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EBM (Evidence-Based Medicine)

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Title: EBM (Evidence-Based Medicine) Author: Last modified by: Masayuki Honda Created Date: 11/8/2000 1:05:17 AM Document presentation ... – PowerPoint PPT presentation

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Title: EBM (Evidence-Based Medicine)


1
EBM (Evidence-Based Medicine)
http//www.usaco.co.jp/EBMR.html
  • EBM?? Evidenc-Based Medicine(???????????)????????
    ??????????????????????????????????????????????????
    ???????????????EBM????????????? (the Agency for
    health Care Policy Research, the American
    college of Physiciaians, the British medical
    Association?the Cochrane Collaboration)???????????
    ??????(Oxford University?Michigan State
    University??)???????EMB???????????????

2
EBM????
  • EBM?????????????????????????????
  • 1.???????????????????
  • 2.?????????????????(?????)???????
  • ?????????EBMR(The Cochrane Database of
    Systematic Reviews?Best Evidence)???????
  • 3.?????????(?????)??????????????
  • 4.?????????????????????
  • 5.?????????????

3
Evidence-Based Medicine Reviews(EBMR) ???
  • 1.The Cochrane Database of Systematic Reviews
    CDSR
  • The Cochrane Database of Systematic
    Reviews(CDSR)?????????(The Cochrane
    Collaboration)????? ?????????45???????????????????
    ??????????Review(?????????? ??)?Protocol(???????
    ?)??????????

??????????1992???????????????? ??????????????????
????????????????????????(randomized controlled
trialRCT)?????????Clinical Trail?????????????(sy
stematic review???????????? ????????)????????????
?????????????????????????????????? ???????????
4
Evidence-Based Medicine Reviews(EBMR)
  • 1.The Cochrane Database of Systematic Reviews
    CDSR

???????????????????????????? 1.
??????????????????????? 2. MEDLINE?EMBASE?BIOSI
S?????????????????????????????????????????? 3.
??????????????????????????????? 4.
??????????????????????? 5. ??????????????? 6.
?????????????
2. Database of Abstracts of Reviews of
Effectiveness DARE ????????The National Health
ServicesCentre for Reviews and Dissemination
(NHS CRD) ???????????????????????????????????????
???????????
5
Evidence-Based Medicine Reviews(EBMR)
  • 3.Best Evidence
  • ACP Journal Club?Evidence-Based
    Medicine?????????????????????????????????????????(
    tructured abstract)????1??????????????????????????
    ??????????????????????????????????????????????????
    ??????????????

6
EBM
  • Evidence-Based Medicine
  • ???????????
  • ??????????????????????????????????EBNEvidence-B
    ased Nursing

7
???????????????
  • ? ???????? (RCT Randomized Control Trial)
  • ? ??????????????????? (??????)
  • ? ??????(Case-control Study)
  • ? ??????????????????

8
???????????????(2)
  • ? ???????? (RCT Randomized Control Trial)
  • ?a???RCT???????? (Meta-analysis)
  • ?b?????1??RCT

9
EBM????????
  • STEP1 ????????? (??????????)
  • STEP2 ??????????????? (?????)???
  • STEP3 ??(?????)????? ?????????
    (critical appraisal)
  • STEP4 ??????????? ??????

IT???
???
10
??????????????????????????
  • International Committee of Medical Journal
    EditorsUniform Requirements for Manuscripts
    submitted to biomedical JournalsAnn. Intern.
    Med. 1988, 108 258-265

11
???????????????
  • Bailer JC, Mosteller F Guidelines for
    Statistical Reporting in Articles for Medical
    Journals - amplications and explanations.Ann.
    Intern. Med. 1988, 108 266-273
  • ????????????????????????????????????????????????3
    ?????????,??? 1992,175-82
  • ??????????(??????????)?23???????????????????????p
    p.668-677,????

12
??????????????
  • 1)Statistical Analysis Methods????Statistical
    Analysis??sub-section???
  • (1)????????????meanSD or meanSE????????????
    ????????percentile median 25?75?range
  • (2)????(????)?????????????????
  • (3)??????????(one-tailed)?????(two-tailed)
  • (4)??????????????

13
??????????????(?)
  • 2)Results???????????????????????????????????????
    ???????
  • 3)Tables and Figures?????????(????)??????????????
    ??????????????????(??????????????)???
  • ??1)Describe Statistical methods with enough
    detail to enable a knowledgeable reader with
    access to the original data to verify the
    reported results.12)Put general description of
    methods in the Methods section, specify the
    statistical methods used to analyze them.
    15)Define statistical terms, abbreviations, and
    most symbols.

14
??????????
  • ????????p value???????????????????????????????????
    ??????????????????????????????????????????????????
    (??)????????(??)?????????????????????????????
  • ???????????????????????????????????????????
  • ??2)When possible, quality findings and present
    them with appropriate indicators of measurement
    error or uncertainty(such as confidence
    intervals)3)Avoid sole reliance on statistical
    hypothesis testing, such as the use of P values,
    which fails to convey important quantitative
    information.

15
????????????
  • ???????????????????????????????????
  • ??????????????Thirty consecutive patients with
    liver cirrhosis who visited our outpatients
    clinic were recruited for this study...
  • ????????????????study protocol??????(??)?eligibili
    ty criteria (inclusion exclusion)?????????
  • ??4)Discussion eligibility of experimental
    subjects.

16
??????????
  • ???????????????????????????????????????????????
    ????????????????????????
  • ???????????????????????(??)????????????????????
    ?????????(????????????????)????(???????)????
    ??????????????????????????????????????
  • ??5)Give details about randomization

17
????????????
  • ?????????????????????????????
  • ??????????????????????????????????????????????????
    ????(?????????????)
  • ????????????????????????????????????
  • ??8)Give numbers of observations. 9)Report
    losses to observation (such as dropouts
    from a clinical trial).

18
???
  • ?????????????????????????????????textbook?????
    ?10)References for study design and statistical
    methods should be to standard works (with pages
    stated) when possible, rather than to papers
    where designs or methods were originally
    reported.
  • ?????????????????????????11)Special any
    general-use computer programs used
  • ???????????????14)Avoid non-technical uses of
    technical terms in statistics, such as
    random(which implies a randomizing device)
    normal,significant,correlation and sample.

19
EBM???????? Evidence Based Medicine and
Meta-analysis
  • ?? ??
  • ?????????????? ?????
  • Masayuki HONDA
  • Department of Medical Informatics, Nagasaki
    University Hospital

20
?????????????????
???????????????(Ver4.1/2001.4.24)
  • ????????????????????????,???????????????????????
    ?????????????.
  • ?????????,??????????????????????????evidence-ba
    sed medicine????????????.???,?????????????????????
    ?,??????????.

21
?????????????????
???????????????(Ver4.1/2001.4.24)
  • ?????(???)1.?????????????(???)???????
  • 2.???????????
  • 3.??????????????????,???(research
    question)???????
  • 4.????????,????????
  • 5.??????????,??????????????????????,??????????????
    ???(included study)????????(excluded study)??????
  • 6.???????????????,???????????????????????????(abst
    ract form)?????????????

?????????1.???? 1)????????????????
2)?????????????????????? 2.????
1)????????? 2)?????????? 3.????????????,??????
???????????????????,?????????????????????????????
??????????????????.
22
?????????????????
???????????????(Ver4.1/2001.4.24)
  • ?????(???)
  • 7.???????????,?????????????(abstract table)???
  • 8.??????,??????????????,????????????????????(??,?
    ???,???,?,?,???)??????
  • 9.????????????????????????????????????????(?????)?
    ??????,?????,???????????????????
  • 10.?????????????????????
  • 11.???????????????????????????????????????????????
    ??.
  • 12.??????????????????,??????????????????
  • 13.?????,?????????????????(????????????
    ????????????????????)????
  • 14.?????3???????????????,?????????????????

?1
?2
23
1.????????????????????????????????????????????
???????.2.???????,???????????????????????????????
????????????????.3.???????,??????????????????????
???????????????.4.???????????,???????????????????
????,????????????????????????????.
?1 ????????????????????
? ?
????
????
24
?.????????????/????????.??????????????????
?.??????????????.???????(????????????????)?.????
(????????????)????.???????????,??????????????.
?2 ??????????????????????
?
???????
?????????
? ?
25
??????????
??????????????????????????????????overview,
pooling, combining????????????????????????????????
?????????????????????????????????????????????????
?(??)
??????????????????????????????????????????????????
??????
???????? ?????????????????????????????????
26
?????????????????????? ???
???????????????????(Points to Consider)????????
??????????????,?????????????????????( Committee
for Proprietary Medical Products(2001))
  • ??
  • ????????????????????????.
  • ????????????????????????????????????????.
  • ?????????????,???????????????.
  • ??????????????,???????????????(???)?????
  • ???????????????.
  • ????,?????????????.
  • ???????????????????
  • ??????????????? ??????,
  • ??????????,
  • ???????????????????????,
  • ?????,???????????????,????????????????,
  • ?????????????????????????????

27
??????? ????
?????????????
  • ???????(????)?????????????????????????????????????
    ????????
  • ?????????????????????????????????
  • ?????????????(??????????????????????????????????)?
    ?????????????????????
  • ??????????????????????????????????????????????????
    ???????????????????????????????????????????????
  • ??????????????????
  • ???????????????????????????????

28
??????(Publication bias) ???(1)
?????????(?????)
????????????
??????????
  • ?????????????
  • ???????(?????????)
  • ??????(??????????????)
  • ??????
  • ????????
  • ????
  • ????(GCP?????)
  • ???
  • ?????????
  • ??????

29
??????(Publication bias) ???(2)
  • ??17?7????????????????????????????????????????????
    ?????(11?)????????
  • UMIN(????????????)???????? (?????????????????17?
    5?????????????)
  • UMIN???????(??????2005.2.2??)

????????????????????????? ??????????????????????
????(?????)???????????? ????????????????? ????????
?????????? ?????????? ? ?????????
????????????????????????????????????? ????????????
?????????????? ??????????
????????????????????
30
??????????????????????
  • ????????????????2??????????(?2?????????????????
    ??????????????)
  • ??????????????????????????????????(????)????
  • ??????????????
  • ?????
  • ???????
  • ???????(?????????)
  • ??????(??????????????)
  • ??????
  • ????????
  • ????
  • ????(GCP?????)
  • ???
  • ?????????
  • ??????

??????? ???? ???? ?????? ???? ????
???????????(?????)
????????????
31
?????????????(1)
  • MAL(meta-analysis of the literature)
    ??????(?????????????)
  • MAP(meta-analysis of individual patient
    data)??????(?????????????????)
  • MAP???
  • ????????????????
  • ??????????????????????????????????????????????????
    ?????????

MAP????(??2002) 1)????????????????????????????????
?????????????????????????? 2)?????????????????????
?????(????,?????????)????????-?????L????????. 3)??
????????,????????????????????????????????????????
?.
32
?????????????(2)
MAP????UMIN????????????? ??????????? ????????
??????? ????????
Cres?? ?????????????
?????????????????????????(????????????)?????????
???????????????????????? ????????????????
??????????? ??????????????????????
???????????????? ??????????????????????
??????????? ????????? ???????
?????????????
33
CReS?? ????????????
34
? ? ?
  • EBM???Sackett(1997)???????????????????????????????
    ?????????????????????????????
  • ???????????(systematic review)????????????????????
    ???????????????????
  • EBM???????????????????????????????????????????????
    ??????????
  • ??????????????????????????????????????????????????
    ???????????
  • ??????????????????????????????????????????????????
    ??????????????????????????????????????????????????
    ???????
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