他職種間コミュニケーションツールとしてのEbm勉強会　

• 1. EBM- 1 2012/1/22 33

2. 1989 1997 EBM 2001 EBM 2004 Center for EBM teaching EBMWorkshop22012/1/22 33 3. 2002 CASP Student CASP Workshop3 2012/1/22 33 4. 2001 3 4 20021 5 EBM12 20031 2 3 5 11 6 Evidence-Based Medicine & Nursing4 2012/1/22 33 5. 2004 1 7 11 112005 1 8 2006 1 9 7 115 2012/1/22 33 6. 20072 10 6 in 7 1 8 1 11 11 12 20081 OCA 2 5 27 2 8 12 6 2012/1/22 33 7. 20095EBM6EBM-Tokyo20101 29 12 1 72012/1/22 33 8. 20112 462 11 3 11 82012/1/22 33 9. EBM ?9 2012/1/22 33 10. What is EBM? Evidence-based medicine (EBM) requiresthe integration of the best researchevidence with our clinical expertise andour patient`s unique values andcircumstances EBM best research evidence 10 2012/1/22 33 11. Early model of the key elements for evidence-based clinical decisions 11 Evid Based Med 2002;7:36-38 doi:10.1136/ebm.7.2.362012/1/22 33 R Brian Haynes, MD, PhD 12. Step 1Step 2Step 3Step 4Step 52012/1/22 33 12 13. Five steps of EBMStep 1 converting the need for information intoan answerable questionStep 2 tracking down the best evidence with whichto answer that questionStep 3 critically appraising that evidence forits validity, impact, and applicabilityStep 4 integrating the critical appraisal withour clinical expertise and with our patient`sunique biology, values, and circumstancesStep 5 evaluating our effectiveness andefficiency in executing steps 1-4 and seekingways to improve them both for next time 2012/1/22 33 13 14. Step 1 of EBM need forConverting theinformation into ananswerable question142012/1/22 33 15. Step Background Questions Foreground Questions Background Questions Foreground Questions PECO2012/1/22 33 15 16. Step Background QuestionsAsk for general knowledge about a condition orthingHave two essential components1) Question root (Who, What, Where, When, How,Why) and a verb2) A disorder, test, treatment, or otheraspect of health careExample) How does heart failure cause ascites? What causes SARS?2012/1/22 33 16 17. Step Foreground QuestionsAsk for specific knowledge to informclinical decisions or actionsHave four essential components (PICO orPECO)1) Patient and/or Problem2) Intervention or exposure3) Comparison4) Clinical outcomes, including time2012/1/22 33 17 18. 2012/1/22 33 18 19. 1. 2. 3. 4. 5. 6. 7. 19 2012/1/22 33 20. EBM Step2 Tracking down the bestevidence with which toanswer thatquestion20 2012/1/22 33 21. EBM Step3 Criticallyappraising that evidencefor its validity, impact, andapplicability21 2012/1/22 33 22. EBM Step4 Integrating thecritical appraisalwithour clinical expertise andwith our patient`s uniquebiology, values, andcircumstances22 2012/1/22 33 23. EBM Step5 Evaluating our effectiveness andefficiency in executing steps 1-4and seeking ways to improve themboth for next time-23 2012/1/22 33 24. Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM Can you master EBM24 Can you master EBM 2012/1/22 33 Can you master EBM 25. EBMEBM 25 EBM2012/1/22 33 26. Teaching EBMEvidence Based Medicine meets Medical Education26 2012/1/22 33 27. EBM Small group learning Problem based learning Team-based learning Interprofessional education 27 2012/1/22 33 28. 28 2012/1/22 33 29. 29 Wikipedia 2012/1/22 33 30. 302012/1/22 33 31. 31 2012/1/22 33 32. 322012 l2012/1/22 33 33. NPO Sotobo World 332012/1/22 33 34. 34 2012/1/22 33 35. 35 2012/1/22 33 36. 362012/1/22 33 37. 37 2012/1/22 33 38. 38 2012/1/22 33 39. EBM 39 2012/1/22 33 40. 402012/1/22 33 41. EBMCenter for EBMhttp://www.cebm.net/ We offer a range of courses to clinicians and other healthcare professionals seeking to develop their EBM skills.Title: How to Practice Evidence-Based Health CareDuration: 3 daysDates: 26th-28th March 2012Venue: St Hughs College, Oxford, EnglandTitle: Teaching Evidence-based Practice WorkshopDuration: 5 daysDates: 3rd-7th September 2012Venue: St Hughs College, Oxford, England 412012/1/22 33 42. EBM 12 CASP JapanEBM OHPOCAOkayama Critical AppraisalHCAHiroshima Critical Appraisal EBM-Tokyo 15 42 2012/1/22 33 43. EBM Hiroshima Critical Appraisal (HCA) Okayama Critical Appraisal (OCA) OHP Workshop Student CASP Workshop EBM 43 2012/1/22 33 44. EBM EBM-Tokyo 44 2012/1/22 33 45. EBM EBM-Tokyo EBM EBM452012/1/22 33 46. EBM EBM-Tokyo 46 2012/1/22 33 47. Come ! This way!Student CASP WS47 2012/1/22 33 48. Student CASP Workshop Student48 2012/1/22 33 49. 20111113 3Student CASP 1230 13001320 13201500 SGL1 15001545 Feedback1 15451700 SGL2 1700Feedback(2) 1745 1800 49 2012/1/22 33 50. orA50 2012/1/22 33 51. A70 155cm 70kg 17kg 14 16 HbA1c 7.5130 180mg/dl51 2012/1/22 33 52. AHbA1c8.0 160mg/dl 52 2012/1/22 33 53. A 53 2012/1/22 33 54. PICOEBM Step1) PPatient IIntervention CComparison OOutcome54 2012/1/22 33 55. PICOStep1)P2 ICO 55 2012/1/22 33 56. Diabetes mellitus Cardiovascular death Insulin Randomized controlled trial Systematic review 56 2012/1/22 33 57. Effect of intensive glucose loweringtreatment on all cause mortality,cardiovascular death, andmicrovascular events in type 2diabetes: meta-analysis of randomisedcontrolled trialsRmy Boussageon et al.BMJ 2011;343:d416957 2012/1/22 33 58. 58 2012/1/22 33 59. All cause mortality? FavoursFavoursintensivestandard treatmenttreatment2012/1/22 33 59 60. Cardiovascular death?2012/1/22 33 60 61. CASP Japan RCT 61 2012/1/22 33 62. EBM Step 14 Good Patient Care 62 2012/1/22 33 63. Student CASP 632012/1/22 33 64. Student CASP WS CASP Japan homepage 64 2012/1/22 33 65. Q)WS EBM discussion SGLFB SGDSGD SGL 65 2012/1/22 33 66. Q)WS EBM 66 2012/1/22 33 67. Q)WS Small group discussionLarge group discussion Interprofessional education67 2012/1/22 33 68. EBM68 2012/1/22 33 69. EBM / 69 2012/1/22 33 70. EBM 10 70 2012/1/22 33 71. EBM OK! 71 2012/1/22 33 72. EBM 72 2012/1/22 33 73. 73 2012/1/22 33 74. EBM 74 2012/1/22 33 75. EBM EBM 75 2012/1/22 33 76. Can evidence-based medicine and clinical quality improvement learn from each other? Paul Glasziou,1 Greg Ogrinc,2 Steve Goodman BMJ Qual Saf 2011;20(Suppl 1)762012/1/22 33 77. EBMUP Can evidence-based medicine andclinical quality improvement learn from each other? BMJ Qual Saf 2011;20(Suppl 1) Paul Glasziou et al. 77 78. Can evidence-based medicine andclinical quality improvement learn fromeach other? BMJ Qual Saf 2011;20(Suppl 1) Paul Glasziou et al. 78 79. Early model of the key elements for evidence-based clinical decisions 79 Evid Based Med 2002;7:36-38 doi:10.1136/ebm.7.2.362012/1/22 33 R Brian Haynes, MD, PhD 80. QI processWork to apply the evidence to individual and systems of care1. What are we trying to accomplish? AIM 2. How will we know a change is an improvement? Measures 3. What changes can we make? Change management 80 2012/1/22 33 81. EBM 1. EBM 2. clinical quality improvement 3. 81 2012/1/22 33 82. Act Plan StudyDo EBM82 2012/1/22 33 83. EBM Systems of Care 83 2012/1/22 33 84. EBM 842012/1/22 33 85. 85 S11.5.26-H24.1.32012/1/22 33 86. 86 2012/1/22 33 87. Systems of Care ActPlan87 2012/1/22 33 Study Do 88. Systems of Care ActPlan88 2012/1/22 33 Study Do 89. ActPlan89 2012/1/22 33 Study Do 90. ActPlan90 2012/1/22 33 Study Do 91. ActPlan91 2012/1/22 33 Study Do 92. EBM92 2012/1/22 33 93. - P.F Drucker 93 2012/1/22 33 94. 94 2012/1/22 33