Definition of evidence-based medicine. The history of the development of

evidence-based medicine. World experience of development. Clinical epidemiology: definition, history

of development, the basic principles and methods of research.

Department of Health Policy and Management,
Associate Professor, Faculty, MD
Turdalieva Botagoz Saitovna

of the mind, is not reliable and therefore not a

true knowledge"
Abu Ali Ibn Sina,
"Danish - nama" ("Book of Knowledge").

of the best results of clinical trials for the treatment

of a specific patient selection. This is a new technology of gathering, critical analysis, synthesis and interpretation of scientific information.

"science"
not "epidemiology"
not "statistics",
not the way to research

V.V.Vlasov

Canadian researchers from McMaster University has proposed to integrate the

best research evidence with clinical expertise and the patient's individual preferences in a separate branch of medicine.
  This scientific and practical section provides an accessible, concise and objective information on the best and most reliable results of clinical trials conducted worldwide and objectively prove the benefits of a treatment or drug and was named the "Evidence-Based Medicine" (EBM).

More than 20,000 medical journals
Exchange of the information about

health is increasing with the development of the telecommunication networks: doubles every 2 years
Rapid obsolescence of knowledge
Inconsistency of the results and conclusions of clinical research

better than outstanding situation
To the assessment influence personal experience, our

knowledge, beliefs and preferences.
We find what we are looking for, and hear what we are waiting to hear, do not notice what you do not want to notice
You can never be sure that the recovery of the patient is due to this interference, and not a coincidence, or other reasons unknown to us
The number of observed patients are often too little to make far-reaching conclusions

is the knowledge we have lost in information?
                                            TS

Eliot

on a short story (anecdotal medicine)
Decision-making by clippings of

articles
Decision-making based on expert opinion (medicine based on celebrities)
Decision-making based on cost minimization

that you can find the answer
Identify the best based

information to answer these questions
Critically evaluate evidence-based information for validity and usefulness
Implement the results of this evaluation in clinical practice
Evaluate the results of the done work

effectiveness is well documented; while the expected harm is smaller

than the benefits;
Efficiency is assumed - the intervention of proven effectiveness is less convincing than the this interventions;

interventions doctor and patient must weigh the value of the

expected benefits and harms to the particular situation;
Efficiency is not installed - evidence of effectiveness is not enough, or they are not completely reliable;

convincing than for the following interventions;
Inefficiency or damage proved

- interference, inefficiency or damage which conclusively proved.

information technology, which allows you to receive evidence-based solutions for

the prevention, diagnosis, treatment of diseases and health organizations. The algorithm using evidence-based medicine is as follows:

- literature data in this research
Evaluation of scientific evidence

(confidence) and the usefulness of the information
Application in practice and / or distribution (publication) of the results obtained in three main areas: the development of clinical guidelines, formation of databases of systematic reviews of randomized controlled trials, the publication of specialized training and background paper and electronic journals, manuals, books and the Internet - resources

re-sharpening and the prognosis of the patient ?, or
What diagnostic

models are optimal for this pathology?, or
What is the efficiency or safety of different treatment options?

drugs
The use of antimicrobial agents (antibiotics, sulfonamides) in acute respiratory

viral infection treatment;
Parenteral administration of vitamin preparations with the purpose of auxiliary treatment of diseases of the internal organs;
Purpose means the metabolic correction of energy metabolism of ischemic myocardium and insufficient;
The use of so-called for the treatment of hepatic cirrhosis;
The use of clonidine and combined antihypertensive drugs in the early stages of treatment of hypertension;
Unwarranted use of infusion therapy for various diseases

for physicians in primary care (David Jewell)
Scrolling in which

flick through the pages in search of material;
Reading for information, search for the answer to a specific question, usually associated with an actual problem for the reader;
Reading - test that is carried out a targeted search for the formation of a comprehensive view of knowledge

discs or (www.cochrane.ru)
Internet DARE, MEDLINE www.ncbi.nlm.nih.gov/Entrez/medline.html, EMBASE
Publication in

the periodic medical press including "J. international medical practice", «Evidence-based medicine"

opened, which was named Cochrane and in the same year

John. Chalmers was organized by the Association of Cochran, which acts as a network of interconnected centers in different countries.
In the structure of the Association organized multidisciplinary teams for analysis and synthesis of a variety of clinical sections (eg, stroke), regions (eg, pediatrics), methodological approaches (eg, statistical methods). There is a department coordination of the various survey of interest groups and networks (eg, the consumer network).
The purpose of the Association: Based on an exhaustive register of all randomized clinical trials to prepare systematic reviews.
In September 29, 2009 established the Center for Evidence-Based Medicine on the basis of KazNMU.

National Library of Medicine, USA. It proindeksovano 4000 journals published

in more than 70 countries around the world, 3 versions available information:
Print (Index Medicus, hand pointer, which is updated every year, on the basis of which are electronic versions);
Online version (the whole database, since 1966., Accessible via the Internet);
CD - ROM (entire database consists of 10-18 discs depending on the manufacturer).
The Cochrane Library contains many hundreds of systematic reviews and hundreds of thousands of peer-reviewed abstracts of randomized trials kontrliruemyh. The Cochrane Collaboration has identified about 60,000 research incorrectly identified in Medline

science that develops methods of clinical studies that allow us

to make a fair conclusion of controlling the effect of systematic and random errors.
CE – it is a science that allows for prediction for each patient based on a study of the clinical course of the disease in similar cases by using rigorous scientific methods to study groups of patients to ensure the accuracy of weather forecasts.

methods of clinical observations that allow us to make fair

conclusions, avoiding the influence of systematic and random errors

diagnosis, prognosis and treatment outcomes for a particular patient is

not uniquely defined, and therefore must be expressed in terms of probabilities;
These probabilities for the individual patient is best assessed on the basis of previous experience gained in relation to the groups of similar patients;
Because clinical observations are carried out on the free in the behavior of patients and physicians make these observations with different skills and personal opinion, the results may be subject to systematic errors, leading to wrong conclusions;
Any observations, including clinical, influenced by chance;
To avoid false conclusions, doctors must rely on research based on scientific principles, using techniques to minimize systematic errors and random errors account

large group of people living in a particular geographic region

or have some indication.
Sample (sample) - part of the population, obtained by selection

the results from the true values

The most susceptible to

systematic errors are clinical studies (trust doctors certain drugs, emotions, behavior, individual characteristics of patients)

in the sample from the true values ​​in the population

Diseases studied in a sample of patients, and not the general population all individuals with the disease in question . Application of statistics helps minimize the random error by selection of optimal methods of investigation data Analysis

the extent to which the results are valid with respect

to the sample.
Generalizability (external validity, or generalizability) - external characteristic, which is determined by the extent to which the results of this study are applicable to other groups of patients.