L**********y
发帖数: 2525 | 1 你觉得有无必要？你是否用到 any kind of guidelines for your work? 如果有，是
哪家的？国内的医生们用不用？这个概念在国内流行不流行？谢~
包子 for first 3 useful responses |
s********g
发帖数: 290 | 2 uptodate
【在 L**********y 的大作中提到】
: 你觉得有无必要？你是否用到 any kind of guidelines for your work? 如果有，是
: 哪家的？国内的医生们用不用？这个概念在国内流行不流行？谢~
: 包子 for first 3 useful responses
|
l*******8
发帖数: 1745 | 3 and new England journal of medicine
【在 s********g 的大作中提到】
: uptodate
|
A*******s
发帖数: 9638 | 4 如果新版能成， 我计划搞一个medicine的讨论。
我的观点，medicine首先必须是科学， 然后是艺术。
国内就不要提了。 中西医结合的必然后果是似是而非，既非科学，又非艺术。
Medicine has to be evidence based. |
k********n
发帖数: 756 | 5 Evidence-based medicine is not science. |
y******a
发帖数: 590 | 6 来挣个包子吧。
guideline当然有必要，但是，就像前两天班上说的，clinical practice不是perfect
science，所以大夫看病人还是要用自己的clinical judgement。同时，不是所有的诊
断治疗都有guideline可循的。
各个professional society 就常见的临床问题发布各种guidelines。通常都是很长的
文章。相比之下uptodate是摘要总结版，一般也就够用了。
我上学的时候，老师开始讲循证医学这个概念。前两个星期给国内做肿瘤科的同学打电
话，她说他们基本上也用的是这边NCCN的guideline，有些肿瘤，比如食道癌，胃癌，
很快国内就要有自己的guideline了。
★ Sent from iPhone App: iReader Mitbbs 6.88 - iPad Lite |
d****y
发帖数: 2180 | 7 The Science and ART of Medicine
Science-based technology and deductive reasoning form the foundation for the
solution to many clinical problems. Spectacular advances in biochemistry,
cell biology, and genomics, coupled with newly developed imaging techniques,
allow access to the innermost parts of the cell and provide a window to the
most remote recesses of the body. Revelations about the nature of genes and
single cells have opened the portal for formulating a new molecular basis
for the physiology of systems. Increasingly, we are understanding how subtle
changes in many different genes can affect the function of cells and
organisms. We are beginning to decipher the complex mechanisms by which
genes are regulated. We have developed a new appreciation of the role of
stem cells in normal tissue function and in the development of cancer,
degenerative disease, and other disorders. The knowledge gleaned from the
science of medicine has already improved and undoubtedly will further
improve our understanding of complex disease processes and provide new
approaches to disease treatment and prevention. Yet skill in the most
sophisticated application of laboratory technology and in the use of the
latest therapeutic modality alone does not make a good physician.
When a patient poses challenging clinical problems, an effective physician
must be able to identify the crucial elements in a complex history and
physical examination, to order the appropriate laboratory tests, and to
extract the key results from the crowded computer printouts of data to
determine whether to "treat" or to "watch." Deciding whether a clinical clue
is worth pursuing or should be dismissed as a "red herring" and weighing
whether a proposed treatment entails a greater risk than the disease itself
are essential judgments that the skilled clinician must make many times each
day. This combination of medical knowledge, intuition, experience, and
judgment defines the art of medicine, which is as necessary to the practice
of medicine as is a sound scientific base.
From Harrison's principles of internal medicine |
d****y
发帖数: 2180 | 8 Evidence-based medicine refers to the concept that clinical decisions are
formally supported by data, preferably data that are derived from
prospectively designed, randomized, controlled clinical trials. This is in
sharp contrast to anecdotal experience, which may often be biased. Unless
they are attuned to the importance of using larger, more objective studies
for making decisions, even the most experienced physicians can be influenced
by recent encounters with selected patients. Evidence-based medicine has
become an increasingly important part of the routine practice of medicine
and has led to the publication of a number of practice guidelines.
From Harrison's principles of internal medicine |
A*******s
发帖数: 9638 | 9 M=S
M=A or B
if A is not S, then B must be S.
According to the definition of medicine, Medicine is the science.
If evidence-based medicine is not the sicence, then non-evidence based
medicine has to the science?
【在 k********n 的大作中提到】
: Evidence-based medicine is not science.
|
m********4
发帖数: 607 | 10 "evidence based medicine"已经提出很久了。最近在文章中看到“Individual
medicine" and " Pricing medicine"的提法。看来，医学模式也是不断发展变化中。
【在 L**********y 的大作中提到】
: 你觉得有无必要？你是否用到 any kind of guidelines for your work? 如果有，是
: 哪家的？国内的医生们用不用？这个概念在国内流行不流行？谢~
: 包子 for first 3 useful responses
|
|
|
k********n
发帖数: 756 | 11 medicine is not science, and evidence based medicine is not science either
【在 A*******s 的大作中提到】
: M=S
: M=A or B
: if A is not S, then B must be S.
: According to the definition of medicine, Medicine is the science.
: If evidence-based medicine is not the sicence, then non-evidence based
: medicine has to the science?
|
L**********y
发帖数: 2525 | 12 马上送包子给 spreadking, yuzaiusa, meigui0714
多谢多谢大夫们的回答
玫瑰如果能谈谈 indiviudal medicine and pricing medicine，再送一个大包子，从
我马甲的账号
。
【在 m********4 的大作中提到】
: "evidence based medicine"已经提出很久了。最近在文章中看到“Individual
: medicine" and " Pricing medicine"的提法。看来，医学模式也是不断发展变化中。
|
L**********y
发帖数: 2525 | 13 多谢。如果能中文说说你的看法，而不只是复制定义，晚上我马甲给你发包子
influenced
【在 d****y 的大作中提到】
: Evidence-based medicine refers to the concept that clinical decisions are
: formally supported by data, preferably data that are derived from
: prospectively designed, randomized, controlled clinical trials. This is in
: sharp contrast to anecdotal experience, which may often be biased. Unless
: they are attuned to the importance of using larger, more objective studies
: for making decisions, even the most experienced physicians can be influenced
: by recent encounters with selected patients. Evidence-based medicine has
: become an increasingly important part of the routine practice of medicine
: and has led to the publication of a number of practice guidelines.
: From Harrison's principles of internal medicine
|
d****y
发帖数: 2180 | 14 我是觉得哈里逊内科学那里已经说得很好了。
我贴主要是看上面关于medicine是science 还是art 争论有感。
关于evidence based medicine, 肯定是要用的，但是也要考虑到病人的个体差异。
这个问题以前讨论过，我就不想再多说了。
【在 L**********y 的大作中提到】
: 多谢。如果能中文说说你的看法，而不只是复制定义，晚上我马甲给你发包子
:
: influenced
|
A*******s
发帖数: 9638 | 15 C'mon, Dory. How could you miss me for a 包子? Your decision for 包子 is
so non-scientific and not evidence based. LOL!
【在 L**********y 的大作中提到】
: 马上送包子给 spreadking, yuzaiusa, meigui0714
: 多谢多谢大夫们的回答
: 玫瑰如果能谈谈 indiviudal medicine and pricing medicine，再送一个大包子，从
: 我马甲的账号
:
: 。
|
d****y
发帖数: 2180 | 16 I think Medicine is the combination of science and art. Evidence-based
medicine is a very important part of scientific side of medicine. Things
like solicitation of history and communication with the patients would be
good examples of art of medicine.
either
【在 k********n 的大作中提到】
: medicine is not science, and evidence based medicine is not science either
|
L**********y
发帖数: 2525 | 17 true. i said baozi for "first 3 useful responses". whether it's useful or
not (to me) is obviously going to be subjective...
i was asking the question not because i want to become a doctor, but trying
to form an opinion about the allegation that the health care industry is
extremely inefficient, therefore wall street will pump small firms which
target to make the process more efficient or provide a unique service to
doctors and hospitals, and in a few years it will be clear who the winners
are.
anyway, thanks for responding.
【在 A*******s 的大作中提到】
: C'mon, Dory. How could you miss me for a 包子? Your decision for 包子 is
: so non-scientific and not evidence based. LOL!
|
d****y
发帖数: 2180 | 18 OMG。 Wall street把美国弄的还不够惨吗？
trying
winners
【在 L**********y 的大作中提到】
: true. i said baozi for "first 3 useful responses". whether it's useful or
: not (to me) is obviously going to be subjective...
: i was asking the question not because i want to become a doctor, but trying
: to form an opinion about the allegation that the health care industry is
: extremely inefficient, therefore wall street will pump small firms which
: target to make the process more efficient or provide a unique service to
: doctors and hospitals, and in a few years it will be clear who the winners
: are.
: anyway, thanks for responding.
|
A*******s
发帖数: 9638 | 19 Please follow up on this topic and I'll let you understand what is evidence
based medicine.
By then, your view will be more objective, hopefullly. :)
or
trying
【在 L**********y 的大作中提到】
: true. i said baozi for "first 3 useful responses". whether it's useful or
: not (to me) is obviously going to be subjective...
: i was asking the question not because i want to become a doctor, but trying
: to form an opinion about the allegation that the health care industry is
: extremely inefficient, therefore wall street will pump small firms which
: target to make the process more efficient or provide a unique service to
: doctors and hospitals, and in a few years it will be clear who the winners
: are.
: anyway, thanks for responding.
|
