临床实践证据.doc

如何形成可回答的临床问题(PICO) 背景问题(Background questions) : 意指与疾病相关的知识性问题, 问题的结构通常包括有带有动词的疑问句(who 、 what 、 where 、 when 、 how 、 why) 与疾病。 Who :病患特性、危险因子等 What :自然病程、症状学等 Where :影响的器官与系统、疾病分布的区域等 When :疾病好发的年龄、时间、季节等 How :病理生理学 Why :病因举例:急性心肌梗塞 Who :老年人、男性、家族史 What :胸痛、心电图的变化等等 Where :冠状动脉阻塞的位置、程度等等 When :气温低、心肌耗氧量高之活动等 How :动脉硬化斑块破裂、血栓形成 Why :动脉硬化危险因子、糖尿病、高血压、高血脂症、抽菸, 肥胖, 少运动前景问题(Foreground questions) : 指与治疗病患相关的特殊性问题,问题的架构通常包括有 4 个项目: ?与病患相关的问题(The patient and/or problem of interest) ?主要的治疗措施,包括诊断、治疗、预后、及病患的观点(The main intervention (defined very broadly, including an exposure, a diagnostic test, a prognostic factor, a treatment, a patient perception, and so forth)) ?比较相关的治疗措施(Comparison intervention(s), if relevant) ?相关的临床成效(The clinical e(s) of interest) PICO 问题 P: patient and/or problem ( 病患) I: intervention ( 处理) C: comparison of intervention ( 对照) O: clinical e ( 临床结果) Levels ofEvidence Levels of Evidence (March 2009) Lev el Therapy/Prevention, Aetiology/Harm Diagnosis 1a Systematic Review(SR) of RCTs SR of Level 1 diagnostic studies; Clinical Decision Rule(CDR) with 1b studies from different clinical centres 1b Individual Randomized controlled trial(RCT) Validating cohort study with good reference standards; or CDR tested within one clinical centre 1c All-or-none Absolute SpPins and SnNouts 2a Systematic review of cohort studies SR of Level >2 diagnostic studies 2b Individual cohort