Definition of evidence-based medicine The history of the

Definition of evidence-based medicine. The history of the development of evidence-based medicine. World experience of development. Clinical epidemiology: definition, history of development, the basic principles and methods of research. Department of Health Policy and Management, Associate Professor, Faculty, MD Turdalieva Botagoz Saitovna

". . . All knowledge, which is not weighed in the balance of the mind, is not reliable and therefore not a true knowledge" Abu Ali Ibn Sina, "Danish - nama" ("Book of Knowledge").

Evidence-based medicine - is fair, accurate and meaningful use of the best results of clinical trials for the treatment of a specific patient selection. This is a new technology of gathering, critical analysis, synthesis and interpretation of scientific information.

Evidence-based medicine it is a way of medical practice, but: not "science" not "epidemiology" not "statistics", not the way to research V. V. Vlasov

Terminology For the first time in 1990 by a group of Canadian researchers from Mc. Master University has proposed to integrate the best research evidence with clinical expertise and the patient's individual preferences in a separate branch of medicine. This scientific and practical section provides an accessible, concise and objective information on the best and most reliable results of clinical trials conducted worldwide and objectively prove the benefits of a treatment or drug and was named the "Evidence-Based Medicine" (EBM).

BACKGROUND of the EBM More than 4 million articles per year More than 20, 000 medical journals Exchange of the information about health is increasing with the development of the telecommunication networks: doubles every 2 years Rapid obsolescence of knowledge Inconsistency of the results and conclusions of clinical research

Background for use of evidence We are remember not typical cases better than outstanding situation To the assessment influence personal experience, our knowledge, beliefs and preferences. We find what we are looking for, and hear what we are waiting to hear, do notice what you do not want to notice You can never be sure that the recovery of the patient is due to this interference, and not a coincidence, or other reasons unknown to us The number of observed patients are often too little to make far-reaching conclusions

Where is the wisdom we have lost in knowledge, where is the knowledge we have lost in information? TS Eliot

Basic approaches of physicians in the decision (not EBM) Decision-making based on a short story (anecdotal medicine) Decision-making by clippings of articles Decision-making based on expert opinion (medicine based on celebrities) Decision-making based on cost minimization

Key aspects of EBM Translate the needs information into the questions that you can find the answer Identify the best based information to answer these questions Critically evaluate evidence-based information for validity and usefulness Implement the results of this evaluation in clinical practice Evaluate the results of the done work

Systems definition of evidence interventions: Effectiveness is proven - interventions whose effectiveness is well documented; while the expected harm is smaller than the benefits; Efficiency is assumed - the intervention of proven effectiveness is less convincing than the this interventions;

continued Advantages and disadvantages of comparable - before use of such interventions doctor and patient must weigh the value of the expected benefits and harms to the particular situation; Efficiency is not installed - evidence of effectiveness is not enough, or they are not completely reliable;

continued Efficiency is unlikely - the evidence of inefficiency intervention less convincing than for the following interventions; Inefficiency or damage proved - interference, inefficiency or damage which conclusively proved.

Algorithms use in EBM Evidence-based medicine – it is a medical information technology, which allows you to receive evidence-based solutions for the prevention, diagnosis, treatment of diseases and health organizations. The algorithm using evidence-based medicine is as follows:

4 steps to take action Formulation of the problem Seek information - literature data in this research Evaluation of scientific evidence (confidence) and the usefulness of the information Application in practice and / or distribution (publication) of the results obtained in three main areas: the development of clinical guidelines, formation of databases of systematic reviews of randomized controlled trials, the publication of specialized training and background paper and electronic journals, manuals, books and the Internet - resources

Step 1: Formulation of the problem What is the probability of re-sharpening and the prognosis of the patient ? , or What diagnostic models are optimal for this pathology? , or What is the efficiency or safety of different treatment options?

Examples of unreasonable traditional approaches to the use of common drugs The use of antimicrobial agents (antibiotics, sulfonamides) in acute respiratory viral infection treatment; Parenteral administration of vitamin preparations with the purpose of auxiliary treatment of diseases of the internal organs; Purpose means the metabolic correction of energy metabolism of ischemic myocardium and insufficient; The use of so-called for the treatment of hepatic cirrhosis; The use of clonidine and combined antihypertensive drugs in the early stages of treatment of hypertension; Unwarranted use of infusion therapy for various diseases

Step 2: Search for data on the problem 3 reading level for physicians in primary care (David Jewell) Scrolling in which flick through the pages in search of material; Reading for information, search for the answer to a specific question, usually associated with an actual problem for the reader; Reading - test that is carried out a targeted search for the formation of a comprehensive view of knowledge

Sources of scientific evidence The Cochrane Library database in Russia on discs or (www. cochrane. ru) Internet DARE, MEDLINE www. ncbi. nlm. nih. gov/Entrez/medline. html, EMBASE Publication in the periodic medical press including "J. international medical practice", «Evidence-based medicine"

EBM Kaz. NMU named after S. Asfendiyarov In 1992, the Oxford center was opened, which was named Cochrane and in the same year John. Chalmers was organized by the Association of Cochran, which acts as a network of interconnected centers in different countries. In the structure of the Association organized multidisciplinary teams for analysis and synthesis of a variety of clinical sections (eg, stroke), regions (eg, pediatrics), methodological approaches (eg, statistical methods). There is a department coordination of the various survey of interest groups and networks (eg, the consumer network). The purpose of the Association: Based on an exhaustive register of all randomized clinical trials to prepare systematic reviews. In September 29, 2009 established the Center for Evidence. Based Medicine on the basis of Kaz. NMU.

Basic base of EBM Database Medline: created and maintained by the National Library of Medicine, USA. It proindeksovano 4000 journals published in more than 70 countries around the world, 3 versions available information: Print (Index Medicus, hand pointer, which is updated every year, on the basis of which are electronic versions); Online version (the whole database, since 1966. , Accessible via the Internet); CD - ROM (entire database consists of 10 -18 discs depending on the manufacturer). The Cochrane Library contains many hundreds of systematic reviews and hundreds of thousands of peer-reviewed abstracts of randomized trials kontrliruemyh. The Cochrane Collaboration has identified about 60, 000 research incorrectly identified in Medline

Clinical Epidemiology Clinical epidemiology (clinical epidemiology) (CE) – it is a science that develops methods of clinical studies that allow us to make a fair conclusion of controlling the effect of systematic and random errors. CE – it is a science that allows for prediction for each patient based on a study of the clinical course of the disease in similar cases by using rigorous scientific methods to study groups of patients to ensure the accuracy of weather forecasts.

Clinical Epidemiology The purpose of CE - development and application of methods of clinical observations that allow us to make fair conclusions, avoiding the influence of systematic and random errors

The main provisions of Clinical Epidemiology In the most cases, the diagnosis, prognosis and treatment outcomes for a particular patient is not uniquely defined, and therefore must be expressed in terms of probabilities; These probabilities for the individual patient is best assessed on the basis of previous experience gained in relation to the groups of similar patients; Because clinical observations are carried out on the free in the behavior of patients and physicians make these observations with different skills and personal opinion, the results may be subject to systematic errors, leading to wrong conclusions; Any observations, including clinical, influenced by chance; To avoid false conclusions, doctors must rely on research based on scientific principles, using techniques to minimize systematic errors and random errors account

Basic principles Subject matter Question Deviation from the norm Healthy or sick patient Diagnosissubject The matter How accurate are the methods used for the diagnosis of the disease? Frequency How accurate are the methods used for the diagnosis of the disease? Risk What factors are associated with an increased risk of disease? Forecast What are the consequences of the disease? Treatment How to change the course of the disease in the treatment? Prevention Are there any measures to prevent the disease in healthy people? Is improved it if the disease in its early recognition and treatment? Reason What factors lead to the disease? What are its pathogenetic mechanisms? Price How much is the treatment of this disease cost?

Basic principles Clinical outcomes Death Bad outcome, if the death is premature Disease Set of symptoms, physical and laboratory data that deviate from the norm Discomfort Symptoms such as pain, nausea, shortness of breath, itching, tinnitus Inability to normal activities at home, at work, during leisure Disability Dicontent Emotional reaction to the disease and treatments, such as sadness or anger

basic principles quantitative Approach Population and sampling Population (population) - a large group of people living in a particular geographic region or have some indication. Sample (sample) - part of the population, obtained by selection

basic principles Systematic error (offset, bias) - the systematic deviation of the results from the true values The most susceptible to systematic errors are clinical studies (trust doctors certain drugs, emotions, behavior, individual characteristics of patients)

basic principles Random error - deviation of the result of observation in the sample from the true values in the population Diseases studied in a sample of patients, and not the general population all individuals with the disease in question. Application of statistics helps minimize the random error by selection of optimal methods of investigation data Analysis

basic principles The accuracy (internal validity) of research is defined by the extent to which the results are valid with respect to the sample. Generalizability (external validity, or generalizability) - external characteristic, which is determined by the extent to which the results of this study are applicable to other groups of patients.