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首页> 外文期刊>Journal of risk research >Science and proven experience: a Swedish variety of evidence-based medicine and a way to better risk analysis?
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Science and proven experience: a Swedish variety of evidence-based medicine and a way to better risk analysis?

机译：科学和经过验证的经验：瑞典各种循证医学和一种更好的风险分析的方式？

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A key question for evidence-based medicine (EBM) is how best to model the way in which EBM should '[integrate] individual clinical expertise and the best external evidence'. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems when it comes to risk analysis, which is here understood as a decision procedure comprising a factual assessment of risk, the risk assessment, and the decision what to do based on this assessment, the risk management. Both the early and updated models of evidence-based clinical decisions presented in the writings of Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research together with information about patients' values and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation (a component usually based on evidence from clinical research) and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making, professional risk-taking and practice to be in accordance with 'science and proven experience' (VBE). In the paper, we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. How scientific evidence and clinical experience is integrated influences both the way we do risk assessment and risk management. In addition, the paper sketches the as yet unexplored historical background to VBE and EBM.
机译：基于证据的药物（EBM）的关键问题是如何最好地建模EBM应该“[整合]个人临床专业知识和最佳外部证据'。我们认为，当今文献中可用的配方和模型对共同主题进行了适度的变化，并且在风险分析方面存在非常相似的问题，这在这里被理解为包括对风险的事实评估，风险评估的决定程序，以及根据本评估，风险管理做些什么。在Haynes，Devereaux和Guyatt的着作中提出的基于证据的临床决策的早期和更新模型，也认为EBM包括与临床研究的证据以及患者价值观和临床专业知识的信息。在这个视图上，EBM描述了在特定合理的医学决策中进行的所有内容。然而，eBM的替代解释是EBM的eBM，其中EBM仅描述决策情况的一个组成部分（通常基于来自临床研究的证据的组分），其中，以及其他类型的证据，EBM导致正当的幻想决定，但没有描述决定本身。这项B视图受到100岁较旧版EBM的启发，瑞典标准需要医疗决策，专业风险和练习符合“科学和经过验证的经验”（VBE）。在论文中，我们概述了瑞典概念如何改善对科学证据和临床经验的方式的理解，并且不能依据EBM。科学证据和临床经验如何融入风险评估和风险管理的方式。此外，纸张草图尚未开发的历史背景为VBE和EBM。

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