该内容转自黄教授的博客：急诊急救循证医学/医学新知的临床转化

2007年11月号的《Academic Emergency Medicine》(AEM)罕见的以全册内容讨论了急诊医学范畴内循证医学证据、医学进展与新知向临床实践转化的问题。本册内容的背景是—— May 15, 2007, Academic Emergency Medicine sponsored a consensus conference with a goal of establishing a research agenda for the specialty of emergency medicine (EM), aimed at facilitating knowledge translation (KT)。

这是一个非常非常值得关注的现象，这意味着美国急诊医学会也将和当年美国的危重医学学会一样，有通过组织编撰“基于循证的临床诊治指南”甚至创立所谓的“***运动”的端倪，其目的无疑是要带动整个行业实践模式的转换和整体水平的提高——本册内容显然就是这个目的，不过显得更为高明一点—— 由于急诊科室的特殊性，人员和设备的短缺导致相关专业进展难以在急诊室得到有效普及，或者被斥之为加剧资源调配紧张，也使从业人员对新指南或新的临床证据依从性不足。现在看来，急诊医务工作者将医学新知转化为临床实践的重要性远比单纯循证进展的继续教育重要得多。本册内容就是对症下药，强调了前者的重要性，并请来多位在急诊室开展过相关研究的作者现身说法，比如我们之前提到的Nguyen，另外一位就是Jones，这两个作者都是将早期目标治疗（EGDT）用于急诊室的先驱，他们的想法与动机实在是值得我们认真学习！

从另外一个角度来看，“急诊监护化”的趋势越来越明显，重症监护医学与急诊医学的交叉性恐怕会越来越大。以早期目标治疗(EGDT)为例，当初Rivers创立该方案是在监护内，但是现在的趋势是在急诊室推广EGDT显然更能突出“早期”的内涵，对提高患者生存率的价值更有意义（患者进入ICU后才开始EGDT恐怕为时过晚）。因此本册《Academic Emergency Medicine》可以说是急诊医学开始全方位提高整体医疗实践水平呼声的一种反映和尝试，我们拭目以待国内国际下一步的相关动态。

COMMENTARIES:

Executive Summary: Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake

Eddy S. Lang, Peter C. Wyer, and Barnet Eskin
Acad Emerg Med 2007 14: 915-918; published online before print October 8 2007, 10.1197/j.aem.2007.07.005 [Full Text] [PDF]  

 

The Development of the Academic Emergency Medicine Consensus Conference Project on Knowledge Translation

Eddy S. Lang, Peter C. Wyer, Barnet Eskin, Christos Tselios, Marc Afilalo, and James G. Adams
Acad Emerg Med 2007 14: 919-923. [Full Text] [PDF]  

 

The Knowledge Translation Paradigm: Historical, Philosophical, and Practice Perspectives

Jerris R. Hedges
Acad Emerg Med 2007 14: 924-927; published online before print August 17 2007, 10.1197/j.aem.2007.06.016 [Full Text] [PDF]  

 

Responsiveness to Change: A Quality Indicator for Assessment of Knowledge Translation Systems

Peter C. Wyer
Acad Emerg Med 2007 14: 928-931; published online before print August 13 2007, 10.1197/j.aem.2007.06.013 [Full Text] [PDF]  

 

CONFERENCE PRESENTATIONS:

Keynote Address: Closing the Research-to-practice Gap in Emergency Medicine

Carolyn M. Clancy
Acad Emerg Med 2007 14: 932-935; published online before print October 4 2007, 10.1197/j.aem.2007.06.028 [Abstract] [Full Text] [PDF]  

 

Some Theoretical Underpinnings of Knowledge Translation

Ian D. Graham, Jacqueline Tetroe KT Theories Research Group
Acad Emerg Med 2007 14: 936-941. [Abstract] [Full Text] [PDF]  

 

Decision Support Technology in Knowledge Translation

Brian R. Holroyd, Michael J. Bullard, Timothy A.D. Graham, and Brian H. Rowe
Acad Emerg Med 2007 14: 942-948; published online before print August 31 2007, 10.1197/j.aem.2007.06.023 [Abstract] [Full Text] [PDF]  

 

Guideline Implementation Research: Exploring the Gap between Evidence and Practice in the CRUSADE Quality Improvement Initiative

Andra L. Blomkalns, Matthew T. Roe, Eric D. Peterson, E. Magnus Ohman, Elizabeth S. Fraulo, and W. Brian Gibler
Acad Emerg Med 2007 14: 949-954. [Abstract] [Full Text] [PDF] [Appendix A] [Figure 7]   

 

Implementation of Clinical Decision Rules in the Emergency Department

Ian G. Stiell and Carol Bennett
Acad Emerg Med 2007 14: 955-959; published online before print October 8 2007, 10.1197/j.aem.2007.06.039 [Abstract] [Full Text] [PDF]  

 

Evidence-based Reviews and Databases: Are They Worth the Effort? Developing Evidence Summaries for Emergency Medicine

Peter C. Wyer and Brian H. Rowe
Acad Emerg Med 2007 14: 960-964; published online before print August 29 2007, 10.1197/j.aem.2007.06.011 [Abstract] [Full Text] [PDF]  

 

Funding Opportunities in Knowledge Translation: Review of the AHRQ's "Translating Research into Practice" Initiatives, Competing Funding Agencies, and Strategies for Success

Michael Handrigan and Jean Slutsky
Acad Emerg Med 2007 14: 965-967. [Abstract] [Full Text] [PDF]  

 

Bridging the Gap between Clinical Research and Knowledge Translation in Pediatric Emergency Medicine

Lisa Hartling, Shannon Scott-Findlay, David Johnson, Martin Osmond, Amy Plint, Jeremy Grimshaw, Terry P. Klassen Canadian Institutes for Health Research Team in Pediatric Emergency Medicine
Acad Emerg Med 2007 14: 968-977. [Abstract] [Full Text] [PDF]  

 

CONSENSUS WORKSHOP SESSIONS:

Development of the Capacity Necessary to Perform and Promote Knowledge Translation Research in Emergency Medicine

Peter S. Dayan, Martin Osmond, Nathan Kuppermann, Eddy Lang, Terry Klassen, David Johnson, Sharon Strauss, Erik Hess, Sandra Schneider, Marc Afilalo, and Martin Pusic
Acad Emerg Med 2007 14: 978-983. [Abstract] [Full Text] [PDF]  

 

Cognitive and Social Issues in Emergency Medicine Knowledge Translation: A Research Agenda

Jamie C. Brehaut, Robert Hamm, Sumit Majumdar, Frank Papa, Alison Lott, and Eddy Lang
Acad Emerg Med 2007 14: 984-990; published online before print September 24 2007, 10.1197/j.aem.2007.06.025 [Abstract] [Full Text] [PDF] [Appendix A: Search Strategy]   

 

Knowledge Translation Consensus Conference: Research Methods

Scott Compton, Eddy Lang, Thomas M. Richardson, Erik Hess, Jeffrey Green, William Meurer, Rachel Stanley, Robert Dunne, Shannon Scott-Findlay, Rahul K. Khare, and Jeremy Grimshaw
Acad Emerg Med 2007 14: 991-995. [Abstract] [Full Text] [PDF]  

 

Informatics and Knowledge Translation

Michael J. Bullard, Stephen D. Emond, Tim A.D. Graham, Kendall Ho, and Brian R. Holroyd
Acad Emerg Med 2007 14: 996-1002. [Abstract] [Full Text] [PDF]  

 

The Emergency Physician and Knowledge Transfer: Continuing Medical Education, Continuing Professional Development, and Self-improvement

Barbara J. Kilian, Louis S. Binder, and Julian Marsden
Acad Emerg Med 2007 14: 1003-1007. [Abstract] [Full Text] [PDF]  

 

Graduate Medical Education and Knowledge Translation: Role Models, Information Pipelines, and Practice Change Thresholds

Barry M. Diner, Christopher R. Carpenter, Tara O'Connell, Peter Pang, Michael D. Brown, Rawle A. Seupaul, James J. Celentano, Dan Mayer KT-CC Theme IIIa Members
Acad Emerg Med 2007 14: 1008-1014. [Abstract] [Full Text] [PDF]  

 

Toward Improved Implementation of Evidence-based Clinical Algorithms: Clinical Practice Guidelines, Clinical Decision Rules, and Clinical Pathways

Gary M. Gaddis, Peter Greenwald, and Sue Huckson
Acad Emerg Med 2007 14: 1015-1022. [Abstract] [Full Text] [PDF]  

 

Effective Synthesized/preappraised Evidence Formats in Emergency Medicine and the Use of Supplemental Knowledge Translation Techniques

Brian H. Rowe, Barry Diner, Carlos A. Camargo, Jr., Andrew Worster, Antoinette Colacone, Peter C. Wyer Knowledge Translation-Consensus Conference Theme Ib Members
Acad Emerg Med 2007 14: 1023-1029. [Abstract] [Full Text] [PDF]  

 

The Use of Health Care Policy to Facilitate Evidence-based Knowledge Translation in Emergency Medicine

Charlene B. Irvin, Marc Afilalo, Scott C. Sherman, Steven J. Stack, Sue Huckson, Amy Kaji, and Barnet Eskin
Acad Emerg Med 2007 14: 1030-1035; published online before print August 31 2007, 10.1197/j.aem.2007.06.022 [Abstract] [Full Text] [PDF]  

 

Public Health Considerations in Knowledge Translation in the Emergency Department

Steven L. Bernstein, Edward Bernstein, Edwin D. Boudreaux, Charlene Babcock-Irvin, Michael J. Mello, Atul K. Kapur, Bruce M. Becker, Richard Sattin, Victor Cohen, and Gail D'Onofrio
Acad Emerg Med 2007 14: 1036-1041; published online before print August 15 2007, 10.1197/j.aem.2007.06.012 [Abstract] [Full Text] [PDF]  

 

Knowledge Translation at the Macro Level: Legal and Ethical Considerations

Gregory Luke Larkin, Cara J. Hamann, Edward P. Monico, Linda Degutis, Jeremiah Schuur, Walter Kantor, and Charles S. Graffeo
Acad Emerg Med 2007 14: 1042-1046. [Abstract] [Full Text] [PDF]  

 

Knowledge Translation in International Emergency Medical Care

L. Kristian Arnold, Hisham Alomran, V. Anantharaman, Pinchas Halpern, Mark Hauswald, Pia Malmquist, Elizabeth Molyneux, Bishan Rajapakse, Megan Ranney, and Junaid Razzak
Acad Emerg Med 2007 14: 1047-1051. [Abstract] [Full Text] [PDF]  

 

Knowledge Translation in the Emergency Medical Services: A Research Agenda for Advancing Prehospital Care

David C. Cone
Acad Emerg Med 2007 14: 1052-1057; published online before print August 29 2007, 10.1197/j.aem.2007.06.014 [Abstract] [Full Text] [PDF]  

 

ORIGINAL CONTRIBUTIONS:

Closing Evidence to Practice Gaps in Emergency Care: The Australian Experience

Susan Huckson and Jan Davies
Acad Emerg Med 2007 14: 1058-1063; published online before print August 17 2007, 10.1197/j.aem.2007.06.015 [Abstract] [Full Text] [PDF]  

 

Qualitative Data Collection and Analysis Methods: The INSTINCT Trial

William J. Meurer, Shirley M. Frederiksen, Jennifer J. Majersik, Lingling Zhang, Annette Sandretto, and Phillip A. Scott
Acad Emerg Med 2007 14: 1064-1071; published online before print July 24 2007, 10.1197/j.aem.2007.05.005 [Abstract] [Full Text] [PDF] [Data Supplement]   

 

Implementing Early Goal-directed Therapy in the Emergency Setting: The Challenges and Experiences of Translating Research Innovations into Clinical Reality in Academic and Community Settings

Alan E. Jones, Nathan I. Shapiro, and Michael Roshon
Acad Emerg Med 2007 14: 1072-1078; published online before print July 13 2007, 10.1197/j.aem.2007.04.014 [Abstract] [Full Text] [PDF]  

 

The Utility of a Quality Improvement Bundle in Bridging the Gap between Research and Standard Care in the Management of Severe Sepsis and Septic Shock in the Emergency Department

H. Bryant Nguyen, Elizabeth Lea Lynch, Joshua A. Mou, Kristopher Lyon, William A. Wittlake, and Stephen W. Corbett
Acad Emerg Med 2007 14: 1079-1086; published online before print October 8 2007, 10.1197/j.aem.2007.06.024 [Abstract] [Full Text] [PDF]  

 

Diffusion of Medical Progress: Early Spinal Immobilization in the Emergency Department

Mark Hauswald and Darren Braude
Acad Emerg Med 2007 14: 1087-1089; published online before print July 12 2007, 10.1197/j.aem.2007.04.020 [Abstract] [Full Text] [PDF]  

 

Knowledge Translation of the American College of Emergency Physicians Clinical Policy on Hypertension

Jill F. Lehrmann, Paula Tanabe, Brigitte M. Baumann, Molly K. Jones, Zoran Martinovich, and James G. Adams
Acad Emerg Med 2007 14: 1090-1096; published online before print September 26 2007, 10.1197/j.aem.2007.05.016 [Abstract] [Full Text] [PDF]  

 

Impact of Human Factor Design on the Use of order Sets in the Treatment of Congestive Heart Failure

Stewart Reingold and Erik Kulstad
Acad Emerg Med 2007 14: 1097-1105; published online before print August 10 2007, 10.1197/j.aem.2007.05.006 [Abstract] [Full Text] [PDF] [Emergency Department CHF Standing orders]   

 

Barriers to Metered-dose Inhaler/spacer Use in Canadian Pediatric Emergency Departments: A National Survey

Martin H. Osmond, Madlen Gazarian, Richard L. Henry, Tammy J. Clifford, Jennifer Tetzlaff PERC Spacer Study Group
Acad Emerg Med 2007 14: 1106-1113; published online before print August 15 2007, 10.1197/j.aem.2007.05.009 [Abstract] [Full Text] [PDF]  

 

Implementation of an Emergency Department–based Transient Ischemic Attack Clinical Pathway: A Pilot Study in Knowledge Translation

Michael D. Brown, Mathew J. Reeves, Ted Glynn, Arshad Majid, and Rashmi U. Kothari
Acad Emerg Med 2007 14: 1114-1119; published online before print June 28 2007, 10.1197/j.aem.2007.04.019 [Abstract] [Full Text] [PDF] [TIA Clinical Pathway]   

 

CONSENSUS CONFERENCE PARTICIPANTS:

2007 Consensus Conference Participants

Acad Emerg Med 2007 14: 1120-1123. [Full Text] [PDF]