02.01.

2015

MedicinbazatpedoveziWikipedia

Medicinbazatpedovezi
DelaWikipedia,enciclopedialiber

Medicinabazatpedovezi(acr.MBD,nenglezEvidencebasedmedicineEBM),esteoconcepiemedicalaprutprinanii70'aisecoluluitrecut,
caresusinecmedicinatrebuiesseconcentrezepeobiectivitate,pedovezi,pemetaanaliz,pefolosireametodic,algoritmic,atotalitiiramurilor
medicinei(epidemiologie,genetic,biostatistic,informaticmedical,medicinexploratividelaboratorprompt,precisidecalitate,etc.)
considerndraportulcosteficien,subuncontroldecalitaterigurosipermanent,mediculconsultatfiindfactorulfrontalalunuilarggrupdespecialiti,
cucaresegseteninterreacie.SpredeosebiredeMBD,medicinaclasic,deductiv(englezOpinionBasedMedicineOBM)estebazatpebagajul
decunotineacumulatdinstudiileiexperienapersonl,petradiionalaarsmedicae(artamedical),peintuiiapersonalaclinicianului.

Cuprins
1Istoric
2MedicinabazatpedovezinRomnia
3MetodologiaMedicineiBazatepeDovezi
3.1Exploziadeinformaie
3.2Alegereadatelorrelevantedinpublicaiicontradictorii.
3.3Asigurareacalitiiserviciilormedicale
3.3.1Fiamedical(dosarulmedical)
3.3.2Organizareasanitar,raportulcosteficien,controluldecalitate
4Vezii
5Referine
6Bibliografie
7Legturiexterne
8Vezii

Istoric
Prin1975,MinisterulSntiiCanadianamobilizatogrupdespecialiti,(TheCanadianTaskForce)cumenireascompundirectivetiinificei
unitaredeexaminaresanitarperiodicapopulaiei.Pentruoapreciereobiectivaprodusuluifinal,aniveluluidevaliditateideevidenaactivitii
preventive,doidintrespecialiti,SuzanneFletcheriDavidSackettaucreat"niveledeeviden"(levelsofevidence)destinatesfoloseascca"gradede
recomandare"(Gradesofrecommendations),criteriideaciunencadrulrespectivelordirective[1].
Caprimpas,ideea"gradelorderecomandare"astatlabazapropunerilorpentrustandardizareamedicaieiantitrombotice[2][3]Ulterior,aceastmetoda
luatamploare,iantritbazeleteoreticeiaduslaapariiauneinoigeneraiidemanuale(evidencebasedtextbooks),ndreptare,ghiduriaxatepe
medicinabazatpeeviden,adic,laapariiauneinoierenmedicin,careveneasonlocuiascpecea"clasic",deductiv,(opinionbasedmadicine).
Nouaconcepiedeiincipientaveaoorientareterapeuticpreventivsarspnditntoateramurilecercetrilor,informaticii,educaieiiprecticii
medicale:ncardiologie(EvidenceBasedCardiology)[4],nmedicinadelaborator(EvidenceBasedLaboratoryMedicine),nasistenamedical
(EvidenceBasedNursing)[5],npsihiatrie(EvidenceBasedMentalHelth)[6],nmedicinageneral(EvidenceBasedHealthCare)[7],nobstetrici
ginecologie(EvidenceBasedObstetricsandGynecology)[8],etc.FacultiledemedicindinOccidentifacuntitludeonoaredininiiereadecentrede
MBDcuscopuldepropagareideevoluareanoilormetodeidecreereanoindreptare,algoritmi(guidelines)pentruanarmaclinicianulcuinstrumente
carelpotscoatedinimpasullipseidecertitudine[9][10][11][12][13][14][15]Acestecentreioferserviciilegratuitsaucontrauneicontribuiimodicefie,din
bibliotecadedatefie,nlegturinterneticdirect,ladispoziiaorganizaiilormedicaledinlumeiamediculuiparticular.

MedicinabazatpedovezinRomnia
nRomnia,M.B.D.ncepesfieluatnconsideraieodatcureorganizareaserviciilormedicaledinultimiianiiapariiadeliteraturdespecialitaten
limbaromn[16][17].
PrimulproiectndomeniulMBDafostiniiatdedr.MariusMrgineanlaInstitutuldeSntatePublicTimioaran1998,proiectfinanatdeFundaia
pentruoSocietateDeschisaluiGeorgeSoros.CuaceastocazieafosttraduslucrareaprofesoruluiSackettiacolaboratorilor[18].Deasemenea,aufost
derulate2workshopuriculectoridelaEBMCentredinOxfordsiCASPInternational,atelierelacareauparticipat20demediciromani.Ulterior,
programesimilareaufostderulateprinCentruldePoliticisiServiciideSntate,CentrulNationaldeStudiipentruMedicinaFamiliei(CNSMF)siScoala
NationaladeSntatePubliciManagementSanitar.CNSMFadezvoltatocurriculaisuportdecurspentru12moduledepregatirenMBDievaluarea
criticaliteraturiimedicale.
CentrulNaionaldeStudiipentruMedicinaFamilieiaelaboratncadrulproiectuluiQualyMed(20022005)ometodologiedeelaborareaghidurilor
(http://www.ghidurimedicale.ro/index.php?option=com_content&task=view&id=19&Itemid=27&Itemid=48)medicalebazatepedovezi,aliniatala
modeleleeuropene,metodologiecareaservitlaelaborareaa5ghiduridepracticpentrumediciidefamilie[19].

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MetodologiaMedicineiBazatepeDovezi
Exploziadeinformaie
Mediculdocticontiincios,fideljurmntuluihippocraticvadepunetoateeforturilepentruaiajutapacientuluisirecapetesntatea.Inacestscopelse
vafolosidetoateinstrumentelepecareorganizaiamedicaldecareaparineileconfer,delastetoscopipnladiagnosticulimaginal,etc.Elesteobligat
decontiinidelegesfiebineicurentinformatcuultimelepublicaiilegatedecazulpecarelexamineaz.Listaprescurtrilortitlurilorpresei
medicaledin1948[20])cuprindeacam4700detitluri.n1990,respectivalistcuprindeadeja,peste100000detitluri!Denotatc,dupspecialitiin
informatic,90%dinrealizriletiinificemajoreauaprutnnumai150dinacestnoiandejurnale.Cumpoateclinicianulsfacfaacesteiexploziide
informaie?

Alegereadatelorrelevantedinpublicaiicontradictorii.
Presamedicalconineomulimedepublicaiialeunorcercetriprivindfenomeneasemntoarentreelesau,chiaridentice,curezultatediferite,careduc
laconcluziidiferite,adesea,contradictorii.Revistelemedicalesentrecntreeleprinexclusivitatea,severitatea,minuiozitateacontroluluiunuiarticol,de
ctreceimaimarispecialitinmaterie,pniaprobpublicarea.Aceastverificareianconsideraierenumeleautorilor,poziialoracademic,publicaii
anterioare,renumeleinstitutuluiundesaufcutcerecetrile,etc.deci,difereneledintrerezultatederegulnusdatorateartefactelorsau,
profesionalismuluilimitatalautorilor.Cumpoateclinicianulsajunglaconcluziacorect?
nmarilecentreuniversitare,specialitininformaticamedicalindiferiteleramuridespecialitatestudiazirecenzeazarticoleleaprute,leapreciaz
validitatea,redndulecompactizatsau,intercalatenndreptare,algoritmi,nreeteledelucru.PrestigiosuljurnalmedicalJAMA(TheJournalofthe
AmericanMedicalAssociation),mpreuncugrupuldelucruMBD(englezEvidenceBasedWorkingGroup)alUniversitaiidinNorthCarolinaCentrul
deEvidenaSntiiaupublicatnanii90'oseriedeghiduripentruliteraturamedical("Users'GuidestotheMedicalLiterature")[21][22]specializaten
diagnostic[23][24],etiologie[25],prognoz[26],etiologie[25],terapie[27][28],evaluareadeeviden[21][22],etc.

Asigurareacalitiiserviciilormedicale
FacultateadeMedicinaUnivesitiiAlberta,n"Introducerenmedicinabazatpedovezi"(IntroductiontoEvidenceBasedMedicine[11]ofercteva
"reete"care,luateseparat,fiecareneparelogicielementar,aproapetrivialdar,luatempreun,cametodpermanentdegndireipracticne
transferpeterenulnoualMBD.
Practicamedicineibazatepeevidencuprindeurmtoarelecomponente:
Identificareaproblemeisauazoneidedubiu,delipsdecertitudine.
Depusnumaintrebrirelevante,concentratepesubiect,coherente,ntrunlimbajclaripeneles,lacarepacientulpoatesrspund.Greutatea
deaformulaontrebareclinicprecis,centralizatpoateconstituiunimpedimentmajornMBD.
Deselectatresurselecelemaipotrivitedecercetare(spreexemplu,deevitatpescuitul,fishingul,comandareauneiinfinitideexamenede
laboratornsperanacvaapareunrezultatpozitiv).
Decercetatievideniatfonduldeeviden(dovezile,faptele).
Apreciereaimportaneicliniceafaptelor,aevidenii.
Apreciereaaplicabilitiicliniceaevidenii.
Deacionatideaplicatevidena.
Deapreciatavantajeleefortuluidepus.
Deadunat,deconspectatidenotatactivitateapentruaofolosinviitor.
Fiamedical(dosarulmedical)
Esteunuldininstrumenteleprincipalealeclinicianului.Pacientulnuarevoiesfieo"apariiespontan"nfaamedicului.Elareoistoriecarecuprinde
bolianterioareiprezente,malformaii,dateheredocolaterale,profesionale,socioeconomice,medicaiiadministrateirspunsullaacestemedicaii,
dinamicarezultateloranalizelordelaboratorefectuatedealungulanilor,etc.Toateacestedate,secreteiaparinnddedreptiexclusivpacientuluisau
tutoreluisucumestecazultrebuespoatfiprezentatelanevoie,cadruluimedicalcompetent,ntruntimpminim,"ndirect"(online),clarei
complete.Dosareleprfuitedinarhiveleunuispitalsaupoliclinici,debordnddefoiiformularescriseindescifrabilsuntdeofolosinlimitatlafaa
loculuiitotalnefolositoareladistan.Calculatorulracordatlaoreeactmailarg,cuundepozitinformaticmareibinentreinutadevenitinstrumentul
celmaiimportantpemasamedicului.
Unuldinrezultatelebeneficeimediatealeuneifiemedicaleunificatevafidepistareapromptiposibiladispariieaunorbolilegatedevecheabirocraiea
sistemuluimedical,ca:sindromulMnchausen,sindromulMnchausenbyproxy,sindromulUlise,etc.
Articolprincipal:SindromulMnchausen.
Articolprincipal:SindromulUlise.
Organizareasanitar,raportulcosteficien,controluldecalitate
Fondurileafectateserviciilormedicale,ntoatlumeailatoatenivelelesuntlimitate,elelimitndicantitatea,calitateaifacilitateadeabordarea
instrumentelordindotareaclinicianului.
Unelementimportantalmedicineibazatepedoveziesteraportulcosteficien,folosireaneleaptaresurselorinclusivbugetarencadrulunei
organizaiieficiente,economice,clditpecriteriitiinifice.
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Instituiilepentruacordaredeasistenmedicaltrebuesicreezegrupedespecialiticumisiuneadeaacordaasistenimediatmediculuideprim
linie,rspectiv,ndrumare,sugeraredealgoritmirelevani,aprobareasau,refuzuldeaaprobaunoranalize,medicamente(prescriereaunoranumite
antibioticetrebuiecondiionatdetestedelaboratorrelevanteideaprobareaunuispecialistnboliinfecioase),hospitalizri,etc.medicinabazatpe
dovezipretindesigurareaunorconductelargideinformaie,accesulliberlaliteraturadespecialitateinternetic("PubMed","MEDILINE")ilacentrede
informatic(GIDEONMotordeepidemiologieibolitransmisibile),posibilitateadeconsultextemporaneucualispecialiti,pnlanivelelecelemai
nalte,controluldecalitateprinceereadecriteriipentruurmrireaiapreciereafielormedicale,spreexemplu,studiereacurbelordedistribuieafolosirii
anlizelordelaborator,aprescrieriidemedicamente,aapelriilainterventiichirurgicaleobstetricelaanumitepopulaii,etc.,pentrucamediciicarese
plaseazlapoalelecurbeigausicespoatfitrimeilacursuridespecializare,controlaiiindrumaimaiintensiv,nfunciedecaz.
Folosireaneleaptaacestorinstrumenteducelacretereacalitiiserviciuluimedicalacordatattdectremediculcareaparineuneiorganizaiimedicale
largictidectremediculautonom,izolatlaperiferie,ncabinetulpropriu.

Vezii
Medicinaintegrativ

Referine
1. ^ en SackettD.:EvidencebasedMedicineWhatitisandwhatitisn't,1994[1](http://www.minervation.com)accesat:18inuarie2013
2. ^ en SackettD.:Rulesofevidenceandclinicalrecommendationsonuseofantithromboticagents,Chest,1986,89:suppl2,3.
3. ^ en CookDJ,GuyattGH,LaupacisA,SackettD,GoldbergRJ.:Clinicalrecommendationsusinglevelsofevidenceforantithromboticagents,
Chest,1995,108:suppl227230(4suplimente).
4. ^ en YusufS,CairnsJA,CammAJ,FallenEL,GershBJ.:EvidenceBasedCardiology,BMJPublGroup,London,1998.
5. ^ en EvidenceBasedNursingapublicationofRoyalCollegeofNursing,BMJPublGroup,1977
6. ^ en EvidenceBasedMentalHealth,http://www.bmjpg.com
7. ^ en JournalofEvidenceBasedHealthCare,edChurchillLivingstone,2000.
8. ^ en EvidenceBasedObstetricsandGynecology,edChurchillLivingstone,2000,http://www.harcourtinternational.com
9. ^ en OxfordCentreforEvidenceBasedMedicine,http://www.cebm.net
10. ^ en Univ.ofIllinois,Chicago,LibraryoftheHealthSciencesPeoria,EvidenceBasedMedicine,
http://www.uic.edu/dets/lib/lhsp/resources/ebm.shtml
11. ^ab en TheUniversityofAlberta,http://www.ebm.med.ualberta.ca/intro.htm
12. ^ en TheCanadianCentreforHealthEvidence,http://www.cche.net/
13. ^ en MountSinaiHospital,CentreforEvidenceBasedMedicine,http://www.cebm.utoronto.ca
14. ^ en HealthSciencesLibrary,Univ.ofNorthCarolina:IntroductiontoEvidenceBasedMedicine,http://www.hsl.unc.edu/
15. ^ en DukeUniversity,MedicalCenter,tutorial,http://www.mclibrary.duke.edu/
16. ^Bicu,C.:Dictionardeepidemiologieclinicasimedicinabazatapedovezi.Ed.Medicala,2002
http://www.dol.ro/Produse/Carti/Stiinte/Dictionar_de_epidemiologie_clinica_si_medicina_bazata_pe_dovezi_Baicus_Cristian_YME00012/index.asp
17. ^BicuC.:Medicinabazatpedovezi.Cumnelegemstudiile.Ed.Medical,2007http://www.ed
medicala.ro/catalog/_medicina_bazata_dovezi.html
18. ^Sackett,DavidL.,Richardson,ScottW.,Rosenberg,William,iHayes,BrianR.,trad.Mrgineanu,M..a.:Medicinabazatpedovezi.Cums
practiciicumspredaiMBD,ed.Eurobit,Timioara,1999,ISBN9739441270
19. ^9ghiduridepracticpentrumediciidefamilie:www.ghidurimedicale.ro(http://www.ghidurimedicale.ro/index.php?
option=com_content&task=view&id=13&Itemid=27)
20. ^ en AlphabeticalListofAbbreviatiosofTitlesofMedicalPeriodicals1948
21. ^ab en GuiattGH,RennieD.:Users'guidestothemedicalliterature(editorial),JAMA,1993,270(17):20962097.
22. ^ab en OxmanAD,SackettDL,GuiattGH,.:Users'guidestothemedicalliterature.I.Howtogetstarted.TheEvidenceBasedMedicineWorking
Group,JAMA,1993,270(17):20932095.
23. ^ en JaeschkeR,GuiattGH,SackettDL.:Users'guidestothemedicalliterature.III.Howtouseunarticleaboutadiagnostictest.A.Aretheresults
ofthestudyvalid?EvidenceBasedMedicineWorkingGroup,JAMA,1994,271(5):389391
24. ^ en JaeschkeR,GuiattGH,SackettDL.:Users'guidestothemedicalliterature.III.Howtouseunarticleaboutadiagnostictest.B.Whatarethe
resultsandwilltheyhelpme?EvidenceBasedMedicineWorkingGroup,JAMA,1994,271(9):703707.
25. ^ab en LevineM,WalterS,LeeH,HainesT,HolbrookA,MoyerV.:Users'guidestothemedicalliteratureIV.Howtouseanarticleaboutharm.
EvidenceBasedMedicineWorkingGroup,JAMA,1993,271(20):16151619.
26. ^ en LaupacisA,WellsG,RichardsonWS,TugwellP.:Users'guidestothemedicalliteratureV.Howtouseanarticleaboutprognosis.Evidence
BasedMedicineWorkingGroup,JAMA,1994,272(3):234237.
27. ^ en GuiattGH,SackettDL,CookDJ.:Users'guidestothemedicalliteratureII.Howtouseanarticleabouttherapyorprevention.A.Arethe
resultsofthestudyvalid?EvidenceBasedMedicineWorkingGroup,JAMA,1993,270(21):25982601
28. ^ en GuiattGH,SackettDL,CookDJ,.:Users'guidestothemedicalliteratureII.Howtouseanarticleabouttherapyorprevention.B.Whatwere
theresultsandwilltheyhelpmeincaringformypatients?EvidenceBasedMedicineWorkingGroup,JAMA,1994,271(1):5963.

Bibliografie
Bicu,Cristian:DicionardeepidemiologieclinicimedicinbazatpedoveziEdituraMedical,2001.
Feingold,DanZ.:VisceralLarvaMigransLipsadecertitudinenstabilireadiagnosticuluincadrulMedicineiBazatepeEviden,tezdedoctorat
(ndr.prof.dr.DanSteriu),UMFCarolDavila,Bucureti,2004.
Bicu,Cristian:Medicinabazatpedovezi:Cumnelegemstudiile,EdituraMedical,2007.

Legturiexterne
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Sackett,DavidL.,Richardson,ScottW.,Rosenberg,William,iHayes,BrianR.,trad.Mrginean,M..a.:Medicinabazatpedovezi.Cums
practiciicumspredaiMBD,ed.Eurobit,Timioara,1999,[2](http://medfam.ro/mm/download/mbd.pdf)accesat:16mai2014
BunescuD,IsarC,MargineanM,:GhiduridepracticpentrumediciidefamilieCentrulNaionaldeStudiipentruMedicinaFamiliei.[3]
(http://www.ghidurimedicale.ro/index.php?option=com_content&task=view&id=1&Itemid=27)accesat:18inuarie2013
BicuCristian:[4](http://www.baicus.ro)accesat:18inuarie2013.
BicuCristian:Statisticadescriptivavariabilelorcalitative[5](http://www.stetoscop.ro/arhiva/2008/71/medicinabazatapedovezi.php)accesat:18
inuarie2013.
fr LiensEBM[6](http://www.churouen.fr/ssf/profes/evidencebasedmedicine.html)accesat:18inuarie2013
fr Introductionl''EvidenceBasedMedicine',l'UniversitdeLige,
[7](http://www.ebm.lib.ulg.ac.be/prostate/ebm.htm)accesat:18inuarie2013
fr Jobin,Guy:EBMquelleplacepourl'thique?,Inserm,2002,[8]
(http://www.ethique.inserm.fr/ethique/Ethique.nsf/397fe8563d75f39bc12563f60028ec43/eb5eb998e77e43e3c1256f9b0067beac/$FILE/15.pdf)
accesat:18inuarie2013

Vezii
GIDEONMotordeepidemiologieibolitransmisibile
WikiProiectulMedicin

Adusdelahttp://ro.wikipedia.org/w/index.php?title=Medicin_bazat_pe_dovezi&oldid=8774437
Categorie: Medicinabazatpedovezi
Ultimamodificareefectuatla02:10,8august2014.
AcesttextestedisponibilsublicenaCreativeCommonscuatribuireidistribuirencondiiiidenticepotexistaiclauzesuplimentare.Vedeidetalii
laTermeniideutilizare.

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