-based treatment decision. Broadly, there are three available sources of information available to the practicing clinician: individual studies, literature reviews, and practice guidelines. In the first two articles in the series, we described the threats-to-validity (T2V) approach in evaluating evidence and specifically discussed the different threats to validity in applying the findings of a single study or a systematic review to an individual patient. In this article, we describe the elements of a treatment practice guideline and evaluate threats to validity at each of these steps. We illustrate the method by evaluating a practice guideline relevant to the treatment question presented in a clinical vignette. We briefly review practice guidelines for the pharmacological treatment of schizophrenia, discuss recommendations from an exemplar guideline about antipsychotic choice in patients with schizophrenia and consider application of its conclusions to the question of which antipsychotic to select for the particular patient with schizophrenia utilizing the T2V approach.
实践循证医学（EBM）需要能够评估相关证据，以便做出基于证据的治疗决策。广义而言，临床医生有三种可用的信息来源：个体研究、文献综述和实践指南。在该系列的前两篇文章中，我们描述了评估证据的威胁到有效性（T2V）方法，并特别讨论了将单一研究或系统评价的发现应用于个体患者时存在的不同有效性威胁。在本文中，我们描述了治疗实践指南的要素，并在这些步骤中评估了有效性威胁。我们通过评估与临床病例中提出的治疗问题相关的实践指南来说明该方法。我们简要回顾了精神分裂症药物治疗的实践指南，讨论了一个范例指南关于精神分裂症患者抗精神病药物选择的建议，并考虑将其结论应用于选择哪种抗精神病药物治疗特定精神分裂症患者的问题，使用 T2V 方法。
