University of South Florida Program for Comparative Effectiveness Research, and Division of Evidence Based Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA; Tampa General Hospital, Tampa, FL, USA.
Department of Clinical Epidemiology and Biostatistics, and Department of Medicine, McMaster University, Hamilton, ON, Canada.
Lancet. 2017 Jul 22;390(10092):415-423. doi: 10.1016/S0140-6736(16)31592-6. Epub 2017 Feb 17.
In response to limitations in the understanding and use of published evidence, evidence-based medicine (EBM) began as a movement in the early 1990s. EBM's initial focus was on educating clinicians in the understanding and use of published literature to optimise clinical care, including the science of systematic reviews. EBM progressed to recognise limitations of evidence alone, and has increasingly stressed the need to combine critical appraisal of the evidence with patient's values and preferences through shared decision making. In another progress, EBM incorporated and further developed the science of producing trustworthy clinical practice guidelines pioneered by investigators in the 1980s. EBM's enduring contributions to clinical medicine include placing the practice of medicine on a solid scientific basis, the development of more sophisticated hierarchies of evidence, the recognition of the crucial role of patient values and preferences in clinical decision making, and the development of the methodology for generating trustworthy recommendations.
为了应对对已发表证据的理解和使用方面的局限性，循证医学（EBM）于 20 世纪 90 年代初开始作为一场运动出现。EBM 的最初重点是教育临床医生理解和使用已发表的文献，以优化临床护理，包括系统评价科学。EBM 逐渐认识到仅证据的局限性，并越来越强调需要通过共同决策将对证据的批判性评估与患者的价值观和偏好结合起来。在另一个进展中，EBM 纳入并进一步发展了 20 世纪 80 年代研究人员开创的制作值得信赖的临床实践指南的科学。EBM 对临床医学的持久贡献包括将医学实践建立在坚实的科学基础上，发展更复杂的证据层次结构，认识到患者价值观和偏好在临床决策中的关键作用，以及发展用于生成值得信赖的建议的方法学。
