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???????????? - DynaMed ??. Dr. Sydney BurwellDean of Harvard Medical School. Half of what you are taught as medical students will in ten years have been shown to be wrong.And the trouble is, none of your teachers knows which half.. ??????????????????????????????????????????????????????????????????????????.
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2. ????????????- DynaMed ??
5. Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values ?(?????????????,????????????)
Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine. How to Practice and Teach EBM. 2nd ed. London: Harcourt Publishers Ltd. 2000. p. 1.
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8. ?????????? ????
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9. ??EBM????? 1. Formulate an answerable question
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2. Track down the best evidence
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3. Critically appraise the evidence for validity, impact, and applicability
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4. Integrate with our clinical expertise and patient values
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5. Evaluate our effectiveness and efficacy
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15. ???????EBM???(Clinical Practice Guideline, CPG) ????????????????????????,??????????????????????????????
?????????????,????????????????????????(Evidence Based Practice Guideline, EBG ),????????????,???????????????????????????????????????,???????
EBM??????????????CPG????
16. ??????????????????????? ????:???????????????????????????????????????????
???????:??????PICO,?????????????
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???????:????(?????????????Exclusion/Inclusion??)
17. ??????????????????????? ?????????
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18. CPG???????:?? - CPG????
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?1999???
National Institute for Clinical Excellence (NICE)
??National Institute for Health and Clinical Excellence (NICE)
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19. CPG???????:?? - CPG??????
National Guideline Clearinghouse (NGC)
by AHRQ
?1998???,?????????
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20. CPG at NHRI ???????
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(???????)
Setting priorities
Establishing the model of clinical guidelines
Measuring the performance
Improving the performance
Life-long study plan.
22. Just-in-Case vs. Just-In-Time ???????
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23. ?????????? ???????
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BMJ 2002 Mar 23;324(7339):710
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????(Fam Med. 2003;35:257-260.)
27. ???????????????????? ????? (????????????)
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28. Acknowledgements David Tovey
Editorial Director, BMJ Knowledge
Editor, Clinical Evidence
Jon Brassey
Editor, TRIP Database
Bruce Arroll
Head of Department, Dept of General Practice and Primary Health Care, University of Auckland
Brian Alper, MD
Founder, Chief Editor, Dynamed
29.
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30. ???????? ????????
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(Systematic Review)
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(Research Monitoring)
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31.
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32.
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35.
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41. CPG Used in Dynamed National Guidelines Clearinghouse (US)
Cochrane Collaboration
National Institutes of Health (NIH)
National Institute for Clinical Excellence (NICE) (UK)
World Health Organization (UN)
North American Medical Societies (AHA, AMA, etc.)
National Organization for Rare Disorders
If youve done all of the other steps correctly but you only do them once a year, what good is it.
This is a constant process and its hard and time consuming.
Lets look at a specific trial that was done of a product, DynamedIf youve done all of the other steps correctly but you only do them once a year, what good is it.
This is a constant process and its hard and time consuming.
Lets look at a specific trial that was done of a product, Dynamed
52. PDA Downloadable Version
54. How much time does your user have to answer the question?
58. Demo