Evidence-tushen magani. Cibiyar Evidence-Based Medicine. Principles of shaida-tushen magani

EBM wakiltar mafi kyau duka hadewa muhawara kimiyya da kuma na asibiti da kwarewa da haƙuri da bukatun. Yana da wani cikakken kuma m amfani da mafi kyau na zamani nasarori a aiwatar da shawarwari da magani na marasa lafiya. Yana amfani kawai wadanda muhawara da aka samu daga tsanaki reviews. Evidence-tushen magani ne asibiti dacewa da bincike, shan la'akari da bukatun na haƙuri. A sakamakon shaida ne AMINCI da kuma daidaito na ganewar asali gwaje-gwaje da kuma dubawa, muhimmancin kintace yi, yadda ya dace da kuma aminci daga cikin far, gyaran fuska da kuma rigakafin.

A labarin na

A 1940, na farko yi da ka (bazuwar rarraba) da karatunsa da yin amfani da kudi "streptomycin" a lura da tarin fuka da aka za'ayi. A 1962, {asar Amirka kwamitin, wanda sarrafa ingancin magunguna da kayayyakin abinci da aka gabatar da dokoki da nufin binciko sababbin iri na kwayoyi. Bayan shekara tara da wannan yaduwa Archi Kokran mooted game da rashin hujjojin kimiyya. Bayan shekaru uku da muka gano hilafa tsakanin ka'idar da yi. A marigayi 80 ta - farkon 90 ta janyo hankali na zuwa da bukatar tsanaki sake dubawa a asibiti wa'azi da shi. Domin da farko lokacin da kalmar "hujja-tushen magani" da aka samarwa a shekara ta 1988 da epidemiologists da clinicians waɗanda suka yi aiki a kasar Canada McMaster University. Archi Kokran ya ba da bayanin yadda za a gabatar da bincike da kwararru. Bugu da ƙari kuma, shi da gudummawar da cewa su sakamakon sun rarrabẽwa ga tattaunawa da kuma cikakken bincike. Cochran da abokan aiki, wanda ya kasance a cikin Burtaniya Medical Research Council, kokari sun yi ta kokarin domin ci gaba na zamani da shaida-tushen magani. Shi ne ya yi, a 1979, ya zo da ra'ayin cewa kimiyya bai isa ba m binciken na yi da ka sarrafawa gwaji. Cochran da aka kafa na farko Center for Evidence-Based Medicine, wanda aka mai suna bayan shi. Ya fara aiki a Oxford shekaru 10 da suka wuce. Akwai halin yanzu 15 irin cibiyoyin duniya. Su shiryar da aiki na kasa da kasa kungiyar masu bincike.

saukarwa

Akwai biyar matakan shaida-tushen magani:

1. Wata tambaya ga wanda akwai yiwuwar samun amsa.
2. Nemo mafi kyau tabbaci.
3. Kimanta da kafofin da bayanai.
4. La'akari da shaida dangane da asibiti gwaninta da haƙuri ta amfane shi.
5. Tantance yadda m da yin amfani da goyon bayan fasahar.

Principles of shaida-tushen magani. Samun mafi kyau shaida

Masana sun nemi shaida, bisa keywords: haƙuri, baki, kwatanta, sakamakon. Da farko, kana bukatar ka ci gaba zuwa din reviews da yi da ka sarrafawa gwaji domin su ne mafi m. Idan shaida an ba da shawarar a fara neman shaidar wani m matakin. Wadannan sun hada da binciken Gungu, "harka-iko" da sauransu.

M kima na shaida

Tare da wannan kima, za ka iya sanin yadda za a dogara da shaida samu da kuma sakamakon binciken. Don duba AMINCI da ka rarraba sarrafawa karatu, dole ne ka amsa wadannan tambayoyi:

1. Kada randomization da marasa lafiya da aka za'ayi?
2. Kada dukan marasa lafiya da shan kashi a cikin binciken kammala shi?
3. Ya akwai kasance wani bincike na marasa lafiya a cikin kungiyoyin wadda suka yi da ka?
4. Ya lura da "makafi" ga masu bincike da kuma marasa lafiya?
5. Shin, da kamance lura a cikin kungiyoyin kafin a fara binciken?
6. Kada wannan magani aka amfani, sai dai da matukin jirgi?

A cikin hali na ingantaccen bincike zai iya ci gaba da kimantawa da sakamakon.

bincike na ayyuka

Wannan kima ne tare da wadannan tambayoyi:

1. Abin da nake yi?
2. Ga abin da ya ke yi, abin da sakamakon da aka shirya za su sami?
3. Mene ne tabbacin da inganci da kuma aminci daga wannan aikin?
4. Shin akwai wani ma mafi alhẽri, mafi dace Hanyar cimma wannan manufa?

koyo damar

Don bincika muhawara da m bincike ne mafi ingancin, da clinician ya kamata da na zama dole gwaninta da kuma lokaci. Bugu da kari, zai iya yin amfani da mujallu a kan batun da sauran kimiyya wallafe-wallafe. Yana da amfani koma zuwa summary na shaida-tushen magani, harhada by sauran kwararru. Wannan na iya zama wani Cochrane database, da littafin M. Enkin, sauran adabi a cikin wannan yanki. Mun kuma bayar da shawarar da shirye-sanya ladabi, wanda aka shirya a kan tushen da shaida-tushen magani.

Lokaci-lokaci review na adabi

Al'ada hikima ce tsanani hujjojin kimiyya ne kawai karamin sashi na kiwon lafiya shisshigi. Shi ne game da 15%. Kowace rana, ma'aikata na magani a duniya ake bukata kafin su sami gagarumin sabuwar shaida bukata domin ya dace da kuma yadda ya kamata a lura da marasa lafiya. Don yin wannan, likitoci bukatar samun takamaiman bayani a cikin wannan profile. An shawarar amfani da likita adabi, wanda a halin yanzu shi ne sosai. Its adadin a shekarar 1970 ya ninka. Haka kuma, shi ne na girma kowace rana. Kowace shekara, Editorial jirgin buga game da 6000 articles a waɗannan wurare kamar yadda gynecology da cutukan. Domin dace da matakin na ilimi na zamani sau, likita ake bukata don karanta 20 articles a rana. Wani tambaya shi ne ko akwai a wannan lokaci, da ma'aikacin kiwon lafiya? Yana bukatar a yi la'akari da cewa da yawa daga cikin articles ba hadu har ma da mafi ƙarancin ma'aunansa na quality.

dace aiki

Sashe na daga likita da ilmi da aka gane erroneous ko aka rabu amfani da bayan shekaru biyar bayan wani dalibi graduating daga wata babbar ilimi ma'aikata. Gaskiya ne, shi ne ba a sani ba daidai da yadda da yawa. Books a kan magani za a iya kwatanta su da wani Jungle, kamar yadda qara sosai hanzari, akwai mutane da yawa "matattu itatuwa", "gizo-gizo" da "macizai", amma wani wuri a duk wannan dukiya.

Basic bayanai

Evidence-tushen magani ne wani tsarin kula da tsarin yanke hukunci. A wannan yanayin, da clinician yana amfani da mafi kyau muhawara da suke da samuwa, da kuma sana'a kwarewa. A yanke shawara aka dauka tare da haƙuri, shan la'akari da bukatun. Kowace rana, ma'aikata aiki a kiwon lafiya filin bukatar daban-daban na kafofin samun amsoshin tambayoyi maimaituwa. Alal misali, dalibai karatu a cikin wannan yanki bukatar asali bayanai, unifying da Sanadin cutar da kuma ta pathogenesis, halitta fasali da kuma sauran bayanai. Basic data kasance a daban-daban sciences. Wannan, musamman, Physiology, pathogenesis, Anatomy, etiology. Basic bayanai ne comparatively barga, shi ne a handbooks, litattafan, da sauran janar magunguna. Duk da haka, mafi likitoci bukatar amsa tambayoyin kai tsaye alaka da kula da haƙuri da magani. Ga wasu misalai na batutuwan da suka danganci zuwa cuta ko yanayin, amma ba mai da musamman zuwa asibiti yi:

• Wanda ke nufin ...?
• Mene ne otitis kafofin watsa labarai?
• Abin da kwayoyin da gudummawar da otitis kafofin watsa labarai?

Amsoshin tambayoyi na da irin wannan za a iya samu a litattafan, reference books da sauran kafofin.

Bayani a kan gudanar da marasa lafiya

Bayan na asali ilmi, likita yana bukatar bayanai na kai tsaye munasaba ga management na haƙuri, ganewar asali hanyoyin, magani da kuma hangen nesa. Yana hulda da al'amurran da suka shafi irin shaida-tushen magani. A key kalmomi a nan ne "da ganewar asali, magani, hangen nesa." Don samun sakamako mafi kyau da kuma mafi kyau martani wajibi ne a kirkiro da tambaya daidai.

asibiti misali

Za ka iya gani da liyafar "diethylstilbestrol" miyagun ƙwayoyi su hana rashin in mata. A dalilin da yin amfani da wannan kayan aiki ya yi aikin m katsewa na ciki. A wannan batun, rawar da estrogen a da miyagun ƙwayoyi a hana ashara an dauki ma'ana. Marasa lafiya da shan wannan magani, ciki, mafi yawa kiyaye. A 50 ta a sakamakon da shida wadanda ba yi da ka nazarin da aka tabbatar da rage yawan abortions a lokacin da gwamnati da miyagun ƙwayoyi "diethylstilbestrol." Har ila yau yana gudanar da biyar karatu, a lokacin da marasa lafiya da aka kasu kashi biyu kungiyoyin da bazuwar daukan samfur. Na farko ya da miyagun ƙwayoyi "diethylstilbestrol", na biyu - a placebo. Bisa ga sakamakon gwajin a mata yin amfani da wannan kayan aiki, rashin faru a 7% na lokuta. Ƙarshe na ciki a karo na biyu kungiyar ya 5%. Saboda wadannan sakamakon da aka samu hujja bayyananna cewa da miyagun ƙwayoyi ba da amfani. Amma, duk da wannan, ta yin amfani da har yanzu faruwa. Kafin shekarar 1970, suka bi da da miliyoyin mata. Evidence-tushen magani na bukatar ba kawai ake bukata karatu kayan a wani lokaci. Abu mai muhimmanci canza naka da kuma wasu 'ayyuka dangane da sabon bayani. Evidence-tushen magani na samar da abubuwan da ake bukata don wani haƙiƙa kima da tasiri na likita shisshigi, kazalika da sakamakon da aikace-aikace a asibiti yi. Hakika, yana da sauki ba, saboda a cikin search for shaida, kuma a cikin su rarraba da gabatarwar canje-canje, za a iya samu cikas cewa faruwa a ko'ina cikin tsari.

da samuwar ideas

Evidence-tushen magani ga kowa da kowa a duniya ne masu tasowa, a wani geometrical ci gaban. An fara tare da '90s, da tsawon da samuwar, da kuma a yau da yawan littattafai, forums da kuma cibiyoyin da wannan yankin da aka kiyasta a dubun, kuma yawan wallafe - da daruruwan. A 1997, 12, irin cibiyoyin sun samu tallafin for 5 shekaru daga US Agency siyasa, kimiyya da kiwon lafiya. Wadannan kungiyoyi da aka kafa a manyan jami'o'i da kuma cibiyoyin bincike a cikin daban-daban jihohi. Kara yawan cibiyoyin sosai na musamman batutuwa kamar yara da hankulansu kiwon lafiya, da taimako na farko da kuma sauran yankunan. Janar tunani don su ne su yi amfani da manufa na shaida a kowane matakin yanke shawara daga jama'a yanayin da shirin da kuma kawo karshen tare da nada mutum magani. A Rasha, cikin shahararrun kamfanoni suna located in St. Petersburg da kuma Moscow. Har ila yau daga saman damuwa da kuma asibitin shaida-tushen magani, Nizhnevartovsk. Institution qware a cikin ganewar asali, ilimin tsarin jijiyoyi, ilimin aikin likita na yara da kuma urology, andrology da gynecology, gastroenterology da ENT cututtuka.

HOA

Evidence-tushen magani ne Rasha Federation ne ma tasowa cikin sauri. A Rasha akwai Interregional al'umma condominiums. An samu rajista a 2003. Society of shaida-tushen magani ne na son rai ba riba jam'iyya. Yana aiki a karkashin Yarjejeniya. Babban ayyuka na condominiums:

1. Koyar da aikin hade da methodological matsaloli na ANNOBA da kuma na asibiti karatu systematics bayanai a filin daga kimiyya wallafe da kuma kimantawa na ilimin kididdiga data analysis.
2. A talla na sakamakon asali kimiyya gwaje-gwajen.
3. A gabatarwar da ci gaba a kiwon lafiya yi.
4. Jarrabawa da ingancin kimiyya wallafe, ladabi ga marasa lafiya da sauransu.
5. Sotsioepidemiologicheskie da ilimin halittu da aikin likita da bincike.

Da ka'idodin 'yan condominiums:

- yaduwar bincike-tushen bayanai game da kiwon lafiya da sa baki da kuma zabin ga saye da irin data;

- kaucewa daga sanarwar yi bayani, wanda ba a tabbatar ta hanyar kimiya.

- da'awarsu, na data kasance inconsistencies amfane shi.

Ma'aikata na kungiyar ne likitoci suka bi su da wadannan ka'idoji da kuma aiwatar da su a aikace. Don kwanan wata, a United 17 yankuna da kuma fiye da 300 mambobi. Shugaban da ofisoshin lardi ne sosai m likita da kuma harkokin kiwon lafiya.

Cibiyar Evidence-Based Medicine (Education, 14, St. Petersburg)

Yana aiki da makaman da takwas da safe har bakwai a dare, kuma yana da guda fitarwa, wanda da dama a ranar Lahadi. A arewa maso yamma Center for Evidence-Based Medicine samar da wani m kewayon ayyuka ga al'ummar jihar. Inda za ka iya samun shawara da magani daga likita da kunkuntar specialization, wuce dakin gwaje-gwaje ganowa, colposcopy, duban dan tayi, tausa hanya. Evidence-Based Medicine Cibiyar ma aikin kullum saka idanu na ECG + jini. Duk ma'aikatan aiki a ma'aikata ne sosai m likitoci. Northwest Center for Evidence-Based Medicine ƙware a cututtuka kamar:

- osteochondrosis, aggravated vertebral Cervicalgia, discogenic radiculitis da lumbodynia.

- matsawa neuropathy, ischemic, wanda shi ne wani alama na numbness a cikin yatsunsu.

- deforming osteoarthrosis a matakai daban-daban (a matsayin magani amfani medikametoznye kawancen amfani hyaluronic acid);

- pathological cuta na tendons kuma jijiyoyin (tendovaginitah, enthesopathies da sauransu).

- Pathology na hadin gwiwa capsules, "dinga" a kan duga-dugansa.

A na biyu sanannun cibiyoyi na St. Petersburg

Cibiyar Evidence-Based Medicine (Lenin 88) gudanar daga takwas da safe har guda takwas a dare. Mun kafa ne ayi a wani gini a kan na farko bene. Modern kayan aiki, babban matakin sabis, m hanyoyin da ganewar asali - wannan ba wani cikakken jerin abũbuwan amfãni cewa Center for Evidence-Based Medicine. Reviews na da yawa marasa lafiya nuna cewa nan kowane baƙo za a bai iyakar da hankali. Ra'ayi da aka bayyana ga ingancin sabis. Za ka iya nema da taimako na wannan masana a matsayin likitan mata da kuma wata gastroenterologist, a neurologist da internist, likitan zuciyar da ophthalmologist, endocrinologist, urologist, da sauransu. A asibitin yayi shaida-tushen magani da kuma bincikowa a cikin Lab, rike duban dan tayi, echocardiography, kalposkopii, tausa, electrocardiography. Manyan likita na ma'aikata nada oncologist Beynusov Dmitriy Sergeevich. gwajin sakamakon za a iya samu ta hanyar kira ko karbar su a cikin mail. Bugu da kari ga likita cibiyar, da ayyukan kwararru ya shafi ma, zuwa ga birnin asibiti. Medical shawara halin kaka 1200 rubles.