Applying Evidence Based Principles to Personalized Medicine

项目摘要/摘要： 循证医学(EBM)将现有的最佳实践与临床医生的经验和 病人的价值观。在循证医学之前，护理质量是基于对当地标准的坚持 由医疗保健提供者提供的实践。这一标准是以历史惯例为基础的，是 通常是自然界中的轶事。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。循证医学原则的采用产生了 循证医学进展缓慢，人们对循证医学相对于基于隆起的整形外科的接受程度也有所下降。为此， 教育外科医生关于高水平证据研究的好处和偏见，包括随机 对照试验(RCT)和前瞻性观察研究，将有助于改善临床护理 整形外科的病人。此外，在实践中的临床解释需要理解综合的 试验报告标准(COSORT)和加强#年观察性研究报告 流行病学(频闪)图。循证医学与以前接受的标准之间的冲突是 在几个EBM质疑其价值的矫形手术中很明显：粘性补充术， 椎体成形术和半月板切除术治疗退行性半月板撕裂。 随机对照试验和观察性研究在外科研究中都占有重要地位。一项做得很好的队列试验 与不适用于许多患者的随机对照试验相比，可能为实际的患者护理提供更多的洞察力。在……里面 此外，观察性研究在解决与外科手术相关的问题时尤其有用。 不能进行随机对照试验的程序或需要的病人数量 统计权力太大，无法使试验变得切实可行。提高外科医生的阅读和教育水平 回顾研究是推进骨科手术实践和外科护理的关键 病人。提高了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，将使重要和迫切需要的 我们在病人护理方面的进步。本次研讨会将讨论以下方面的优点和缺点 肌肉骨骼护理中的这些类型的分析。最近流行的用于质量目的的登记处数据 将探讨这如何符合证据和医生/患者决策的层次结构 制作。这一点尤其重要，因为AAOS强调和发展国家登记册 主要的整形外科手术。

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.