Users' Guides to The Medical Literature - XXV. Evidence-based medicine: Principles for applying the Users' Guides to patient care
Users' Guides to The Medical Literature - XXV. Evidence-based medicine: Principles for applying the Users' Guides to patient care
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DOI：
10.1001/jama.284.10.1290
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发表时间：
2000-09-13
影响因子：
120.7
通讯作者：
Richardson, WS
中科院分区：
文献类型：
--
作者：
Guyatt, GH;Haynes, RB;Richardson, WS
本系列为临床医生提供了策略和工具，以便他们在患者护理中解读和整合已发表研究的证据。将本系列的所有文章应用于患者护理的两个关键原则涉及临床决策的价值负载性质以及循证医学所假定的证据等级。临床医生需要能够区分原始研究、系统综述、实践指南以及其他侧重于管理建议的综合研究中的高质量和低质量证据。循证从业者还必须了解患者的情况或困境；识别知识差距并提出问题以填补这些差距；进行高效的文献检索；批判性地评估研究证据；并将该证据应用于患者护理。然而，治疗判断往往反映了临床医生或社会对于干预益处是否值得成本的价值观。许多关于如何引出偏好以及如何将其纳入临床诊疗的未解决问题，构成了循证医学极具挑战性的前沿领域。时间限制仍然是循证实践的最大障碍，但临床医生应从适当的证据等级中尽可能高的层级寻求证据，并且每个临床决策都应针对患者的特定情况。
This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients. The 2 key principles for applying all the articles in this series to patient care relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine. Clinicians need to be able to distinguish high from low quality in primary studies, systematic reviews, practice guidelines, and other integrative research focused on management recommendations. An evidence-based practitioner must also understand the patient's circumstances or predicament; identify knowledge gaps and frame questions to fill those gaps; conduct an efficient literature search; critically appraise the research evidence; and apply that evidence to patient care. However, treatment judgments often reflect clinician or societal values concerning whether intervention benefits are worth the cost. Many unanswered questions concerning how to elicit preferences and how to incorporate them in clinical encounters constitute an enormously challenging frontier for evidence-based medicine. Time limitation remains the biggest obstacle to evidence-based practice but clinicians should seek evidence from as high in the appropriate hierarchy of evidence as possible, and every clinical decision should be geared toward the particular circumstances of the patient.