临床问题的来源及提出技巧

2015-07-04 MedSci MedSci原创

一、如何提出可回答临床问题临床研究人员在进行临床实践和研究时，首先必须具有提出可回答的临床问题的能力。提出可回答的临床问题的重要性，可考虑从以下几个方面提出问题，见图1。图1 临床问题来源提出临床问题的注意事项临床医务人员首先应注意了解病人的治疗需求和喜好，从此点出发提出临床问题，使治疗决策与病人的喜好相一致。例如对龋病的治疗，有些病人特别强调美观，即使是磨牙的充填也要求用与牙齿同色

首先要提出明确的科研假设 hypothesis，例如：某种因素与某种疾病之间是否真正有病因学联系？研究方法可靠吗？是否受到了混杂因素的影响？可以提高诊断方法的敏感性与特异性吗？可以进一步提高药物治疗或其他医护治疗措施的临床效果吗？……科学研究实际上就是对科研假设的验证过程。在拟订科研计划时，要充分考虑实施课题的可行性 feasibility，例如是否考虑了医德问题並进行了妥善处理？有无足够的纳入对象？纳入对象的依从性有保证吗？现有的技术力量、仪器设备能够满足实验的要求吗？课题的完成有经费保证吗？課題能在预定时间内完成吗？要在可行性允许的条件下，确定科研设计方案，原则是首先选择论证强度最高的试验设计方案。例如，随机对照试验是论证强度最高的研究方式，而其次才是前赡性的观察研究，病例对照研究及断面调查研究论证强度较弱，叙述性研究论证强度最差。良好设计的实验研究如动物实验研究和实验室实验研究，是临床研究的先导和重要补充。无论设计如何严谨，科学试验中总会有误差，要在科研设计中充分体现这一个观点。因为变异（variability）是无处不在的，可以产生于任何种类研究方式，既有个体变异（indivi

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2016-05-03 jjzouyan

学习了，有用

74 0
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2015-09-18 xingcy

全面，对于写临床类文章有帮助。

102 0
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2015-09-18 xingcy

全面，对于写临床类文章有帮助。

104 0
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2015-08-06 hlycom3356

这些技巧很实用哦

108 0
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2015-08-06 hlycom3356

真的从中领悟了很多

124 0
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2015-08-06 hlycom3356

以前怎么没看到这样的文章呢

86 0
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2015-07-06 owlhealth

挺好的

61 0
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2015-07-06 owlhealth

挺好的

35 0
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2015-07-05 18619c0a62m

呵呵

66 0
[GetPortalCommentsPageByObjectIdResponse(id=83579, encodeId=12e9835e9ec, content=学习了，有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0d231626576, createdName=jjzouyan, createdTime=Tue May 03 07:39:00 CST 2016, time=2016-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=37007, encodeId=2b9b3e00754, content=全面，对于写临床类文章有帮助。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=18bb1631067, createdName=xingcy, createdTime=Fri Sep 18 12:31:00 CST 2015, time=2015-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=37008, encodeId=f0dc3e008ac, content=全面，对于写临床类文章有帮助。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=18bb1631067, createdName=xingcy, createdTime=Fri Sep 18 12:31:00 CST 2015, time=2015-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34740, encodeId=324934e40f6, content=这些技巧很实用哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 10:41:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34741, encodeId=e81134e4166, content=真的从中领悟了很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 10:41:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=34742, encodeId=5c4d34e4225, content=以前怎么没看到这样的文章呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Thu Aug 06 10:41:00 CST 2015, time=2015-08-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30879, encodeId=e8f9308e9a0, content=挺好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Jul 06 07:23:00 CST 2015, time=2015-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30880, encodeId=29303088068, content=挺好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Jul 06 07:23:00 CST 2015, time=2015-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30799, encodeId=50d830e992b, content=呵呵, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sun Jul 05 16:11:00 CST 2015, time=2015-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30800, encodeId=f1623080063, content=(^_^), beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12a31627589, createdName=18619c0a62m, createdTime=Sun Jul 05 16:11:00 CST 2015, time=2015-07-05, status=1, ipAttribution=)]
2015-07-05 18619c0a62m

(^_^)

67 0

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