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DARWIN AMIR
Bgn Penyakit Saraf RS DR. M. Djamil / Fakultas Kedokteran Universitas Andalas PADANG
Medicine
in the pre historic had no concept of probability (the ancients and the Greek, the Gods decided all life, therefore that probability did not
After
Luca Piccauli (1494) defined basic principles of algebra and multiplication tables introduced the first statistic problem and Girolamo Gardano (1545) introduced the first attempt to use mathematics to describe statistic and probability.
Galileo expanded on this by calculating probabilities using two dice Thomas Gataker expounded on the meaning of probability by noting that it was natural laws. Huygens (1657), Leibniz (1662) and Englishman John Graunt (1660) wrote on norms of statistic including the relation of personal choice and judgement to statistical probability.
John
of the London populate using statistical sampling and predict the human lifespan.
Graunt
1660
100% 25% 10% 1%
1993
100% 98% 95% 70%
Medical practice
growing demand for public accountability in health care and the increased availability of information to users -------- >
EBP
will be central theme in general practice and the organization of care for many years to come
The core of GP is the relationship between the doctor and patient. Central aspects of this relationship is the process of decision making (range from simple clinical types of decision to decision at a level about how service should be organized
The
decisions ought to involve a negotiated in the context of a partnership between the health care professional and the patient and takes account of factors such as patient need, preferences, priorities, available resources and evidence of the effects of providing different forms of care
Needs
Effects of care
Resources
Priorities
Both the doctor and patient require access to reliable and valid information ----- > to the situation is required. EBM is the phrase used to describe such an approach and entails (from the doctors perspective): - the conscientious - explicit - judicious use GP acquire, wisdom and judgment through their clinical experience
This expertise produces clinical skills and acumen (diligent) in detecting signs and symptoms. Greater understanding of individuals (predicament, rights and preferences) in making clinical decisions about their care.
The judgment for decision making based on the availability of better research methods for assessing the validity of evidence of effectiveness through to improved techniques for collating evidence in a systematic way
Conceptual approach that health care professionals can use in making decisions about the care of individuals patients
Broader concepts that incorporates improve approach to understanding patients, families and practitioners beliefs, values and attitudes. Takes account evidence at a population levels
How to get started: a five-step process for using an evidence based approach in GP
The McMaster University EBM Resources Group have identified a five-step approach need to follow : 1. define the problem; 2. track down the information sources you need; 3. critically appraise the information; 4. apply the information with your patients; 5. evaluate how effective thisapplication of information is
Medical literature which can assist in providing answers to the question raised in clinical practice is broadly scattered; journals, family medicine journals and government reports
How to apply the information obtained to the particular circumstances of your patients ?. This is a probably the most crucial step in the process. Whether there are any methodological issues raised about the evidence which might prompt you to reject it outright. This process requires a partnership between the doctor and patient. If at the end of the process the decision is made be a mutual and conscientious
As professional you have the challenge and responsibilities in facing general practice
Framework needs to be built around ensuring that the evidence required to inform decision-making is available, accessible, acceptable and applied by GP.
Emerged internationally which aim to produce systematic summaries with trying to practice EBP.
Good examples are: - Cochrane library (a database of high quality systematic review of health care) - AGP Journal Club. - BMJ and Lancet. At a more local level, there are a growing number of networks being amongs general practitioner of searching for and appraising evidence A natural extension of this process is o apply EB Protocols and guidelines, develop by he colleagues in clinical practice.
Prognosis
- What are the consequences of having the disease
Is
it dangerous ? Could I die of it How long will I be able to continue my present actives ? Will it ever go away altogether?
Risk Factors
Biologic onset
Clinical Diagnosis
Outcome
Prognostic factors
Biologic onset
Clinical diagnosis
Outcome
Summary
If the concept is embraced it will improve general practice Will make the GP an even more rewarding discipline within which to practice.
Will support shared decision making with users. It is the ideal model of making decisions within the medical encounter. EBM / EBP will help maintain the central role of general practice in health care.