『EBMの道具箱』を読んで
『EBMの道具箱』を読んで
EBMとは、scienceとartが出会う場所
■STEP1 臨床的な疑問を解答可能な形であげる
patient
intervention
comparison
outcome
■STEP2 最善のevidenceをみつける
■STEP3 Evidenceを吟味する
妥当性? 重要? 有用?
■STEP4 診療に関わる決断
目の前の患者の役に立つのか?
患者の価値観や目的に合うか?
費用対効果は?
■STEP5 振り返り
次回以降に生かすには?
●カテゴリー
・病因 aetiology → 症例対照研究・コホート
・診断 diagnosis → 診断法検証
・予後 prognosis → 発端コホート
・費用対効果 → 経済分析
・QOL → 質的研究
●最初に探すといい情報源
Trip database http://www.tripdatabase.com/
EBM online http://ebm.bmj.com/
clinical evidence http://www.clinicalevidence.com/
cochrane library http://www.thecochranelibrary.com/
●ガイドライン
英国国立健康図書館 http://www.library.nhs.uk/
英国国立保健臨床評価研究所 http://nice.org.uk/
スコットランド大学連合ガイドラインネット http://sign.ac.uk/
カナダ医師会インフォベース http://mdm.ca/cpgsnew/cpgs/index.asp
ニュージーランドガイドライングループ http://nzgg.org.nz/
米国ガイドライン情報センター http://www.guideline.gov/]
●critical appraised topic
Maker http://www.cebm.net/cats.asp
Crawler http://www.bii.a-star.edu.sg/research/mig/cat.asp
●Hearlth technology assessment
http://www.ncchta.org/
●害・効果の吟味
・疑問は明確?(母集団・暴露・検証したいアウトカム)
・2つの患者群は明確に定義?
・両群とも同じ方法で測定?
・追跡は十分?
●治療方法の吟味
・定義は明確?
・ランダム化されている?
・ITT?
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