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راهنماهای طبابت بالینی Clinical Practice Guidelines

راهنماهای طبابت بالینی Clinical Practice Guidelines. هدایت سالاری دکترای تخصصی سیاستگذاری سلامت. مطالب. پزشکی مبتنی بر شواهد هرم شواهد طراحی سوال بالینی تعاریف و مفاهیم راهنماهای بالینی اهمیت و کاربرد راهنماهای بالینی چگونگی دستیابی به راهنماهای بالینی چگونگی استفاده از راهنماهای بالینی

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راهنماهای طبابت بالینی Clinical Practice Guidelines

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  1. راهنماهای طبابت بالینیClinical Practice Guidelines هدایت سالاری دکترای تخصصی سیاستگذاری سلامت salarihedayat@gmail.com

  2. مطالب salarihedayat@gmail.com پزشکی مبتنی بر شواهد هرم شواهد طراحی سوال بالینی تعاریف و مفاهیم راهنماهای بالینی اهمیت و کاربرد راهنماهای بالینی چگونگی دستیابی به راهنماهای بالینی چگونگی استفاده از راهنماهای بالینی چگونگی ارزیابی کیفیت راهنماهای بالینی و نقد آنها بومی سازی راهنماهای بالینی ابزارهای بومی سازی راهنماهای بالینی

  3. مقایسه تصاویر؟؟؟؟؟ salarihedayat@gmail.com

  4. What is evidence-based medicine? salarihedayat@gmail.com Evidence based medicine is the conscientious, explicit, andjudicious use of current best evidence in making decisions aboutthe care of individual patients. Sackett, et al. BMJ 1996;312:71-72

  5. salarihedayat@gmail.com “A 21st century clinician who cannot critically read a study is as unprepared as one who cannot take a blood pressure or examine the cardiovascular system.” BMJ 2008:337:704-705

  6. What is Evidence-Based Medicine? salarihedayat@gmail.com “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values”

  7. Clinical Expertise Research Evidence Patient Preferences EBM - What is it?

  8. Traditional medicine Experiences Pathophysiology, references,… Patient value

  9. Practice Pradigms Old paradigm Unsystematic clinical experience Pathophysiology expertise & authoritarianism New paradigm Systematic clinical experience Pathophysiology necessary but not sufficient Rules of evidence salarihedayat@gmail.com

  10. The 5 Steps Towards Evidence Based Practice salarihedayat@gmail.com 1. Ask the right clinical question: Formulate a searchable question 2. Collect the most relevant publications: Efficient Literature Searching Select the appropriate & relevant studies 3. Critically appraise and synthesize the evidence. 4. Integrate best evidence with personal clinical expertise, patient preferences and values: Applying the result to your clinical practice and patient. 5. Evaluate the practice decision or change: Evaluating the outcomes of the applied evidence in your practice or patient.

  11. Background questions: salarihedayat@gmail.com What microbial organisms can cause community-acquired pneumonia? How does pneumonia cause egophony? What is the incidence of community-acquired pneumonia?

  12. a.s salarihedayat@gmail.com Notice that the students’ questions ask for general or “background” knowledge about pneumonia, the disorder that presumably explains much of this patient’s acute illness.

  13. A practitioners’ questions: salarihedayat@gmail.com In this patient are any clinical findings sufficiently powerful to confirm or exclude pneumonia? In this patient is a chest radiograph necessary for the diagnosis? In this patient is the probability of Legionella infection sufficiently high to warrant considering covering this organism with the initial antibiotic choice? In this patient , do clinical features predict outcome well enough that as a “low risk” patient can be treated safely at home?

  14. salarihedayat@gmail.com Clinical questions generally fall into two categories: Background questions have to do with general information, the “lay of the land” of a certain medical topic, or just building one’s general fund of knowledge regarding a specific topic or condition or treatment. Foreground questions have to do with addressing a specific problem for a specific patient. It can be helpful to formulate “foreground” questions into the “PICO” format. Source: Huang X, Lin J, Demner-Fushman D. Evaluation of PICO as a knowledge representation for clinical questions. AMIA AnnuSymp Proc. 2006:359-63. PMID: 17238363

  15. Samples salarihedayat@gmail.com Intensive treatment in patients with type II diabetes does not decrease mortality. Intensive treatment can lower blood glucose levels in patients with type II diabetes

  16. Clinical Questions salarihedayat@gmail.com • Foreground – “What do I do for this patient?” • Patient • Intervention/Investigation • Comparison Intervention/Investigation • Outcome (Patient-Oriented)

  17. Question components : PICO • What types of Participants? • What types of Interventions? • What types of Comparison? • What types of Outcomes?

  18. Clinical Questions - “PICO” salarihedayat@gmail.com Example: In a 5 year old child with conjunctivitis (patient) will topical antibiotics (intervention) compared to no treatment (comparison) lead to quicker symptom relief (outcome)? In a 5 year old child with conjunctivitis (patient) will topical antibiotics (intervention) compared to no treatment (comparison) lead to improved cure rates (outcome)?

  19. Evidence-based medicine Evidence-based Medicine Gathering medical information Evaluating quality of medical information Making medical decisions using best evidence salarihedayat@gmail.com

  20. salarihedayat@gmail.com

  21. Levels of Evidence • Level 1: Randomized Clinical Trials • Level 2: Head to Head Trial or Systematic Review of Cohort Studies • Level 3: Case-Control Studies • Level 4: Case-series • Level 5: Expert Opinion salarihedayat@gmail.com

  22. Levels of Evidence salarihedayat@gmail.com Adapted from: Sackett DL et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Churchill Livingstone; 2000.

  23. CPG salarihedayat@gmail.com Clinical Practice guidelines have been defined as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. CLINICAL PRACTICE guidelines are being promoted as one strategy to assist clinical decision making to improve the effectiveness and reduce unnecessary costs of delivered health care services.

  24. انواع شواهد salarihedayat@gmail.com Primary evidence Secondary evidence Tertiary evidence (CPG)

  25. Concepts What makes a good guideline? • “Should provide extensive, critical and well-balanced information on the benefits and limitations of various interventions so that the practitioner can carefully judge individual cases” • Derived from: • Subcommittee of WHO. Summary of the 1993 WHO. • BMJ 1993; 307: 1541-1546 salarihedayat@gmail.com

  26. Guidelines Purpose • “To make explicit recommendations with a definite intent to influence what physicians do” salarihedayat@gmail.com

  27. GUIDELINE DEVELOPMENT PROCESS TOPIC SELECTION & SCOPE COMPOSITION OF THE GUIDELINE DEVELOPMENT GROUP Subject Groups Evidence Editing Review IDENTIFICATION & EVALUATION OF EVIDENCE FORMATION OF RECOMMENDATIONS & GRADING CONSULTATION &PEER REVIEW EDIT & PUBLICATION FORMULATION OF AUDIT & PEER REVIEW salarihedayat@gmail.com

  28. بومی سازی راهنماهای بالینی salarihedayat@gmail.com ADAPTE tool kit

  29. salarihedayat@gmail.com

  30. salarihedayat@gmail.com از حسن توجه شما سپاسگزارم

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