以循证医学为基础的健康体检ppt课件.ppt
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1、以循证医学为基础的健康体检,周仲华医生陆康宁医生海口市人民医院全科医学科2009年4月,课程大纲,1.周期性健康体检的概念 2.以证据为基础的医学方法 3.疾病的筛查原则 4.筛查实验的缺陷 5.符合循证医学的成人健康体检项目,案例讨论,某单位有职工20人,年龄分布从20岁至55岁。现要求为职工安排集体健康体检。你计划如何安排体检项目?,周期性健康检查的概念,概念:针对就诊者的不同年龄、性别、职业等存在的主要卫生问题或健康危险因素进行的周期性的、终生健康检查。对象:无症状的个体;目标:一、二级预防;我国缺少符合循证医学的“临床预防服务指南”。,以李先生为例:李先生54岁,从事后勤管理工作。有3
2、0年吸烟史,每天一包。他知道戒烟的害处,确感到戒烟很难。他现在没有不适的感觉,但担心长期吸 烟史是否会使他患肺癌。他问医生是否应该进行CT或胸片检查?他既往曾患胃食道反流疾病,父亲65岁时死于肺癌。,案例继续:你计划安排个体化的健康体检,你计划给李先生安排什么体检项目?要给他做胸部X线片吗?为什么?,以证据为基础的医学方法循证医学(Evidence Base Medicine),P=PATIENT 病人 I=INTERVENTION干预C=COMPARISON对比O=OUTCOME结局,Patient=healthy,asymptomatic male smoker 病人=健康,无症状男性吸烟
3、者Intervention=lung cancer screening 干预=肺癌筛查Comparison=no test 对比=不检查Outcome=prolonged survival 结局=延长生存期,Evidence Based Medicine循证医学,Focused clinical question:临床关注的问题,In a healthy,asymptomatic,male smoker,does screening for lung cancer lead to prolonged survival,compared to no testing?与没有进行检查的人相比,健康无
4、症状的男性吸烟者筛查肺癌会延长寿命吗?,Ideal Screening Program:理想的筛查项目,Sensitivity&Specificty:敏感性特异性,Ideal:理想的,Reality:现实的,Principles of Screening 筛查原则,筛查的精确性 Accuracy of the screening test风险和利益 Risks and Benefits循证医学方法EBM approach,A.The USPSTF strongly recommends that clinicians provide the service to eligible patien
5、ts.The USPSTF found good evidence that the service improves important health outcomes and concludes that benefits substantially outweigh harms.B.The USPSTF recommends that clinicians provide this service to eligible patients.The USPSTF found at least fair evidence that the service improves important
6、 health outcomes and concludes that benefits outweigh harms.C.The USPSTF makes no recommendation for or against routine provision of the service.The USPSTF found at least fair evidence that the service can improve health outcomes but concludes that the balance of benefits and harms is too close to j
7、ustify a general recommendation.D.The USPSTF recommends against routinely providing the service to asymptomatic patients.The USPSTF found at least fair evidence that the service is ineffective or that harms outweigh benefits.I.The USPSTF concludes that the evidence is insufficient to recommend for o
8、r against routinely providing the service.Evidence that the service is effective is lacking,of poor quality,or conflicting and the balance of benefits and harms cannot be determined.U.S.Preventive Services Task Force Ratings:Strength of Recommendations and Quality of Evidence.Guide to Clinical Preve
9、ntive Services,Third Edition:Periodic Updates,2000-2003.Agency for Healthcare Research and Quality,Rockville,MD.http:/www.ahrq.gov/clinic/3rduspstf/ratings.htm,Strength of Recommendations,没有足够的证据说明用胸片、痰细胞学检查等方法筛查肺癌能延长寿命USPSTF 2004:insufficient evidence for or against LDCT,CXR,sputum cytology or comb
10、ination of testsAmerican College of Chest Physicians 2003:LDCT only in context of well-designed clinical trialsAmerican Cancer Society 2002:against routine screeningCanadian Task Force on Periodic Health Examination 1994:against CXR or sputum cytologyAmerican College of Physicians 1991:against use o
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