Kanita dayali Tip

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Kanita dayali Tip

• The Cochrane Collaboration

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Kanita dayali Tip
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McMaster UniversityCanada

• 1980lerde Sackett, Haynes, Tugwell
• kritik degerlendirme kitap/makale/raporlarda
  hatalar
• Kanita dayali Tip Çalisma Grubu
• 1990larda Gordon Guyatt EBM KDT ismini koydu

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KDTBir Tanim

• The conscientious, explicit, and judicious
  application of current best evidence in making
  decisions about the care of individual patients.
• Hasta bakimi hakkinda karar verirken güncel en
  iyi kanitin dürüst, açik ve tedbirli sekilde
  uygulanmasi

Kararlari kim verir?
(Sackett 1995)
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KDTBir ek tanim

• The integration of best research evidence with
  clinical expertise and patient values.
• En iyi arastirma kanitlari ile klinik tecrübe ve
  hasta degerlerinin entegrasyonu

Hasta degerleri/seçimleri
(Sackett 2000)
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Kanit
Hasta Seçimi
EBM ÜÇLÜSÜ
Klinik teshis
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Biz Kimiz?
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Archie Cochrane
Iain Chalmers
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The Cochrane Collaboration

• 1992de kuruldu
• 80 ülkede 15,000 kisi
• 51 Ortak Inceleme Gruplari
• 12 Merkez, Alanlar, Metod Gruplari ve
• Cochrane Tüketici Agi
• Cochrane Sekreterligi Oxford UK

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Cochrane Collaboration
Ortak Inceleme Gruplari
Merkezler
Yönetim Grubu
Metod Gruplari
Alanlar
Tüketici Agi
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Biz neredeyiz?
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COUNTRIES IN WHICH INDIVIDUALS ARE CONTRIBUTING
TO THE COCHRANE COLLABORATION
Represented in 2000, 2002 2003 Represented in
2002 2003 Represented in 2003
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Biz ne yapariz?
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The Cochrane Collaboration is an international
organisation that aims to help people make
well-informed decisions about healthcare.KOKREY
N Ortakligi saglik konusunda insanlarin
bilgilendirilmis kararlar almasina yardimci
olmayi hedefleyen uluslar arasi bir
organizasyondur
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by preparing, maintaining and promoting the
accessibility of systematic reviews of the
effects of healthcare interventions saglik
müdahalelerinin etkilerinin sistematik
incelemelerini hazirlanmasini, düzenlenmesini ve
kolay erisimin için yayilmasini saglayarak
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The Cochrane Collaborationa neden gereksinim
vardir?
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Kanit
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Kanit önemlidirNeden?

• In 10yrs 50 of what you have been taught will
  have been shown to be wrong
• only problem is which 50?
• 10 yil içinde size ögretilenlerin 50sinin
  yanlis oldugu gösterilecek
• Tek problem hangi 50?
• Burwell
• Dean of Harvard Medical School 1950

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Kanit
Hasta Seçimi
KDT ÜÇLÜSÜ
Klinik teshis
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(No Transcript)
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Yaptigimiz isi nasil yapariz?
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Kanit hiyerarsisi
Systematic Review of RCTs

• Randomised Controlled Trials
  
• Non Randomised Controlled studies
  
• Non Controlled Studies
  
• Case Studies
  

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RCT
RCT
SYSTEMATIC REVIEW
RCT
RCT
Meta-analysis
STRONGER EVIDENCE
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Hangi konulari kapsariz?
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• Acute Respiratory Infection
• Airways
• Anaesthesia
• Back
• Breast Cancer
• Colorectal Cancer
• Consumers and Communication
• Cystic Fibrosis and Genetic Disorders
• Dementia and Cognitive Impairment
• Depression, Anxiety and Neurosis
• Developmental, Psychosocial Learning Problems
• Drugs and Alcohol

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• Ear, Nose and Throat Disorders
• Effective Practice and Organization of Care
• Epilepsy
• Eyes and Vision
• Fertility Regulation
• Gynaecological Cancer
• Haematological Malignancy
• Heart
• Hepato-Biliary
• HIV/AIDS
• Hypertension
• Incontinence

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• Infectious Diseases
• Inflammatory Bowel Disease
• Injuries
• Lung Cancer
• Menstrual Disorders and Infertility
• Metabolic and Endocrine Disorders
• Methodology Review Group
• Movement Disorders
• Multiple Sclerosis
• Musculoskeletal
• Musculoskeletal Injuries
• Neonatal
• Neuromuscular Disease

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• Oral Health
• Pain, Palliative and Supportive Care
• Peripheral Vascular Diseases
• Pregnancy and Childbirth Group
• Prostatic Diseases and Urological Cancers
• Renal
• Schizophrenia
• Sexually Transmitted Diseases
• Skin
• Stroke
• Tobacco Addiction
• Upper Gastrointestinal and Pancreatic Diseases
• Wounds

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Cochrane Fields

• Cancer
• Child Health
• Complementary medicine
• Health care of older people
• Health promotion and public health
• Neurology
• Primary Health Care
• Rehabilitation and related therapies
• Vaccines

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Kanitlarimizi nerde bulursunuz?
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WHAT IS THE COCHRANE LIBRARY
The Cochrane Library is the single most reliable
source for evidence on the effects of health
care.
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Who benefits from The Cochrane Library?

• Health professionals at all levels, health
  researchers, health policy makers, care givers,
  the pharmaceutical industry, and patients.

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How can The Cochrane Collaborationinform
healthcare decision making?
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How can The Cochrane Collaborationinfluence
healthcare decision making?
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ROFECOXIB FOR RHEUMATOID ARTHRITISGarner S,
Fidan D, Frankish R, Judd M, Towheed T, Wells G,
Tugwell PDate of most recent amendment 10 May
2002Date of most recent substantive amendment
27 May 2002

• Reviewers' conclusions
• In patients with RA, rofecoxib demonstrates a
  greater degree of efficacy than placebo, while
  having a comparable safety profile. Rofecoxib
  demonstrates a similar degree of efficacy as
  naproxen, but with a significantly lower rate of
  ulceration and gastrointestinal bleeding.
  Rofecoxib was associated with a greater risk for
  MI, but the exact significance and
  pathophysiology of this possible relationship is
  unclear

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Thank you
Tesekkür ederim
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Any Questions?