著者
岡村 智教
出版者
一般社団法人 日本脳卒中学会
雑誌
脳卒中 (ISSN:09120726)
巻号頁・発行日
vol.30, no.6, pp.920-924, 2008 (Released:2009-01-13)
参考文献数
8

Evidence based medicine (EBM) was proposed by Guyatt in the early 1990s. Sackett and colleagues have established basic concept of EBM. They defined that EBM was the conscientious, explicit, and judicious use of current best evidence in making clinical decisions for each patient. Recently, although many clinicians recognized epidemiology as an importance tool for EBM, there were some misunderstandings in the decision-making process to use evidence level. Some clinicians believe EBM must need randomized-controlled trials (RCT). However, RCT is not always best available evidence. RCT is not suitable to examine harmful exposures, such as smoking, due to ethical problems. Furthermore, to clarify very week association, such as dietary habit and stroke, RCT requires too huge sample size to perform practically. When we are looking for second best evidence, the consistency is a main target. For example, cohort studies anywhere on the globe showed the positive relationship between smoking and cerebral infarction. Although EBM is substantially made to resolve a one-on-one clinical relationship (one therapy and one outcome), clinical questions usually consist of more complex matters with many-to-many, many-to-one, one-to-many associations. We should combine the best available external evidence with our clinical expertise, and neither alone may work enough.

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医学的エビデンス 最終的な治療方針については,現場の専門家と患者という「人」が判断することになり,EBM やそこから導き出されたガイドラインはそのための補助手段に過ぎない https://t.co/FjZmkxuBYh
医学的エビデンス EBM(Evidence Based Medicine) は臨床の現場に疫学的な客観評価を持ち込んで,独善的な判断を排除する機会を切り開いた.しかしながら今まで述べてきたようにこの手法にも限界があり,どんな事象でも評価可能な魔法の定規ではない. https://t.co/FjZmkxuBYh
現在のEBM (Evidence Based Medicine)の手法では,「総合リスク評価→危険因子への非薬物的および薬物的介入」のような複雑系に対処するのは難しい https://t.co/FjZmkxuBYh
新薬によって疾病による死亡の相対危険度が0.8 になった場合,製薬会社の宣伝では「リスクが20% 低下」と大きく取り上げられる.しかし実際には,1,000 人あたりの死亡者が10人から8 人に減ったというレベルで20% という評価がなされている https://t.co/FjZmkxuBYh

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