Bài giảng Bài 1: Dẫn nhập y hoc (EBM) /y tế công cộng (EBPH) dựa vào chứng cứ

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.
Nội dung trích xuất từ tài liệu:
Bài giảng Bài 1: Dẫn nhập y hoc (EBM) /y tế công cộng (EBPH) dựa vào chứng cứ 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 Decision Making Clinical Expertise Patient Preference Qui trình y học chứng cứ / y tế công cộng Patients Ask Questions Appraise Searching Validity Results Applicability 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 What’s the difference between foreground and background questions? Asking the Precise Question • Background questions • Foreground questions • Basic aspect of a • Specific knowledge disease • Have 4 parts: • Pathophysiology •Patient/problem • Etiology • Basic treatment •Intervention •Comparison • Who, what, when, how intervention •Clinical outcomes Background or Foreground? • What is asthma? • Is prednisone helpful in asthma? • What are the newest medication 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 foreground vs. background questions • Formulate 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 of interest Formulating the Clinical Question PICO Comparison Patient Intervention Outcome (if relevant) In patients with does the use of compared with lead to a asthma discharged both inhaled and oral steroids reduction in home from the oral corticosteroids alone asthma relapse? emergency department Can You Identify PICO? • In children under 6 months, how does sleeping on back compared to sleeping on the stomach in terms of risk of SIDS? • In children under 6 months (P), 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? ...