Applying Evidence Based Principles to Personalized Medicine

项目概要/摘要： 循证医学（EBM）将最佳实践与临床经验相结合， 患者价值观。在循证医学之前，护理质量是基于对当地标准的遵守 医疗保健提供者提供的实践。这一标准是基于什么样的历史实践， 通常是自然界的轶事。改进统计分析手段，特别是多变量分析， 系统评价和荟萃分析有助于循证医学的发展。采用循证医学原则， 进展缓慢，接受循证医学超过基于隆起的骨科已经受到影响。为此， 教育外科医生了解高水平证据研究（包括随机研究）的好处和偏见 对照试验（RCT）和前瞻性观察性研究，将有助于改善 骨科患者此外，实践中的临床解释需要理解综合 试验报告标准（CONSORT）和加强观察性研究报告 流行病学（频闪）图。循证医学与以前公认的标准之间的冲突是 这在EBM价值受到质疑的几种矫形手术中是明显的：粘滞补充， 椎体成形术和膝关节切除术治疗退行性椎体撕裂。 随机对照试验和观察性研究在外科研究中占有重要地位。一项出色的队列试验 与不适用于许多患者的RCT相比，可以为实际患者护理提供更深入的见解。在 此外，观察性研究在解决与手术相关的问题方面特别有用。 无法进行RCT的手术或达到充分 统计功效太大，无法使试验切实可行。改善外科医生阅读的教育， 回顾研究对于推进骨科手术实践和外科护理至关重要， 患者提高对最高证据水平研究的益处和偏见的理解， 即随机对照试验和前瞻性观察性研究， 我们在病人护理方面的进步。本次研讨会将讨论 这些类型的分析在肌肉骨骼护理。最近流行的登记数据的质量目的 将探讨这如何符合证据和医生/患者决策的层次结构 制作。考虑到美国农业科学促进组织的重点和国家登记册的发展， 主要骨科手术。

Project Summary/Abstract: Evidence-based medicine (EBM) combines the best available practices with clinician experience and patient values. Prior to evidence-based medicine, quality of care was based on adherence to local standard practices given by healthcare providers. This standard was based on what historical practices, and was often anecdotal in nature. Improved means of statistical analysis, especially multivariable analysis, systematic reviews and meta-analysis has helped the advancement EBM. The adoption of EBM tenets has been slow, and acceptance of EBM over eminence-based orthopaedics has suffered. To this end, educating surgeons about the benefits and biases of high level of evidence studies, including randomized control trials (RCTs) and prospective observational studies, will help improve the clinical care of orthopaedic patients. Further, clinical interpretation in practice requires understanding of the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) diagrams. The conflict between EBM and previously accepted standards is evident in several orthopaedic procedures in which EBM has questioned value: viscosupplementation, vertebroplasty, and knee meniscectomy for degenerative meniscal tears. Both RCTs and observational studies have important places in surgical research. A well-done cohort trial may provide greater insight to practical patient care than a RCT that is not applicable to many patients. In addition, observational studies can be particularly useful in addressing questions related to surgical procedures where RCTs cannot be performed or the number of patients necessary to achieve adequate statistical power is too numerous to make the trial practical. Improved education for surgeons reading and reviewing studies is critical to advancing the practice of orthopaedic surgery and the care of surgical patients. Improved understanding of the benefits and biases of studies at the highest levels of evidence, namely RCTs and prospective observational studies, will enable important and much needed advancements in the care of our patients. This symposium will address the strengths and weaknesses of these types of analyses in musculoskeletal care. The recent popularity of registry data for quality purposes will be explored as to how this fits within the hierarchy of evidence and physician/patient decision making. This is especially important given the AAOS emphasis and development of national registries for major orthopaedic procedures.