Workshop on Evidence Based Medicine

1
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??????????????? ?????? ?????????? ???????
??????????????????????? ??????????????
???????????? ????????? ???????????? Cases ????? -
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??????????????? ???????????? ???????? ?
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??????????
2
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• ?????
• ??????????? ???????
• people
  exposed disease
• population without the
  no disease
• disease
  
• 
  not exposed
  disease
• 
  
  no disease

at risk
3
?????? ???????????? ??????-????????

• ?????
• ??????????? ???????
• Start with
• Exposed
  cases (people
• 
  with disease)
• Not exposed
• Population
• Exposed
  controls (people
• 
  without disease)
• Not exposed

4
???????, ??????? ?????????? ??????, ????? ?
?????????? ?????????? ? ??????? ????????? ??????
(????, ????? ?????????? ? ???????? ???)

• ?????????? ??????????
• ????????? ?????
• ?????? ?????? ??? ?? ???
• ?????????
• ???? ???????? ??????????
• ????????????? ??????? ?? ???
• ??????? ???????

5
????? ? ???????
???????????? ???????

• Explanation Finding
• Association
• Bias in selection Yes No
• or measurement
• Chance Likely Unlikely
• Confounding Yes No
• Cause Cause

????? ????????
6
????? ? ???????

• Explanation Finding
• Association
• Bias in selection Yes No
• or measurement
• Chance Likely Unlikely
• Confounding Yes No
• Cause Cause

P value
7
????? ? ???????

• Explanation Finding
• Association
• Bias in selection Yes No
• or measurement
• Chance Likely Unlikely
• Confounding Yes No
• Cause Cause

8
???????? ???????????? ????????? ?????

• 1. ??????? ?? ?????????????? ????????
  ????????????? ?? ??????
• 2. ?????? ?? ????????? ??????
• 3. ???????? ?? ???????? ????? ??? ?? ? ?????????
  ??????????????
• 4. ????? ?? ????????? ??????
• 5. ??????? ?? ???????? ??????????? ?????? ??
  ?????
• 6. ????? ?? ????????????? ????? ?????????????
  ????????? ??????
• 7. ???????? ?? ?????????? ????????????
• (???????????? ?? ?.?????)

9
????????????

• 1. ???????????? ?????? ??????????? ?????????
  ??????? ???????????? ??? ? ?????? ???????, ??? ?
  ? ?????? ???????? (????? ??????? ???????????
  ?????? ?????????????)
• 2. ???????? ?? ?????????? ????????? ? ???????????
  ????????????? ????????
• 3. ??????? ???? ??? ???????????? ???????????????
  ???????

10
???????? ??????? ???????????? ??? ???????? ???????
Systematic reviews
11
?????, ?????????? ?? ??????????, - ????????????
?? ??????, ?????????? ? ???? ?????????????????
?????????????

• Benson NEJM 20003421877
• Concato NEJM 20003421887

? ????????? ??????? -??
? ?????? - ??? !
12
??????????? ???????????? - ??????????! -?????????
????? ??? ???????? ??????? ?????? ?? ???????
??? ??????, ? ???? ????? ?????
?????, ?????????? ?? ??????????, ?????
?????????? ??????????????? ????? ???????????
???? ???? ????? ???????? ?? ??, ? ???? ?????
?????
13
????? ???? ???????? ???????? ?? ?????? ?

• Matzen P. Ugeskr laeger 20031651431-5
• ?????????? ???????- 50
• ??????????- 65
• ?????? (????????, ????????? ??????, ????????????)
  -??????
• Lai Br. J Ophthal . 20034385-90
• 42.9 ???? ???????????? ?? ??????? ??????????? ??
  ????????? ??????????? ???, ????-??????? ?
  ??????????????? ??????? (? 23 ??????? ???
  ????????? ?????????????)

14
???????? ?????????? ????????????????
15
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• ?? ?????? ???????????, ???? ??? ?????????????
  ????? ?? ????????? ????????????/????????? ??????
  ?? ?????? ???????????? ??????????? ??????

16
?????????????? SHEP
?? 447,921 (100) ??????????????????
31,960 (11.6) ????????????? ??????????? ?????????
4,736 (1.03) ?????????????????
17
of Pop
Men, genl pop
DM CVD CHF MI Angina
Wom., genl pop
Messerli et al, Arch Int Med, 1999
SHEP pop
18
????-???? ???????.!
??? ????
19
????-???? ???????.!
20
????????? ? ????????????? ?????? ??? ?
??????????? ??????? ??????? ???????

• 1.????????? ?????????? ????? ??????? ??????? ?
  ??????? ???????, ? ?? ? ???, ??? ???? ??? ??????
  ??????????

• 2. ????????????? ??????????? ?? ????????, ??
  ????????????? ??????????????? ???????

21
?? ??????? ? ??????????? ???????????????!
ACP J Club, Bandolier, POEMS, ???????????
??????????????, ???????????? ??????, ???????????
???????????
??????????? ?????????? ??????
22
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