EBM????????????

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EBM????????????
??????.??????

• ???
• ???????????? ?????? ????
• ??????
• ?? 2008/5/23 810-900
• clifchen_at_tmu.edu.tw
• http//www.wanfang.gov.tw/ebm  

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EBM???????
??????????????????????????? Knowledge
Translation (or KT)(????) describes either a
structured process or the activity that results
in scientifically researched evidence being used
to improve the outcomes of professional practice.
http//en.wikipedia.org/wiki/Knowledge_translati
on
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??????????? --from bench to bed (B2B 5S ,
7A)
7A
5S

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????????
Richard Grol Jeremy Grimshaw. From best evidence
to best practice Effective implementation of
change in patients' care. The Lancet Oct 11,
2003 362,9391. pg. 1225
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?????????
Richard Grol Jeremy Grimshaw. From best evidence
to best practice Effective implementation of
change in patients' care. The Lancet Oct 11,
2003 362,9391. pg. 1225
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(Burt Hing, 2005)
???CDC(Centers for Disease Control)2005????????,??
????CDSS???????????10
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Conclusion
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???????????When systematic reviews are not
available, clinicians need efficient strategies
for identifying relevant research

• Systematic Review
• Steps
• . Answerable Question
• .Search
• .Appraise 2
• .Synthesize
• Apply
• Time 6 months

• EBM
• Steps
• .Answerable Question
• .Search
• .Appraise
• Apply
• Time 6 minutes

???Paul Glasziou s lecture, 2006
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Doer or User???????

• Doer
• Clinical trial (???)
• Systematic review (???)
• Guideline development
• ? of us are Users only.

U
D
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EBM 3???
Knowledge gap
Knowing-doing gap
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????(1)???? (Asking An Answerable Question)
??????.??????
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Universal Doubt ---??? Rene Descartes
1596-1650

• I think therefore I am. (?????)
• Self-evident
• I
• Think doubt

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????????

• ?? ???? EBM Center
• 2007

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??????

• CVP??7???????

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Clinical bottom line

• Pulmonary and peripheral artery catheters need
  not be routinely replaced more often than every
  57 days
• Other short-term CVCs and arterial catheters need
  not be routinely replaced

• Safdar N, Kluger DM, Maki DG. A review of risk
  factors for catheter-related bloodstream
  infection caused by percutaneously inserted,
  noncuffed central venous catheters implications
  for preventive strategies. Medicine (Baltimore).
  2002 Nov81(6)466-79.

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reference

• Safdar N, Kluger DM, Maki DG. A review of risk
  factors for catheter-related bloodstream
  infection caused by percutaneously inserted,
  noncuffed central venous catheters implications
  for preventive strategies. Medicine (Baltimore).
  2002 Nov81(6)466-79.
• Single citation matcher (PubMed)

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appraisal

• Level Ib

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action
Action?????????
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????(2)???????
??????.??????
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Evidence Cart
-CEBM - Centre for Evidence Based Medicine
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• Mobile CDSS
• ?????

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Questions answerable by an EBM resource
Koonce TY, Giuse NB, Todd P. Evidence-based
databases versus primary medical literature an
in-house investigation on their optimal use. J
Med Libr Assoc. 2004 Oct92(4)407-11.
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???? ????Finding data Practice strategy

Slawson, 1994
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How EBM Helps CME?

• ????(push) ?????(??)????(just in case
  learning)
• SkolarMD
• MDConsult
• Cochrane databases
• ????(pull) ?????(??)????(just in time
  learning)
• Auto alert or MyNCBI
• Google ??

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POC (Point of Care) Searching
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????(3)?????
??????.??????
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???????
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????????
?????? ISO????
??????? FDB30004
????? FDB30005
????? FDB30006
????? FDB30007
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??????(clinical practice guideline)

• ?????????????,?????????????,???????????,??????????
  ???
• Systemically defined statements to assist
  practitioner and patient decisions about
  appropriate health care of specific
  circumstances.
• -------Institutes of
  Medicine, 1990

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Evolution of Evidence-Based Medicine
Opinion based Medicine
Physician Centered EBM
Patient Centered EBM

• Emphasize clinical evidence
• Focus on patient understanding
• Integrate physician experience with patient values

• Relies on memory
• Emphasizes experience

• Popularized since 1992
• Emphasize published clinical science
• Practitioner experience is important
• Acknowledge patient values

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???????????
??????.??????
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http//www.nhi.gov.tw/webdata/AttachFiles/Attach_6
13_1_CPG.pdf
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Clinical Epidemiology - ??????
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?????????????(Evidence-Based Medicine How to
Practice and Teach EBM with CD-ROM 3/e)

• ??? ??
• ???? 2007

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??????????

• ??? ?????
• ??? ??
• ???? 2007

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?????????? ???? ?????????? (2006)
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??????????http//ebpg.nhri.org.tw--???????
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????EBM?? Roundtable on Evidence-Based
Medicine, Institute of Medicine
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????

• ??????(IOM)? 2003?7????????????????5?????
• 1.????????? 2.??????????
• 3.???????????
• 4.??????
• 5.??????

--Health Professions Education A Bridge to
Quality, Institute of Medicine 2003
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Goal

• by the year 2020, ninety percent of clinical
  decisions will be supported by accurate, timely,
  and up-to-date clinical information, and will
  reflect the best available evidence.

                              
Released On    April 02, 2007
LeighAnne Olsen, Dara Aisner, and J. Michael
McGinnis, editors, Roundtable on Evidence-Based
Medicine. The Learning Healthcare System
Workshop Summary (IOM Roundtable on
Evidence-Based Medicine) (2007), p353
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What next?

• IOM?????????????????????????????????????
• A Learning Healthcare System??????????????????????
  ????????????????????

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?????????????????
(meta-analysis of seven trials)
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51 Cochrane Review Groups (CRGs)
26. Incontinence Group 27. Infectious Diseases
Group 28. Inflammatory Bowel Disease and
Functional Bowel Disorders Group 29 Injuries
Group 30. Lung Cancer Group 31. Menstrual
Disorders and Subfertility Group 32. Metabolic
and Endocrine Disorders Group 33. Methodology
Review Group 34. Movement Disorders Group 35.
Multiple Sclerosis Group 36. Musculoskeletal
Group 37. Neonatal Group 38. Neuromuscular
Disease Group 39. Oral Health Group 40. Pain,
Palliative and Supportive Care Group 41.
Peripheral Vascular Diseases Group 42. Pregnancy
and Childbirth Group 43. Prostatic Diseases and
Urologic Cancers Group 44. Renal Group 45.
Schizophrenia Group 46. Sexually Transmitted
Diseases Group 47. Skin Group 48. Stroke Group
49. Tobacco Addiction Group 50. Upper
Gastrointestinal and Pancreatic Diseases Group
51. Wounds Group
1.  Acute Respiratory Infections Group
2.  Airways Group 3.  Anaesthesia Group
4.  Back Group 5.  Bone, Joint and Muscle Trauma
Group 6.  Breast Cancer Group 7.  Childhood
Cancer Group 8.  Colorectal Cancer Group
9.  Consumers and Communication Group 10.Cystic
Fibrosis and Genetic Disorders Group 11.Dementia
and Cognitive Improvement Group 12.Depression,
Anxiety and Neurosis Group 13.Developmental,
Psychosocial and Learning Problems Group
14.Drugs and Alcohol Group 15.Ear, Nose and
Throat Disorders Group 16.Effective Practice and
Organisation of Care Group 17.Epilepsy Group
18.Eyes and Vision Group 19.Fertility
Regulation Group 20.Gynaecological Cancer Group
21.HIV/AIDS Group 22.Haematological
Malignancies Group 23.Heart Group
24.Hepato-Biliary Group 25.Hypertension Group
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Guidelines International Network (G-I-N)

• 2002???,????????????????
• ??32????76???????????GIN
• ????????95???????????,????????????,?????????????

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Bench Marks from our neighbourhood
-example of CPG development
Keeping up with the Joneses!
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??????_?CPG??

• ???????????(JCQHC)??,??2002?4???Minds????????

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35 CPGs on Minds
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???EBM??

• Natioanl health insurance
• NICE, SIGN
• Oxford University EBM curriculum
• Cochrane collaboration
• ????

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EBPG in WHO

• In 2005 the WHO asked its Advisory Committee on
  Health Research (ACHR) for advice on ways in
  which WHO can improve the use of research
  evidence in the development of recommendations,
  including guidelines and policies.
• The ACHR established the Subcommittee on the Use
  of Research Evidence (SURE) to collect background
  documentation and consult widely among WHO staff,
  international experts and end users of WHO
  recommendations to inform its advice to WHO.

Ref Andrew Oxman et al, Health Research Policy
and System, 2006, 412
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Guidelines International Network (G-I-N)

• ???2002?,??????????????????
• ??32????76???????????GIN?
• ??????????????????95???????????,????????????,?????
  ?????????

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??EBM???????

• ??????
• ?????????
• ?????????
• ??????????
• ????????
• ??EBM??????????
• ?????????????

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????????(Taiwan Evidence-Basded Medicine
Association, TEBMA) 2007?8?15?????

• -????-
• http//www.tebma.org.tw

???????????????
(?????????0960137058?)
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• ?????????2008???????9?20????????????????,?????????
  ??,????????????,?????????????????????????????????,
  ??????????????,??????,??????????,? 7?11????
• ????
• 1.??????(Evidence to Practice,E2P)
• 2.???????????(EBM health information
  technology)
• 3.???????????(Teaching and continuing education
  in EBM)
• 4.?????????(EBM/CPG legal consideration)
• 5.????????????(EBM in allied health professions)
• 6.????(Research,including appraisal,
  meta-analysis, systematic reviews)
• ????????????????http//www.tebma.org.tw

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???? Thank You !!!
????????????!

• ?????_at_ ????clifchen_at_ms1.hinet.net