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Bài giảng Bài 1: Dẫn nhập y hoc (EBM) y tế công cộng (EBPH) dựa vào chứng cứ trình bày tầm quan trọng của y học chứng cứ; khái niệm y học chứng cứ; phân biệt foreground với background questions; đặt câu hỏi dạng PICO; tìm nguồn tư liệu; giá trị của một bào báo khoa học y học;...Mời bạn đọc cùng tham khảo.
BÀI 1. DẪN NHẬP Y HOC ( EBM) / Y TẾ CÔNG CỘNG ( EBPH) DỰA VÀO CHỨNG CỨ GS TS BS LÊ HOÀNG NINH Nội dung cốt lõi • Tại sao y hoc chứng cứ là quan trọng • Y học chứng cứ là gì ? • Phân biệt foreground vs. background questions • Đặt câu hỏi dạng PICO • Tìm nguồn tư liệu • Giá trị của một bào báo khoa học y học / sức khoẻ • Đánh giá các dạng bài báo : can thiệp điều trị / dự phòng; chẩn đoán/ sàng lọc; nguyên nhân… Tại sao EBM là quan trọng? • MEDLINE – 400,000 new entries added each year • To keep up-to-date – Need to read 6,000 articles each day Tại sao EBM là quan trọng? sự chậm trễ “ từ lúc biết cho tới lúc áp dụng” – 13 years for thrombolytic therapy – 10 years for corticosteroids for acceleration of fetal lung maturity (Antman EM, JAMA, 1992) Traditional Approaches Self-reported reading time per week. (University setting) – Medical students 60 min. – Interns none – Senior residents 10 min. – Fellows 45 min. – Attendings graduating • Post 1975 60 min. • Pre 1975 30 min. There is simply no way we can keep up to date in medicine using traditional approaches! Nội dung cốt lõi • Why is EBM important? • What is EBM? • Understand foreground vs. background questions • Formulate PICO questions • Find resources, do searches • Validity of an article • Appraise “Therapy” articles • Appraise “Diagnostic” articles Research Evidence Clinical Expertise Patient Preference Decision Making Qui trình y học chứng cứ / y tế công cộng Patients Ask Questions SearchingAppraise Validity Results Applicability [...]... To assess the accuracy of the test • Cohort study To assess effect of test on health outcome • Randomized controlled trial Prognosis •Longitudinal cohort Etiology/Risk factors • Randomized controlled trial • Cohort • Case-control Pre-appraised Resources • Cochrane – http://www.cochrane.org/cochrane/revabstr/mainindex.htm – Very high quality reviews – Mostly questions of therapy • National Guideline... of varying levels of quality – Do broad searches • PEM database – http://researchinpem.homestead.com/homepage.html – Not pre-appraised Pre-appraised Resources • Best Evidence Topics – http://www.bestbets.org – Developed in the ED of Manchester Royal Infirmary in UK – Usually EM topics – Free • Clinical Evidence (CE Concise) – http://www.clinicalevidence.com – From UK – Focus mostly on therapy – Free... Why is EBM important? • What is EBM • Understand foreground vs background questions • Formulate PICO questions • Find resources, do searches • Validity of an article • Appraise “Therapy” articles • Appraise “Diagnostic” articles What’s the difference between foreground and background questions? Asking the Precise Question • Background questions • Basic aspect of a disease • Pathophysiology • Etiology... hospitalization (O)? Nội dung cốt lõi • Why is EBM important? • What is EBM • Understand foreground vs background questions • Formulate PICO questions • Find resources, do searches • Validity of an article • Appraise “Therapy” articles • Appraise “Diagnostic” articles Searching Superhero Best Bets The Evidence Pyramid If your question is about… Look for a … Intervention/Therapy • Randomized controlled trial... Free Primary Search Engines • Pubmed • Ovid What is MEDLINE? • MEDLINE is a DATABASE • MEDLINE is produced by the National Library of Medicine • MEDLINE is available free via Pubmed • MEDLINE is sold to many vendors, like Ovid, who search the DATA in MEDLINE through different search engines PubMed: Clinical Queries • Pre-filtered searching • Search on questions of – Therapy – Diagnosis – Etiology – Prognosis... for asthma? • Does atrovent used acutely make you feel better? Background or Foreground? • What is asthma? (B) • What are the newest medication for asthma? (B) • Does atrovent used acutely make you feel better? (F) • Is prednisone helpful in asthma? (F or B) • Foreground if compare to other drugs • Background if interested in how it works Nội dung cốt lõi • Why is EBM important? • What is EBM • Understand... PICO questions • Find resources, do searches • Validity of an article • Appraise “Therapy” articles • Appraise “Diagnostic” articles Structure of a Well-built Question • Patient or population • Be specific to capture the group you want • Ex: Children w/ asthma • Intervention • Be specific • Comparison group (if any) • Compare to standard therapy or test • Outcome • Be precise • What are the outcome... through different search engines PubMed: Clinical Queries • Pre-filtered searching • Search on questions of – Therapy – Diagnosis – Etiology – Prognosis Limit any of the categories to sensitivity (broad) or specificity (narrow) • Or, search for Systematic Reviews ... how does sleeping on back (I) compared to sleeping on the stomach (C) in terms of risk of SIDS (O)? Can You Form a PICO Question? Clinical scenario: 5 yo with moderate persistent asthma now in severe acute asthma exacerbation Intern gave 2 albuterol and orapred with minimal improvement Intern asks why how good is atrovent? Searchable PICO Question P: Population I: Intervention/diagnostic test/risk factor... Formulating the Clinical Question PICO Patient In patients with asthma discharged home from the emergency department Intervention does the use of both inhaled and oral corticosteroids Comparison (if relevant) compared with oral steroids alone Outcome lead to a reduction in asthma relapse? Can You Identify PICO? • In children under 6 months, how does sleeping on back compared to sleeping on the stomach . BÀI 1. DẪN NHẬP Y HOC ( EBM) / Y TẾ CÔNG CỘNG ( EBPH) DỰA VÀO CHỨNG CỨ GS TS BS LÊ HOÀNG NINH Nội dung cốt lõi • Tại sao y hoc chứng cứ là quan trọng • Y học chứng cứ là gì ? •. Preference Decision Making Qui trình y học chứng cứ / y tế công cộng Patients Ask Questions SearchingAppraise Validity Results Applicability Nội dung cốt lõi • Why is EBM important? • What is EBM •. each day Tại sao EBM là quan trọng? sự chậm trễ “ từ lúc biết cho tới lúc áp dụng” – 13 years for thrombolytic therapy – 10 years for corticosteroids for acceleration of fetal lung maturity (Antman